Tips for Working with Medical Interpreters

Prepare ahead before entering the patient’s room. Have an initial plan for the conversation including what information you want to convey and specific questions you want to ask. If possible, discuss these ahead with the interpreter. Being patient, using clear language, and a respectful tone will go a long way to establishing trust with the patient and their families. Beware of possible prejudices and assuming cultural values of the patient and others who speak that language. Physicians should document the interpreter’s name and identification number if available in the patient’s chart.

Telephone-Based Services

Remote tele-interpreter services have certainly improved access to certified and qualified interpreters with extended availability and a wide range of spoken languages. Users must ensure a reliable connection speed and good audiovisual capabilities (especially for the elderly and hearing- or sight-impaired), and consider the of lack visual cues such as body language and facial expressions that can be a source of misunderstandings when compared to in-person services.⁶

Using Ad Hoc Interpreters

In emergency cases, ad hoc interpreters (friends, family, community members, or untrained staff) will need to be used because of extenuating circumstances. Ideally, medical staff should attempt some vetting of the ad hoc interpreters and confirm the patient agrees with using this person to interpret.⁷ Unfortunately, non-adult children are often used as ad hoc interpreters, which can be fraught with issues. Ad hoc interpreters have a higher rate of potentially consequential errors compared to professional interpreters (22 percent versus 12 percent) and outcomes significantly are improved for individuals with over 100 hours of training (2 percent).⁸

Although there are no current standards forbidding it, multilingual physicians may be tempted to use their own language backgrounds to forgo an interpreter.⁹ Being bilingual is often not enough to be a medical interpreter, which requires precision, experience, and knowledge of medical jargon, as well as culturally specific idioms and phrases. For example, the French-Canadian patient who claims to have chair blesseé has a flesh wound and not a holy seat and the Spanish-speaking patient who is constipado may just need a nasal decongestant and not a stool softener. A physician once attemtpted to use his limited Diné, which is notably hard to pronounce, to ask a Navajo patient for their ch’ah (stool sample) and just ended up getting a chuckle and her chąąʼ (hat) instead.

Documentation

Providing patient-facing documentation such as procedural consent forms, discharge instructions, and medication prescriptions in the appropriate language can provide a distinct challenge. Some electronic-health-record packages provide discharge instructions for common diagnoses in common languages; however, these are certainly not extensive and can lack individualized information. Although tempting to use, current online language translation programs can be inconsistent, worse than human translators, and possibly even lead to dangerous mistranslations.^10-11