A Minnesota Area Geriatric Education Center & Center on Aging

project in collaboration with the School of Social Work

Working with Interpreters – Part II

Hee Yun Lee, Ph.D.

Assistant Professor
School of Social Work

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 Introduction

In this module we will continue to explore topics related to working with

interpreters. We will define the roles of the interpreter, provider and patient
in the interpreted medical visit. Additionally, we will describe the different
types of interpreters.

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 Focus of the Module

1. Understand the roles and responsibilities of the interpreter, provider

and patient in the interpreted medical appointment. From my point of view, the document
says that the interpreter is as important
as the doctor because a barrier in
communication could have serious
consequences for the patient

2. Explore the different types of interpreters and understand the

differences between them.

3. Understand the purpose of professional translation services.

4. Learn of the current resources available for teaching and learning the
effective use of interpreters in the medical visit.

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Role and Responsibilities of a Professional Interpreter

Interpreter

Provider
Patient

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Role and Responsibilities of a Professional Interpreter

Primary role is to support and reinforce the

relationship between patient and provider
Actively supports change in patient health;
Patient Advocate
requires clear rationale. Part of our job as interpreters is help to
clarify to the patient why the doctor is
giving an indication or prescribing a
medicine

Cultural Clarifier
Supports the health and well-being of the
patient; facilitates communication between
patient and provider.
Message Clarifier

Follows standard health care interpreting

Message Converter
practices; upholds laws, regulations and policies.
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 Is Your Interpreter Qualified?

I think that it is a good source of

information as it describes how is a
YES, if s/he: quilified interpreter, what attitudes
and activities she or he has to do in
order to convey the message
accurately

• Listens attentively in one language

• Repeats the original message accurately and completely in another language
without adding, omitting or changing key information or intended meaning
• Understands the ethical obligation to repeat everything
• Takes notes when appropriate
• Recommends optimal positioning
• Ensures confidentiality of patient’s health information

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 Interpreter Positioning

Interpreter next to and Patient faces both the Interpreter between the
slightly behind the patient provider and provider and the patient
the interpreter

Interpreter next to the

provider

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 Provider’s Roles and Behaviors During Encounter

Patient

Guides the
medical encounter

Evaluates quality of interpreting;

Provider Directs conversation Interpreter

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 Tips for Healthcare Providers:
Prior to the Visit:

• Make an honest, formal assessment of your

own foreign language skills, including correct
medical terminology

• If not fully competent, use an interpreter

• Arrange for trained interpreter to be present

• Briefly discuss goals for visit with interpreter

• Allow introductions of all parties

• Set the tone for the interview:

– Ask interpreter to interpret accurately

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 Tips for Healthcare Providers:
During the Medical Encounter

• Look and speak directly to the patient, not the interpreter

• Speak in short sentences and pause

– Allow the interpreter to repeat what has been said

• Use even pace and normal tone of voice

• Some patients may understand some English, and all patients respond
positively to a calm tone of voice and respectful body language

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 Patient’s Roles and Behaviors
During the Encounter

Patient
Acknowledges the need for interpreter
services and makes request
Takes part in medical interview,
Guides the decision making and treatment
medical encounter plan at desired participatory level
Requests services
when needed

Evaluates quality of interpreting;

Provider
Directs conversation Interpreter

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 Types of Interpreters
Recommended
• Staff interpreters and volunteers
Trained, On-Site • High quality of interpretation
• If done correctly, enhances patient-physician
Interpreters
relationship
• Costly program
• Trained interpreters
Telephone • High quality of interpretation
Interpreters • Less effective at enhancing patient-physician
relationship
• Available for a fee the patient's family member has
knowledge of the patient's
disease and has a good
command of the vocabulary
• Family members & bilingual staff
• Unknown quality of interpretation and therefore
potentially harmful
Untrained • Often do not have the appropriate knowledge of
Interpreters medical terminology; can’t accurately relay messages
• Introduce a dangerous bias: speak on behalf of their
Not relative, instead of actually translating what is being
Recommended said.
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 Problems with Using Untrained Interpreters
Recommended

• Not familiar with medical terminology

• Lack language skills
• Omit, add or change the message
• Not familiar with HIPAA or how to
respect confidentiality rules
Not Untrained • Not familiar with patient’s rights and
Recommended Interpreters may want to make important decisions for
the patient

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 Research Data on the Effect of Using
Untrained Interpreters on Clinical Outcomes

• Incorrectly interpret 23% to 53% of words

• More likely to make mistakes with potential
clinical consequences
• Quality of care is inferior for limited English
proficiency patients:
 Lower likelihood of having medication side
effects explained
 Decreased satisfaction with care
 Distortions in psychiatric encounters

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Marcos 1979; David 1998; Ebden 1998; Kuo 1999; Flores 2003

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 Problems Using Children/Family as Interpreters

Recommended
Children:
• The information may not be appropriate
• May conflict with family dynamics and
roles
• Places child in awkward situation
• May cause trauma due to gravity of
discussion
Family:
• May create emotional burden or family
pressure
Untrained • May create a conflict of roles within the
Interpreters
family structure
• Confidentiality is compromised
Not
Recommended • Patient self-determination is at risk

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 Professional Translators

• Provide translation of medical documents

• Provide medical editing

• Have an educational background in translation and healthcare

• Provide back translations to check for accuracy

• Provide community to review for appropriateness and dialect

Note: Machine translation is not recommended

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 Teaching Effective Use of Interpreters

 Performance-based assessment
 Standardized/simulated patients
 Role-play exercises

 Checklists for assessment

 Role-modeling effective work with interpreters

 Web-based curriculum
 NYU: “Working with Interpreters” website
 http://edinfo.med.nyu.edu/interpreter/

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 Conclusion

• Working with interpreters is a challenging,

yet vitally important aspect of working with
clients who have limited English
proficiency.

• There are advantages and disadvantages to

working with different types of interpreters.

• The interpreter, patient and provider all

have a role in the interpreting process.

• Professional interpreters can help reduce the

disparities in health literacy that exist for
immigrants and refugees in Minnesota.

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 References
Aranguri, C., Davidson, B., & Ramirez, R. (2006). Patterns of communication
through interpreters: A detailed sociolinguistic analysis. JGIM, 21, 623-
629.
Bereknyei, S., Hooper, K., & Braddock, C. (2008). “I don’t speak Russian!”:
Working effectively with interpreters and translators (PowerPoint slides).
Stanford Geriatric Education Center Program in Health Literacy and
Ethnogeriatrics.
California Health and Safety Code 1259. Retrieved on May 3, 2009 from
http://law.onecle.com/california/health/1259.html.
Flores, G. (2006). Language barriers to health care in the United States. New
England Journal of Medicine, 355(3), 229-231
Hennepin County. (n.d.).Ethics and competency standards for interpretation.
Training documents for interpreters.
Hudelson, P. (2004). Improving patient-provider communication: insights
from interpreters. Family Practice, 22(3), 311-316.

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 References
Karliner, L.S., Perez-Stable, E., & Gildingorin, G. (2004). The language
divide: The importance of training in the use of interpreters for outpatient
practice. JGIM, 19, 175-183.
Marcos, L.R. (1979). Effects of interpreters on the evaluation of
psychopathology in non- English-speaking patients. American
Journal of Psychiatry, 136(2), 171-174.
Parker, M., Kiatoukaysy, L.N., (1999). Culturally responsive health care: The
example of the Hmong in American. Journal of the American Academy of
Nurse Practitioners, 11(12), 511-518.
Schapira, L., Vargas, E., Hidalgo, R., Brier, M., Sanchez, L., Hobrecker, KI.,
et al. (2008). Lost in translation: Integrating medical interpreters into the
multidisciplinary team. The Oncologist, 13, 586-592.
Title Vi of the Civil Rights Act of 1964. In. 42 U.S.C. 2000d ed; 1964.
(http://www.usdoj.gove/crt/cor/coord/titlevi.htm)
Ulrich, L.P., (1999). The patient self-determination act: meeting the challenges
in patient care. Washington D.C., Georgetown University Press.

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 Resources

• Telephonic Interpreters
- Language Line: http://www.languageline.com
- Language Access Network:
http://www.languageaccessnetwork.com/

• Language Resources:
- Hablamos Juntos Language Testing 2008
- Ethnomed http://ethnomed.org/

• Online Teaching Module:

- NYU online module: Kalet A et al, 2002, 2005
http://edinfo.med.nyu.edu/interpreter/

• Performance Assessments:
- Interpreter Impact Rating Scale: Lie D et al, 2007
- Interpreter Scale: Lie D et al, 2008

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