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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Cultural Differences

3. What is your experience with cultural differences in medical settings?  What have you noticed?

Cultural norms vary from group to group and from place to place.  “Finding the line between general trends and cultural norms and individuality” requires a great deal of flexibility at all times. It is important to enter situations with open minds.  For example, GLBT culture is unique; different sensitivities are required when interpreting in childbirth situations in typical Western culture and in Native American cultures; support groups such as AA or AIDS support groups have norms that are different from one another.  It was identified as important to reflect cultural values and norms within the interpretation.  It helps if interpreters learn about different cultures when preparing for assignments and working with consumers.  Being aware of one’s language usage when talking with people from different cultures is very important. 

Within the medical milieu, individual health care professionals have their own perspectives on deaf people and deafness.  Especially when practitioners are themselves from other countries, the cultural implications—medical culture, practitioner’s culture, Deaf culture—add more layers of challenge with which interpreters have to deal. 

Differences between Deaf and non-deaf cultures were highlighted in all of the focus group discussions. Specifically,  practitioners were often unaware of the fact that Deaf people have their own culture. Deaf culture and medical culture are not the same.  In one instance it was stated, “Everything in the medical field is very, very quick and most deaf clients are not.  They are digging in the bag for the prescription or taking 20 minutes for a urine sample.”  Some deaf people have “learned helplessness” and are not able to articulate their medical history to health care professionals.  At times, deaf people want interpreters to remember and to tell the professionals what is wrong or what prescriptions the patient is taking.  Some deaf people want to ask many questions making sure they understand what is being said.  The health care professional is most often in a hurry, requiring interpreters to use strategies to keep the doctor present to answer all of the deaf patient’s questions.

Health care professionals often made assumptions about deaf people.  For example, some health care professionals encouraged deaf people to have cochlear implants even though this was not the health care provider’s area of specialization.  Other health care professionals assumed deaf people had transportation or that the interpreter would take them home after their medical procedure.  Education needs to occur informing health care professionals that this is not the case and interpreters are not responsible to provide transportation to patients.

Differences were apparent between deaf people from rural communities and those from urban centers.  Urban deaf people had experiences that were more similar to the larger non-deaf population.  Whereas, deaf people from rural communities tended to be more “grassroots”.  In addition, the resources available to deaf people are much more limited than those available to the non-deaf community. As well, the information to which deaf people have access is not always accurate or up to date.

There was also mention of the differences between clinics located in suburban and urban centers.  Urban centers tended to have lower socio-economic conditions.  Usually patients were sicker, were less knowledgeable about their rights, and less likely to know medical culture. “Advocacy and support were perceived as being “much greater and more necessary in urban environments than in suburban environments”.  All of these factors created a “greater burden” on interpreters to facilitate the communication process.

Deaf patients also have to deal with an insufficient availability of interpreters to provide adequate service and/or health care professionals unwilling to acquire interpreting services either because they don’t want to pay for the service or because they feel that they can communicate with deaf patients on their own. 

Another issue that was raised in most of the groups was the work of Spoken language interpreters and how their behaviors impact health care professionals’ perceptions of Signed Language interpreters.  For example in one community spoken language interpreters in medical settings were billing illegally.  This mandated a change in procedures by requiring all interpreters, spoken and signed, to have forms signed at all medical appointments.  In some geographic areas there is inconsistency and lack of training among spoken language interpreters.  For example, family members may provide interpretation, rather than hiring a professional interpreter.  When this occurs, the expectations for the Signed Language interpreter can be negatively affected because health care professionals assume interpreters are family members or friends, not professionals. 

There are times when signed and spoken language interpreters may work together such as when the child is deaf and the parents speak a language other than English.  In this situation, a relationship between the interpreters is formed.  A question arises which is “what is the background and training of the spoken language interpreter”?  Does he or she follow a code of professional conduct as do Signed Language interpreters?  It requires time and effort to establish mutual understanding and develop a working rapport with another interpreter to make the communication process effective.  This adds to the complexity of the work and the time it takes to complete the interaction among all parties.  There is a sense that “the level of professionalism has risen because spoken and Signed Language interpreters are working together.”