What would you need to be mindful of when arranging an interpreter for a client

Trained health care interpreters can reduce liability, help ensure appropriate utilization, and increase client adherence and satisfaction with services. Trained interpreters help to assure effective communication between the client and provider, support effective use of time during the clinical encounter, and improve outcomes. The National Council on Interpreting in Health Care has published a comprehensive Glossary of Terms commonly used in the field of health care interpreting.

Who Can Serve as a Health Care Interpreter

Trained bilingual staff, on-staff interpreters, contract interpreters, telephone interpreters, and trained volunteers can serve as health care interpreters. The following people, however, should not serve as health care interpreters: patients’ family and friends, children under 18 years old, other patients or visitors, and untrained volunteers.

Working Effectively Through an Interpreter

Introduce yourself to the interpreter. Determine the interpreter’s level of English proficiency and professional training and request that the interpreter interpret everything into the first person (to avoid “he said, she said”). For a detailed script intended for use when working with a remote interpreter via phone or video, click here.
Acknowledge the interpreter as a professional in communication. Respect his or her role.
During the medical interview, speak directly to the patient, not to the interpreter.
Speak more slowly rather than more loudly.
Speak at an even pace in relatively short segments. Pause so the interpreter can interpret.
Assume, and insist, that everything you say, everything the patient says, and everything that family members say is interpreted.
Do not hold the interpreter responsible for what the patient says or doesn’t say. The interpreter is the medium, not the source, of the message. If you feel that you are not getting the type of response you were expecting, restate the question or consult with the interpreter to better understand if there is a cultural barrier that is interfering with communication.
Be aware that many concepts you express have no linguistic or conceptual equivalent in other languages. The interpreter may have to paint word pictures of many terms you use. This may take longer than your original speech.
Give the interpreter time to restructure information in his/her mind and present it in a culturally and linguistically appropriate manner. Speaking English does not mean thinking in English.
Remember that your patient may have been a victim of torture or trauma. This may also be true for the interpreter. If you need to ask questions that may be extremely personal or sensitive, explain to the patient that doing so is part of your evaluation and reiterate that the information will remain confidential.
Avoid: Highly idiomatic speech, complicated sentence structure, sentence fragments, changing your idea in the middle of a sentence, and asking multiple questions at one time. Also avoid making assumptions or generalizations about your patient or their experiences. Common practices or beliefs in a community may not apply to everyone in that community.
Encourage the interpreter to ask questions and to alert you about potential cultural misunderstandings that may come up. Respect an interpreter’s judgment that a particular question is culturally inappropriate and either rephrase the question or ask the interpreter’s help in eliciting the information in a more appropriate way.
Avoid patronizing or infantilizing the patient. A lack of English language skills is not a reflection of low cognitive function or a lack of education. Your patient may be a college professor or a medical doctor in her own country just as easily as she may be a farm worker.
Ask the patient what he/she believes the problem is, what causes it, and how it would be treated in their country of origin.
Ask the patient to repeat back important information that you want to make sure is understood.
Be patient. Providing care across a language barrier takes time. However, the time spent up front will be paid back by good rapport and clear communication that will avoid wasted time and dangerous misunderstandings.
Allow time for a pre-session with the interpreter. When working with a professional face-to-face interpreter to facilitate communication with a limited English proficient (LEP) refugee, a pre-session can be helpful to both the healthcare provider and the interpreter.

Interpreter Pre-Session

The pre-session is an opportunity to be clear about the nature of the upcoming encounter and any particular concerns that the provider would like to address regarding the patient’s condition. This provides the interpreter with the information necessary to make any adjustments in his/her interpreting. For example, you may discuss whether or not the interpreting will be done in consecutive or simultaneous mode, whether there will be highly technical language that will be used, whether subsequent adjustments in register will need to be made, and whether or not the content of the session is going to be highly emotional or intense. It is also an opportunity to raise any cultural concerns that may be pertinent to the patient’s presenting problem.

Contributed by The National Council on Interpreting in Health Care (NCHIC)

Whenever possible, the need for an interpreter should be decided before an appointment. This may be determined from information contained in a referral, when the client requests an interpreter, when you are assessing the need for an interpreter or by asking the client.

Assessing how well a person can understand and communicate in English is the first step in identifying the need for an interpreter. Engaging an interpreter is recommended when the client:

Requests it
Speaks English as a second language and is in a stressful, complex or unfamiliar situation
Is difficult to understand
Responds only in a limited way
Relies on family or friends to interpret
Wishes to communicate in his or her preferred language
Cannot grasp or respond to questions in English.

Remember, an interpreter serves not only the client. You can request an interpreter if you believe you need one. To determine a client’s level of English language proficiency, ask open-ended questions that require more than a ‘yes’ or ‘no’ answer, such as ‘Why are you here today?’

A client’s language cannot be determined reliably from their country of birth as many countries have multiple languages and dialects. Furthermore, a person such as an asylum seeker may not have spent much time in their country of birth. If unknown, a client’s language can be determined by:

Asking the client or person accompanying them (such as a family member, friend or support worker)
Using a visual aid that lists languages, although be aware that this method assumes the client can read their own language (and note that some languages do not exist in written form)
Contacting an interpreter agency, which may be able to assist you by engaging telephone interpreters.

Tip: The Victorian Government offers the ‘Find Your Language’ tool, which allows you to create a poster or flip chart that will assist in identifying the languages your clients speak.

How you offer a client an interpreter will affect the response you get.

Poor: “You (or the client) won’t need an interpreter, will you?” Asking the question this way discourages the client, or the person who is making the appointment, from asking for the language assistance that he or she may need.

Better: “Will an interpreter be needed? In what language?” This question may generate information on the need for an interpreter. On the other hand, many clients may reply ‘no’, believing that they have to either bring their own interpreter or have a family member interpret.

Basic: “What language do you (or the client) speak at home?” This question will give you information about the client’s home language, but ignores the possibility that the client may be bilingual in English as well.

Best: “In what language do you (or the person for whom you are making the appointment) prefer we offer our service?” Asking the question this way will provide you information on the language the client feels he or she needs to speak in a health or other service related conversation.(1)

Reference:

Adapted from Roat, CE (2005), Addressing Language Access Issues in Your Practice: A Toolkit for Physicians and Their Staff Members, California: The California Academy of Family Physicians

If a client refuses the offer of an interpreter, it is important to clarify and address the reasons. Below are some reasons for refusing an interpreter and some possible remedial actions.

Workers receive information, education and training about interpreters; people in the community generally do not. They are less likely to know that:

Qualified interpreters exist.
They are entitled to the services of an interpreter.
Often there is no charge to the client for these services.

Where people are aware that professional interpreters exist, they may not know the procedure to access them.

Possible remedial actions:

Inform people that interpreters are available and that they are free of charge to the client. This can be done at first point of contact with a service provider, by displaying information at reception, through letters sent out to clients/ communities and at community consultations.

This may be for the above mentioned reasons of concern for confidentiality and privacy. There may be a sense of obligation for family members or friends to interpret as an extension of the support role they offer the client.

Possible remedial actions:

Explain that accepting support from family or friends does not need to extend to interpreting. Furthermore, the involvement of an accredited interpreter will relieve family members or friends of the burden of interpreting and free them to be fully engaged in a support role.

The client may feel confident that he/she can competently communicate in English and understands everything that is being said. Alternately, the client may be embarrassed that his/ her speaking and comprehension of English is not as good as it should be.

Possible remedial actions

State that it is your organisation’s policy that you are required to communicate via an interpreter when there is a language barrier. Alternately explain that it is YOU who needs the interpreter − for example: “In order for me to know that I am doing my job well, I need an interpreter.”

This sometimes happens in issues related to compliance. This may be the case where the client fears prosecution.

Possible remedial actions

Make sure that you go through all the options in addressing the client’s concerns before documenting their refusal. You may need to have a co-worker in attendance to act as a witness.

Clients are concerned that they may know the interpreter and the interpreter will tell everyone the client’s personal business. If a client continues to refuse an interpreter and you choose to continue with the appointment, document your concerns.

Possible remedial actions

Reassure the client by explaining the role of the interpreter and the requirement for interpreters to adhere to the AUSIT Code of Ethics, which includes confidentiality. If this does not allay the client’s concern you can take actions to conceal the client’s identity by:

Engaging a telephone interpreter
Requesting a telephone interpreter from interstate (you may need to pre-book the interpreter)
Using a false name to conceal the client’s identity from the interpreter.

It is best to discuss these strategies with your client first.

This information sheet is one of a series produced by the Centre for Culture Ethnicity & Health (CEH) covering aspects of language services. Other tip sheets in this series include:

Languages: English

Resource Type: Tip/Fact Sheets