TEACHING TOOLS

GENERAL GUIDELINES FOR PROVIDERS USING INTERPRETERS
IN HEALTH AND MENTAL HEALTH CARE SETTINGS

Unless providers are thoroughly fluent in the patient’s language, it is strongly recommended that they work with a trained interpreter. In this way, providers know that their patients fully understand the diagnosis, treatment, instructions, or advice and that the providers know that they understand patients’ description of their illness and concerns as completely as possible.

If providers have limited knowledge of a language, they can use their skills to establish rapport and express their respect (e.g., greetings and informal exchanges).

Be aware of patient barriers to requesting interpreter services

Patients may not ask for an interpreter because they:

• may be shy or fear appearing too demanding;
• do not want to appear stupid or uneducated;
• are unaware of their legal rights as mandated under Title VI and other statutes;
• fear seeming disrespectful or seeming to call into question a provider’s linguistic expertise;
• may be afraid of losing face by showing ignorance of medical terminology or unfamiliarity with the way health care is structured in the United States;
• may be concerned that it will cost them extra money; and
• may be worried about confidentiality issues.

As a provider, if you suspect that patient care would be enhanced by using an interpreter, it is incumbent upon you to encourage getting an interpreter and to advocate for, and even insist on, services. Many patients prefer a same gender interpreter, particularly when a physical examination is to take place. This preference may require a level of sophistication that the system lacks, so it is important that providers advocate for this.

If you are working for the first time with a trained interpreter, you will need to agree on how you will work together as a team. If you consistently work with the same trained interpreter, your team style will soon become automatic.

The all-important pre-encounter briefing

• Tell the interpreter what you hope to accomplish, what the encounter is about. This is necessary in all but the most routine patient visits. Preferably, do this out of the hearing of the patient.
• Ask the interpreter if he or she is familiar with the concepts involved.
• Reach consensus with the interpreter on interpretation techniques (e.g., how the interpreter can signal you to pause or show that he or she needs to stop to explain something the patient has said).
• Reach consensus with the interpreter about use of first- or third-person mode of interpreting. If first person is used, the interpreter speaks as each speaker alternately, using the pronoun “I.” Using the first person, although initially more difficult, improves the accuracy of the interpretation.
• Point out the importance of accuracy, completeness, impartiality, and especially confidentiality when working with non-staff and staff interpreters. Encourage, interpreters to ask questions when they are uncertain.
• Encourage interpreters to make pertinent comments when they notice a conceptual or linguistic misunderstanding occurring. If the interpreter is familiar with, or from the same cultural group as, the patient, he or she may notice cultural misunderstandings as well.
• Insist that the interpreter interpret everything that is said by you or by the patient.

During the interpreted encounter

• Be sure to introduce the interpreter to the patient if unknown to the patient. Emphasize that the interpreter is bound by patient-provider confidentiality just as you are.
• Ask the interpreter to place himself or herself slightly to one side and behind the patient, so that it is easy to look directly at the patient when the interpreter is speaking.
• Look at the patient, not the interpreter. The interpreter should be viewed only as a conduit. Observe non-verbal signs that will give you an indication of the patient’s emotional affect; this will provide you with important information.
• Express one concept at a time. Avoid using contractions, acronyms, or jargon. Provide a brief explanation of technical terms if they cannot be avoided.
• Pace your speech so that the interpreter and the patient can understand and follow it.
• Make sure the complexity of the language is not beyond the interpreter’s medical, health, or mental health care knowledge and familiarity with institutional protocols and procedures.
• Speak slowly, enunciate clearly, and avoid using medical, health, or mental health care jargon or American slang. When the interpreter finishes explaining a point to the patient, occasionally ask the interpreter to tell you in English exactly what he or she just told the patient. This “re-telling” will give you the feedback you need to feel confident about the quality of the translation or to identify and catch mistakes.

Debriefing the interpreted encounter

Ask for feedback from the interpreter. If possible after the interview, speak privately with the interpreter. Interpreters from the same cultural group of the patient may perceive cultural and emotional subtleties more clearly than you. Take advantage of their unique bicultural or multicultural perspectives. Be open to comments.

Teamwork

It is helpful for providers to meet with staff or contract interpreters periodically to refine their mutual working methods and strategies. Discuss the techniques that are working well and those that need to be improved. In many instances, interpreters also can give providers important background on the language and culture of patients. In these instances, the interpreter is acting in the role of cultural broker (see Bridging the Cultural Divide in Health Care Settings: The Essential Role of Cultural Broker Programs at
http://gucchd.georgetown.edu/nccc/documents/Cultural_Broker_Guide_English.pdf). A much more comfortable working relationship will develop if interpreters are openly recognized as an important part of the health and mental health care team and are clearly valued for their contribution to high-quality patient care.