Effective Use of Interpreters

Adopted from St. Mary’s Interpreter Services

References: The Medical Interview Across Cultures,

Debra Buchwald, MD: Patient Care April 1993.

Working Effectively with Interpreters in the Primary Care Setting, Jane E. Poss, ANP, MSN: Nurse Practitioner, Dec 1995.

Interpreter Services

Core Values Respect Social Justice Compassion Care of the Poor

and Underserved Excellence

Interpreter Services

Vision Statement

We will be trusted partners in improving community health, especially among the poor and underserved.

Interpreter Services

Title VI of the Civil Rights Act of 1964 requires St. Mary’s provide interpreter services, including certified interpreters for the deaf

JCAHO requires St. Mary’s provide for the predominant languages in our service area

Interpreter Services

Interpretation – verbal

Translation - written

Interpreter Services

The “old ways” of communicatingGesturingFew common wordsWritten materialVolunteer staff memberFamily members

Interpreter Services

Problems with the “old ways” Competence of the interpreter No way to assure accuracy Unable to determine understanding May be illiterate Families put in uncomfortable

situations Staff busy at their primary jobs

Communicating with non-English speaking patients Learn some basic words and phrases in the

patient’s language, if possible. The purpose is to help the patient feel more comfortable. Know how to introduce yourself, say good morning, or ask how the patient is feeling in his or her language.

Remember that some patients who require an interpreter may actually understand English quite well. Any comments you make to other providers or to the interpreter may be understood by the patient.

Setting up for success Brief the interpreter on the patient and the goals of

the exam Ask the interpreter to suggest culturally appropriate

strategies to use Use bilingual/bicultural interpreters whenever

possible. Placing the patient, health care provider, and

interpreter in a triangular relationship may be most conducive to good communication. The interpreter should be considered a member of the

health care team. Document in the progress notes the name of the

interpreter who translated for the patient.

Do not use the patient’s children as interpreters if at all possible. Most patients will not discuss problems of a personal nature in front of their children, and in many cultures using the child to interpret will upset the family’s social order.

Communication Basics

Look at the patient when you speak

Watch the patient during the interpretation

Working with an interpreter

Speak slowly in a normal tone of voice

Speak a sentence or two and then wait

Be prepared to clarify for the interpreter

Working with an interpreter Use nouns rather than pronouns to

avoid confusion Allow time for the patient and

interpreter to respond Be sure to ask if the patient has any

questions before you end the conversation

Remember, the patient may understand English, just not speak it well

Working with an interpreter Provide written information for the

patient just like you would for an English speaking patient

Ask the interpreter to translate the written information if needed

Do not ask questions that make the interpreter uncomfortable – part of their role is to be a patient advocate

When to use a professional interpreter Informed consent, surgery permits,

procedure consents Notification of death and

completion of all documents Admission assessment Explaining results of tests that are

abnormal Patient teaching

Allow extra time because everything has to be said at least twice. Explanations will generally take longer, especially if the patient is not knowledgeable about western medicine.

Always allow time for patients to ask questions and seek clarification.

Sentence-by-sentence translation works best. Expecting an interpreter to remember long explanations is unreasonable and will lead to omissions.

Use simple language and straightforward sentences. Avoid metaphors, slang, and jargon.

Explain all medical terms in simple language, especially if the interpreter is not knowledgeable about western medicine.

Use nouns rather than pronouns whenever possible so the referent will be clear.

Avoid abstractions, idiomatic expressions, similes, and metaphors. It is useful to learn about these usages in the target language.

Allow the interpreter to ask open-ended questions. if needed, to clarify what the patient says.

Do not interrupt the translator. Question the interpreter

if he or she seems to answer for the patient.

Collecting the case history

Use short questions without complicated clauses.

Make allowances for terms and concepts that do not exist in the target language.

Giving directions during the physical exam

Learn some basic phrases so the translator may not be needed for much of the exam Look up, right, left, down

When asked about the results politely defer to the end of the exam when you will discuss everything, BUT remember to discuss it.

Discussing the exam outcomes

Use language that your interpreter can handle. Try to use plain English instead of technical terminology and professional jargon, such as workup.

Giving treatment instructions

Always ask the patient to repeat instructions to you to be certain they have been properly translated and understood.

Document in the progress notes the name of the interpreter who translated for the patient.