Interpreting in Medical Settings:

Synthesis of Effective Practices Focus Group Discussions

Developed by Marty Taylor, Ph.D., Project Consultant
CATIE, College of St. Catherine/NCIEC
DRAFT ~ 2007

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Background | Data Collection/Process | (1) Requisite Skills | (2) Advocacy/Support | (3) Cultural Differences | (4) Diversity | (5) Deaf Interpreters | (6) Sight Translations | (7) Patient Charts | (8) Conveying Meaning | (9) Crossover to Legal | (10) Job Description | Summary/Implications | Appendices | Download PDF of Report | Download PDF of Focus Group Survey Results

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Summary of Data Collection and Process

A total of 12 focus groups held across the United States were convened between March and June 2007 to discuss effective practices for signed language interpreters working in medical settings.  The focus groups represent a national sample of diversity including age, ethnicity, hearing status and years of experience.  The focus groups were held in Georgia, Illinois, Kansas, Maine, Minnesota, New Mexico, Oregon, and Texas.  In some instances more than one focus group was held in the same state.  Eight of the groups consisted of non-deaf interpreters.  One group included deaf-blind consumers, a second group included a combination of deaf and non-deaf sign language interpreters and consumers, a third group included deaf interpreters, and a fourth group included interpreters and professionals who were deaf.  For a detailed description of the specific demographics of the participants see the CATIE Center document, “Medical Interpreting Focus Groups Results for the Background and Experience Survey CATIE and NCIEC, Spring-Summer, 2007”. 

This report and analysis includes a synthesis of the comments made by the 63 participants from all 12 focus groups. The participants met in small groups ranging in size from two to seven people.  Each group had an experienced interpreter, either deaf or non-deaf, who functioned as a facilitator. Each facilitator was provided with the protocol for standardizing the selection of, the questions to ask, as well as the process and procedures for collecting the data.  The protocol was based on a pilot focus group held in Canada and facilitated by the author of this report (see Appendix A).  The discussions from this group are not included in this report but form the foundation of the standardized protocol used for selecting participants and documenting discussions.  Following the prescribed protocol, facilitators were responsible to organize and manage the focus group process probing whenever possible to determine what interpreters say they do and what they “actually do”.  In addition, a notetaker took notes throughout the discussions with two groups being videotaped.  The notetaker was responsible to take notes writing complete thoughts in point form and asking questions of clarification needed for note taking purposes.  With only one exception, neither the facilitator nor the notetaker participated in answering the questions that make up this report.

A total of ten questions were asked of each participant in nine of the 12 groups following the standardized protocol.  One group provided their responses via email and two groups discussed scenarios related to interpreters’ role and boundaries (see Appendix B).  The comments from the participants in the latter two groups are embedded within the summary of discussions related to the the ten questions.  The ten questions were:

1. Assuming bilingual fluent interpreting skills, what do you see as requisite skills unique to interpreters working in medical settings? 
2. Maintaining confidentiality, discuss examples of situations where advocacy and/or support occurred or did not occur when it could have. 
1. Describe the situation in terms of what the interpreter did or did not do, and your perspective on the result.
2. How are advocacy and support the same and/or different?
3. What boundaries, if any, do you feel should be followed when interpreting in medical settings? How are these boundaries the same or different from other settings?
3. What is your experience with cultural differences in medical settings?  What have you noticed?
4. What is your experience with diversity in medical settings?  What have you noticed? (For facilitator only if needed -- e.g. Language, socioeconomics, age, educational background).
5. What is your experience working with Deaf Interpreters (DIs) in medical settings?  Are the boundaries the same or different as hearing interpreters? 
6. What is your experience interpreting documents when the professionals are not present?  (e.g., Sight translation of informational brochures, consent forms)
7. Do you read the patient’s chart prior to interpreting? Why or why not?
8. How active are you in conveying meaning?  What is your experience using visual cues in the environment such as pictures, models (e.g., eye, heart, circulatory system).  Do you think critically about how to construct meaning so the patient and doctor understand each other or do you tend to stay off to the side and sign what you hear and speak what you see, giving them the responsibility to construct meaning.  
9. What is your experience when assignments crossover from medical to legal (e.g., interpreting pelvic examinations which could become a rape examination)? 

In addition, when there was sufficient time, participants were asked to comment on the job description contained in the Effective Practices Draft Document (11/28/06) developed by the Expert Group. The focus group participants were asked the following question.

10. Comment on the job description of the health care interpreting specialist.  Is this you?  Who is it? 

• JOB DESCRIPTION:  A health care interpreting specialist is a credentialed professional with national certification (CI and CT or NIC) who facilitates communication between users of signed and spoken languages in health care settings from birth to death. This includes:

• Bilingual fluency in English and ASL including sociolinguistic variation and limited language proficiency.
• Awareness of the linguistic, social and cultural influences which may impact health care interactions, including specialized vocabulary, discourse styles, register, power and prestige, and triadic communication.
• General knowledge of the physiological and psychological implications of health care.
• Awareness of various health care approaches (e.g., Chinese, ayurvedic, holistic, homeopathic, Western medicine).
• Understanding of various health care delivery systems and the roles of self and others on the health care team (e.g., including Certified Deaf Interpreters (CDIs) and advocates that can enhance the interpreting situation).
• Sharing information and resources through advocacy, leadership, education, and liaison with individuals in health care settings.
• Ability to balance the need for professional distance with empathy and flexibility.
• Adherence to the Registry of Interpreters for the Deaf professional code of ethics and conduct.
• Knowledge of laws and policies related to health care settings. 

A synthesis of the comments of all 63 participants is provided in the next section.  Each section is divided into the ten questions noted above with the discussion of the scenarios imbedded within each section.  When direct quotes were taken directly from the notes, quotation marks surround the comments.  These illustrate a specific person’s comment and are representative of several related comments found in the discussion notes.  

Due to the natural flow of conversations within small group interactions, some comments occurred in more than one section. In addition, other comments were made in one section that may have echoed comments made by another group in a different section.  When these incidents occurred, comments were combined in logical groupings under the most appropriate section.