Commentary on Interpreting in Medical Settings

Encouraging Words

2008-08-04T10:00:00.004-06:00

by Mel Deleon-Benham

Translation by Doug Bowen-Bailey

I was asked to share a few encouraging words for new interpreters entering the field. I've been interpreting for 15 years now and have done some mentoring with newer interpreters who feel unsure of themselves. Often, I see that they have great skills and attitudes, but the barrier seems to be their own sense of self-esteem and confidence. They feel like they can't do the job and that they are not good enough, and my job was to let them know that they can do it.

So, I think sometimes the biggest barrier to newer interpreters is that they are overly self-critical. So, it's really important to be gentle with yourself. Good luck.

The Support of an Agency

2008-06-02T08:10:00.004-06:00

by Brenda Nicodemus

Translation by Brenda Nicodemus

I can remember one particular incident where I realized the importance of having the support of an interpreting agency. I went to an assignment between a Deaf person and an opthamologist, that is, a doctor who specializes in serious eye problems. The Deaf person had never had an interpreter go with him to this doctor, but things had become more serious in his condition so he wanted an interpreter there to make sure the information was clear.

But the doctor was clearly surprised to see an interpreter there and said to the Deaf person, "You and I have never needed an interpreter before and always got along fine. You lipread me and when it didn't work out, we just wrote back and forth." The Deaf person obviously didn't want to insult the doctor and clearly felt uncomfortable. The Deaf person kept looking at me as if to say, "What should I do?" I didn't say anything and just kept interpreting. Throughout the appointment the doctor continued to try to get the Deaf person to look at him and the Deaf person continued to steal glances at me as I interpreted. As the appointment came to a close, the doctor said again, "You don't need an interpreter for our next appointment, right? We'll do it like we've done it all along, with just you and I." It was an awkward situation.

After the Deaf person and I left the office, the Deaf person said, "Gosh, I didn't know what to do or how to respond to that situation." I also felt a little unsure of how to respond because I didn't want to criticize the doctor or get into the ADA, but I did tell the Deaf person that he had a right to an interpreter when going to a doctor. I also recommended that he contact the agency for further discussion and perhaps get a Deaf advocate to support him. The Deaf person agreed to do that and did make the call later.

That day I realized how much I appreciated the support of the agency so that interpreters don't have to try to do it all!

Importance of Certified Interpreters for Medical Appointments

2008-03-13T15:10:00.002-06:00

by Jimmy Beldon

Translation by Doug Bowen-Bailey

I have a story to share with you that is so typical of doctor's offices who claim to have an interpreter working for them when the person isn't actually qualified and doesn't hold any certification. Generally, it takes some effort to educate the office about the importance of an interpreter having certification as a measure of competency. Without certification, how can I really know if someone is qualified or not?

Doing that advocacy can be tiring, however, and so with a new doctor that I started going to in a small town, I decided to give them the benefit of the doubt to see what would happen.

I showed up for the appointment and it was with a doctor I selected because of his specialty in sports medicine. I wanted to have his knowledge for this topic, so I decided to just make it through with whatever interpreting service they provided.

When I first went in, I met with the nurse and the so-called interpreter. The "interpreter" made an introduction, signing her name and saying it was nice to meet me, though making a mistake in how she signed "meet."

Right away, it made me realize that this situation was the same as so many I had experienced before where people think that having a certified interpreter isn't necessary for a medical appointment.

I decided not to say anything at first, and just tried to sign as slowly and clearly as I could. The "interpreter" was surprised to be able to understand me.

Then the doctor came in. He was a really neat man, but talked rather rapidly. The "interpreter" did her best to keep up.

I didn't worry so much about understanding the "interpreter", just waited until she was done and it was my turn. I then signed at a level of native fluency in ASL. The "interpreter" didn't understand me at all and asked me to slow down. I repeated it again at the same pace, only to be asked to repeat it again and again.

The doctor watched this scene unfold in which there obviously was no communication happening, and I made my frustration extremely clear. The doctor seemed to be starting to understand what was going on. In a few minutes, after expressing my impatience, I finally put pen to paper and wrote, "Reschedule with a new interpreter," and then left.

The next day I found that my point was clearly made. For all my subsequent appointments, everything was all set with a certified interpreter waiting for me. Because of this, my visits to that doctor's office went much more smoothly.

Dealing with Varying Ages

2008-02-15T09:04:00.001-06:00

by Amy Williamson-Loga

Translation by Doug Bowen-Bailey

I recently interpreted a medical situation where the patient was a Deaf boy who was of middle-school age. His parents were also Deaf. Now, before I go into any situation, I spend some time thinking of how I can best match the language usage of the people I work with. If I feel there are going to be a variety of language levels in the audience, it can be a challenge to do that. Especially if you see some in the audience who are not understanding the interpretation at the same time as others clearly are.

So, I was thinking of how this dynamic would play out with a medical appointment with Deaf parents of a Deaf patient in middle school. So, before I went to interpret, I spent some time trying to strategize because this was my first time with this experience.

Ironically, my deliberation and worry were really unnecessary because the doctor took care of it. That doctor spoke directly to the patient and used language fitting for talking to someone his age, and then spoke to the parents using more fitting language for adults.

It did send me thinking about when I was young, growing up and going to the doctor with my parents and learning from the conversations the doctor had with my parents. So, in interpreting for the doctor and nurse talking with the parents, I did match their language use. I think the boy was able to generally understand the conversation, probably on par with who a hearing child would in listening to the conversation between a doctor and parents.

Role Confusion?

2007-10-26T11:28:00.000-06:00

by Jimmy Beldon
Translation by Doug Bowen-Bailey

I want a share a story of an experience with an interpreter who forgot the human factor. I realize it is important for interpreters to maintain boundaries, but sometimes, it can go too far.

This happened right after the birth of our child. The new parents had to move to a different room. There was a cart with all the clothes that the father was pushing. The nurse was pushing the mom, who was sitting in a wheelchair holding the newborn. Additionally, there was an IV which the nurse was also managing to move along. But with the weight of the mom and child, it was quite a strain on the nurse.

The interpreter walked along beside us. Eventually, we came to a closed door which didn't have an automatic opener. While the interpreter, who had relatively empty hands, watched, the nurse managed to push open the door and navigate through with the wheel chair and IV. But once we were through that doorway, there was a small threshold to cross to get into the room.

I watched the interpreter just observed all of this without offering to help at all. I realized this interpreter was probably not savvy about realizing when to offer assistance. I don't know if it was concern about role confusion, but the interpreter just observing everything made me feel angry. I felt like I wanted to knock her over with the cart to make her realize she needed to help. Of course, I didn't do that and just pushed the cart through the door instead.

That experience really did make me wonder about that interpreter.

Managing the Waiting Room

2007-07-20T18:06:00.000-06:00

by Trudy Suggs

Translation by Doug Bowen-Bailey

For me, one of the things I detest about medical appointments is dealing with the waiting room. Obviously, there is the challenge of trying to know when I am called. But in regards to interpreters, there is a list of challenges. I'll share a story about an experience I had.

I went to the doctor for something minor like a cold, I don't quite remember what. I didn't know who my interpreter would be, so when I arrived, I scanned the waiting room looking for someone who fit my picture of an interpreter dressed in black or dressed professionally. I didn't see anyone who looked like an interpreter. Actually, there were very few people that day. Sitting across from me was a woman, a bit older, who wore a hoodie with a shirt underneath and jeans.

I didn't really give her a second thought, and after waiting a bit, I took out my pager. The woman asked if I was Deaf. I replied that I was and she said she was my interpreter. I was a bit taken aback by her casual clothes, but I talked with her some and her signing skills were okay; they were at least acceptable for this particular appointment. So I politely chatted with her. Our conversation dragged on because she wouldn't stop talking. I felt the need to be polite, though I really wanted to go back to my pager. This went on for almost 15 minutes until the nurse finally called me.

That experience made me think about what I look for or what some of the things interpreters should do. One thing I know that interpreter education programs stress is the need for an interpreter to meet with the consumer prior to the appointment to assess the consumer's language usage. But programs don't often convey the flip side that consumers also need the opportunity to assess the interpreter so that we can figure out if the interpreter is a good fit for us. Sometimes, an interpreter's skills may be good but she or he may not be a good fit for me. Or maybe the interpreter is a good friend of mine - the town I live has many deaf people, so many of the interpreters are friends with us; it's almost like an extended family. So if I went to an appointment of a personal nature, like an OB-GYN visit, I would prefer not to have an interpreter who is a good friend interpret for me. So it depends on the situation.

For me - this is my preference, and other Deaf people may have different preferences for themselves - but I prefer that, when an interpreter comes to an appointment, she or he wear a name badge identifying her or him as an interpreter, along with the name. This really is a top priority. After the interpreter notifies the staff of her or his presence, if it is not too public a setting, I'd like the interpreter to introduce himself or herself to me. This will allow both of us to assess each other's language usage. Then the interpreter could go somewhere else, like into the back area of the doctor's office and leave me to read, use my pager, or do whatever I want to at that point. Sometimes, I just need that time to myself. It doesn't matter if the interpreter is a friend or not; for me, it is good to maintain clear boundaries between work and friendship. Then when the nurse calls me, it'd be good for the interpreter to come out with the nurse so I don't have to struggle with trying to figure out when my name is called.

All of these steps really depend on the situation. Sometimes I haven't seen the interpreter in a while and want to chat, and sometimes I'd just like to be left alone. The bottom line comes down to a few steps: interpreters need to dress appropriately, wear a name badge, and understand that even if the interpreter and I are friends, certain medical situations can be awkward for me, and for the interpreter too, because medical appointments are so frequently personal.

The three things I mentioned are various factors for medical situations and the waiting room that interpreters should consider.

Working with a CDI

2007-04-06T12:33:00.000-06:00

by Trudy Suggs

As a Certified Deaf Interpreter (CDI), one of the most common questions I am asked, by both deaf and hearing people, is if being a CDI means I am skilled with gestural communication, or work with DeafBlind people. I always clarify that I don't necessarily specialize in gestural communication. I do work with DeafBlind individuals occasionally, but my real specialty and interest is with everyday situations. I'll explain what I mean by that.

I find it interesting that, in my many years as a Deaf interpreter, the interpreters who typically request or want a CDI tend to be among the top interpreters in the field. Those who may be new interpreters or not necessarily the best interpreters almost never call me. Maybe this is because they're intimidated by having a Deaf Interpreter there, or they feel like having a Deaf interpreter suggests that they are lousy interpreters. The truth is actually the opposite: having a CDI there means they are better interpreters because they are willing to work with any resource available.

So I'm always interested in how the process works when people, or I, arrive at a job in a medical setting, such as a doctor's appointment. Upon arrival, of course both interpreters should meet and discuss what the process is, how to feed, how to work together, and what the seating arrangement should be - because having a CDI means the room will be set up differently than for general interpreting situations. So, after we've discussed the details and have everything figured out, we then approach the consumer and explain what's going on. Some consumers might be skeptical but accept it, and some consumers will be offended. I address their concerns by explaining the process, how the hearing and deaf interpreter will be working together, and then they typically become comfortable. When we go into the job, sometimes it's necessary to explain the situation to the hearing consumer as well. I tell them that I am Deaf, I don't hear or speak, and explain how the hearing interpreter and I will work together, and so forth.

It's interesting that, in every job I've worked at, one thing never fails to happen. At the beginning of the appointment, even though we may have already discussed the process, the deaf consumer will start by looking back and forth between me and the hearing interpreter, but then gradually only watch me or only occasionally glance at the hearing interpreter. That's because the consumer trusts me at this point, given our connection based on our using the same language. Of course, I adjust my native language style to the consumer's.

The hearing interpreter tends to begin the job with some apprehension, maybe wondering what's going to happen, not knowing what to expect. But as the process goes on for a few minutes, relief usually becomes apparent on the interpreter's face because we have formed a bond, just like the one I share with the deaf consumer.

The experience of working with a deaf interpreter answers the question of why it's so important to bring in a Deaf Interpreter. This applies to any situation, no matter how simple or complex, especially because language levels can vary so much. Having a CDI is important for teamwork, taking advantage of available resources and having a Deaf person who is fluent in ASL and has language training, interpreting training and experience. This truly makes it a win-win solution for all situations, especially in medical settings.

Managing Waiting in an Exam Room

2007-03-03T11:44:00.000-06:00

Editor's Note:
In the comments to Jimmy Beldon's previous post, someone raised the possibility of stepping out of the exam room to wait for the doctor or nurse in the hall to be sure they were familiar with how to work with an interpreter. Here is a follow-up commentary by Amy Williamson-Loga posting some questions about that very issue.

by Amy Williamson-Loga

I have a question I'd like to pose to all of you. During a medical appointment, the nurse generally starts in the examination room taking vitals, like pulse, temperature, and weight, and then asking preliminary information about what is wrong with the patient, This all happens before seeing the doctor. Generally, the nurse, after getting the information, then leaves the room, leaving the patient to wait for the doctor.

My question is how do you handle this waiting time. Do you stay and talk with the patient? Do you leave and wait outside for the doctor to come? And with these two choices, how do you interact with the patient? Do you ask them if they'd like you to stay or leave? Or do you just leave? Or just stay and engage them in conversation?

For me, it really depends on the individual and what my relationship with them is, but I'm really wondering how you handle this part of a medical appointment.

Translation by Doug Bowen-Bailey

The Importance of Explaining How to Work with Interpreters

2006-12-12T10:15:00.000-06:00

by Jimmy Beldon

I want to share a story with you that illustrates the importance of having a pre-appointment discussion with health care providers to make sure they know how to work with interpreters.

In many doctors' offices, a variety of people come in and out of rooms to interact with the patient. In the situation I am going to share, the interpreter did not connect with everyone to make an introduction and explain about how to work with an interpreter.

What happened in this situation is that a nurse came into the room of a Deaf woman. The nurse noticed the interpreter, and proceeded to ask some questions of the patient. The interpreter moved into position just behind the nurse to establish an effective sight line, as is standard practice. The nurse was not comfortable with this proximity and moved away from the interpreter to establish some personal space. The interpreter again moved into a similar position, causing the nurse to move again. This was repeated until the nurse was finally forced into the wall.

All of this took place because the interpreter didn't recognize the need to explain to the nurse how to work effectively with an interpreter. This simple act of politeness would have allowed the nurse to be more comfortable and thereby stay in position without being pinned against the wall.

Imagine the consequences of this omission on the part of the interpreter.

English Translation by Doug Bowen-Bailey