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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Advocacy and Support

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?

Interpreting in medical settings and making constant decisions while in this setting is a “human activity”.   The consensus across all groups was that “roles and boundaries are different in medical settings from general interpreting settings.”  Interpreters must be mindful of their boundaries and have good reasons to back up their decisions.  “Support is mainly establishing rapport and respect for one another.”  It is not “supporting” or “influencing” consumers’ decisions, such as whether an MRI or a CAT scan would be the best option.  People in medical settings are often in vulnerable states and therefore holding or rubbing the patient’s hand, carrying a bag or a small child was seen as within the boundaries of the interpreter’s role and often referred to as “support”.  Encouraging deaf consumers to ask their questions directly to health care professionals, rather than asking interpreters was sometimes called “support” and other times called “advocacy” during the focus group discussions. Whichever term was used the goal was that same which was to enable deaf people to use their own power.

Support and comfort for individual deaf people will vary from person to person.  A woman who has gone through a procedure for an abortion may or may want to “chat” with the interpreter afterwards.  When patients are diagnosed with terminal illnesses and then are dying, often interpreters are present for extended periods of time.  One interpreter stated that her “role is primarily that of support while waiting”.  Interpreters must be sensitive to deaf people’s individual needs.

The focus group participants made a distinction between being staff interpreters and working as community interpreters for an agency or independent contractors working for the hospitals.  One interpreter reported, “as a staff interpreter the organization’s mission is primary where service and access are first.”  The same interpreter went on to report, “as a freelancer my professional code is first” meaning the NAD-RID Professional Code of Conduct outlined by the Registry of Interpreters for the Deaf.  Some staff interpreters felt that one-on-one conversations with health care professionals was acceptable, whereas, some contract interpreters felt this was outside of the interpreter’s role and therefore unacceptable. 

 “Youth and maturity affect decision making.”  The ability to think through all the scenarios and possibilities is crucial.  How one decides to approach situations are important aspects of working as an interpreter and understanding one’s roles and boundaries.  For example, a less seasoned interpreter had a schedule of appointments, one of which was a critical medical situation that was taking longer than anticipated.  The interpreter decided to leave this setting and go to her next interpreting appointment at a dentist’s office.  Now looking back on the situation, the interpreter would make a different decision and stay with the critical medical situation, rather than leaving it for a routine dental appointment.  In another example, the interpreter felt the doctor was not paying attention to the deaf patient and gave an inaccurate diagnosis.  The interpreter did not do anything at the time.  However, she did speak with a mentor afterwards and now wonders how this situation affected her work, roles and boundaries, from then on.

“Advocacy often occurs when a person is at a disadvantage, either due to physical, mental or emotional difficulties or due to oppression.”  Advocacy was defined in several different ways.  One participant described advocacy as borrowing someone else’s power; another participant described it as education.  Providing information about how to acquire the services of interpreters, the need for qualified interpreters, and describing the role of interpreters were all considered to be advocacy.  Giving health care professionals information on deaf-related resources was also considered advocacy – outside the role of the interpreter, but necessary. 

However, one group of interpreters reported that deaf medical professionals did not require advocacy, but instead required information directly related to the encounters.  For example, deaf professionals asked interpreters to let them know what the conversations were around them, in other words “eavesdropping”.  Also deaf professionals asked for interpreters’ opinions that interpreters provided in as neutral a manner as possible.

Among almost all of the focus group discussions the term advocating was used when the deaf person needed more clarification and the interpreter chose to “speak up” and make this known to the medical professional.  This was seen as critical to the successful outcome of the interaction.  In one instance it was mentioned that this was done because it was a “weighty health situation”.  In other situations interpreters decided to maintain their perceived role and not indicate the the health care professionals that their message was not being understood.  For example one interpreter mentioned that if she doesn’t have a boss to go to then she is less likely to say or do anything.  She would not indicate the perceived lack of understanding. 

At times health care professionals were unwilling to secure the services of interpreters, feeling that communication could occur without interpreters present.  In these cases interpreters advocated for the right to communication access on behalf of the deaf patients.  Interpreters explained laws and rights of deaf people to medical treatment and communication while undergoing examinations and treatments.  In some instances Deaf interpreters were required and at times health care professionals were not willing to follow the non-deaf interpreter’s recommendation leaving the communication process at risk. 

Also, in some cases, the role and boundaries became even more complex; interpreters are part of the Deaf community.  Thus, in many instances interpreters cannot be as detached in the situation as health care professionals because the latter are typically not involved in the Deaf community, thereby don’t personally know the consumers.