Interpreting in Medical Settings:
Synthesis of Effective Practices Focus Group Discussions
Developed by Marty Taylor, Ph.D., Project Consultant
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
Prior to accepting assignments interpreters should know what type of medical appointment it is (e.g., pediatric, ophthalmology), who the health care professional and the patient are including gender, and all the necessary information regarding background of the situation. All of this information assists in forming a solid foundation that results in a more successful interaction between all of the parties involved.
Possessing a thorough understanding of the medical system and the interpreter’s role in it (e.g., hierarchy) was also evident among all groups. Knowing more than one venue within hospital settings such as ICU and emergency room protocol are also important. Knowing various settings outside of hospitals such as clinical settings and dental offices are necessary. All interpreters, especially staff interpreters, realize there is more than “medical” interpreting involved in their work. One group reported that, “the number of layers is amazing”. Hospital interpreting is typically very in depth, “for example, six pages of medication, various procedures, and extensive history” were not uncommon.
The ability to maneuver within the ever-changing demands of the setting and the variety and number of consumers is crucial. Of particular importance is knowing when to ask for a Deaf Interpreter (DI) or a Certified Deaf Interpreter (CDI), and most importantly which CDI to request as a part of the team. CDI’s have different skill sets, therefore knowing who has what expertise is critical.
One of the goals in providing interpretation is to give the best service possible to health care professionals, patients and family members. To accomplish this goal interpreters must possess fluency in both English and ASL, specifically working between the languages to convey the nuances and complicated information ever-present in medical settings. This need for a sophisticated level of fluency was mentioned in all of the groups. Specifically, interpreters should have a high level of receptive skills. They should be able to handle the speed and complexity of the environment. They should possess the ability to pronounce and sign a vast range of medical procedures, terms and medications. Particularly several groups noted the demand for the fluent use of classifiers.
Knowledge and skill to implement consecutive interpreting was mentioned as necessary when there was a need to clarify or elicit information. One group stated, “the more complex the topic/subject/procedure, the more the need for a consecutive interpretation.”
Three groups mentioned that using time references was crucial, such as expressing terms like three times a day or once a week. If comprehension was not reached, then using environmental surroundings like calendars would be useful, marking the calendar so the patient could visually see when to take what pills. One group referred to this kind of communication assistance as “cultural mediation”. Another group used the same term, “cultural mediation,” when interpreters asked health care professionals to use the PDR to be sure medications were properly identified, “rather than guessing that the pink pill that starts with M is such and such”.
Possessing the ability to “determine patient’s level of health literacy and act on evaluation” was identified as a useful skill for interpreters. Several participants mentioned that some times deaf people simply nod indicating they understand the information relayed, but unfortunately are only nodding and are not understanding the information. For example, in some communities knowledge of HIV and AIDs is extremely limited. One participant stated, “50% of non-signing patients/general public leave the medical office not understanding what was discussed.”
Interpreters must be able to work with a wide range of individuals with different needs and expectations. “Interpreter must use their interpersonal skills to navigate their way through the medical setting.” Rapport with health care professionals was identified as vital. It was noted that nurses have a great deal of power and can be of assistance when they have a clear understanding of interpreters’ role and their function. With a good rapport “things work smoothly.”
Interpreters must be sensitive to all the consumers involved in the interaction. Understanding the personal nature of assignments while maintaining ones’ professional demeanor can be challenging. For example, interpreters may know deaf consumers through their involvement at Deaf community events or from their freelance work in the community. Realizing that this could be difficult or uncomfortable for deaf consumers is an important element of sensitivity.
All groups mentioned the need for interpreters to be flexible. The need to be flexible varied depending on the specific setting, for example a doctor’s office, an emergency ward, and medical treatment intervention will require interpreters to be flexible in different ways. At times the space may be crowded or confined requiring interpreters to find ways to make the communication process as effective as logistically possible for all participants involved. Flexibility was also required when health care professionals were on-call or behind in their schedule which in turn affected interpreters and their own schedules.
Terms such as “humble”, “comfortable” and “professional” came up throughout the focus group discussions. Interpreters must be humble enough to express their lack of understanding whether it is related to difficulty comprehending the English or ASL, even if this has to be done numerous times. They must be willing to try other methods of communication when the first and maybe the second attempt are unsuccessful. Interpreters must be comfortable in the medical environment and with medical procedures. They must be professional at all times regardless of the situation. They must know and be able to stand up for themselves in their role as interpreters, whether this is to gain clarification or to make health care professionals understand what the deaf person is conveying.
Interpreters must be aware of their emotions and their own limitations. If a routine doctor’s appointment suddenly “becomes a surgical procedure, the interpreter must be able to decide if he/she is qualified, and if not, must ask to be replaced. Even though this may not be practical it is important for interpreters to know their limitations.”
Interpreters have to remain calm in emergencies. They can’t be afraid of blood. Basic physicals can turn into minor procedures. It is important to know when to sit down or step back, communicating at all times with the health care professionals and patients if the interpreter has to leave the room.
The ability to focus on the job at hand was highlighted in one group. Interpreters should have strategies to detach from the procedure knowing that the health care professionals are responsible for the outcome, not the interpreters.
Role & Boundaries
In addition to several groups mentioning the need to know one’s limitations, most of the groups mentioned the importance of interpreters understanding their role as part of the medical team. Interpreters must be able to clearly convey their role to all participants involved in the interaction, for example providing explanation and rationale as to why interpreters leave the room when health care professionals leave. Interpreters as part of the medical team can take a leadership role, and often should, especially when access to communication is at risk. For example, “relaying to the medical professional that the patient relying on sign language communication is slipping out of consciousness (eyes rolling, eye lids closing) and how that affects communication” is within the expertise of interpreters’ and may be outside of the health care professionals’ expertise. At the same time interpreters should keep in mind that the goal of the communication process is the patient to professional relationship. The ownership of the interaction belongs to the health care professionals.
Interpreters must be trustworthy especially when it comes to confidentiality. They must also maintain their boundaries. When situations become more than interpreters can handle they must be able to remove themselves from the situation in a professional manner. For example when a medical assignment becomes a legal interaction such as making a police report while in the ER, then interpreters who are not qualified to interpret for legal settings would make it known that a legal interpreter is required to interpret for the police report.
Interpreters have several layers of decision-making that offer guidance to their work. One group referred to this as a “personal decision making tree” and encompassed the following components: “Code of Professional Conduct, laws that apply to the situation, personal ethics and regulations/rules in the medical setting.” It was also reported that it is important for interpreters to know when to document information (e.g., when and where something occurred, or did not occur when it should have), for example when interpreting services were denied to deaf consumers or signers were used instead of professional interpreters. One participant in the focus group discussions stated, “if it’s not documented, it didn’t happen.”
Knowledge of how to keep oneself safe within medical settings is crucial. Procedures like when to wear masks and gloves and knowing whom to ask if unsure are important aspects of working in medical settings. “At times, the medical professionals will caution you to suit up, but it’s good to know safety” just in case the health care professional doesn’t say anything in a particular situation.
“Interpreters never fully know patient’s medical history” or the specifics of the situations. Interpreters should be well aware of what immunizations they have had and maintain them if they require booster shots, or additional immunizations. Interpreters should also know about transmittable diseases. Knowing how diseases and illnesses are transmitted can assist interpreters in not catching them.
Interpreters should be aware of vicarious trauma and the effect this can have on themselves and on their work. Having support systems in place is vital for maintaining health and working through difficult situations to which interpreters are exposed.
Consumers of interpreting services include deaf, hard of hearing, deaf-blind and non-deaf people. It is difficult and at times impossible to predict what services interpreters will have to provide. Knowing in advance of the situation consumers’ history is helpful in preparing for assignments and providing the best service possible. Knowing how to accommodate for a variety of special needs is important. For example, deaf-blind people may have minimal vision and use a modified visual approach to understanding a Signed Language interpreter or may require tactile interpreting services. If interpreters know this prior to appointments, then the interaction will likely be more successful.
There are a variety of situations when it is not the patient who is deaf. Instead it may be the health care professionals who are deaf and require the services of Signed Language interpreters to communicate with non-deaf patients. For example if the surgeon is deaf it is important for interpreters to know the protocol for surgery and how to scrub in.