1. Arrange for a medical interpreter. Find out the patient’s/family’s language or dialect preference before meeting with them. For sensitive topics, consider working with an interpreter of the same gender as the patient. When available, always work with certified medical interpreters. Never ask minor children to interpret.
2. Introduce yourself to the family and to the interpreter. Allow the interpreter to do the same.
3. Document the interpreter’s name and the interview language on the visit note or medical record.
4. Conduct a brief pre-visit conference with the interpreter. Ideally, this may be conducted before you are present with the patient/family, but this can be done in the room with the family unless sensitive issues need to be discussed. It is especially useful to have a pre-conference when working with a telephonic interpreter who cannot see what is happening. The following should be covered.
- Establish the style of interpretation. Spoken language medical interpreters usually perform consecutive interpreting where the provider/patient speaks in short utterances and pause, giving time for interpretation. Sign language interpreters utilize a simultaneous mode in which they interpret as the provider/patient speaks.
- Encourage clarification. Ask the interpreter to tell you if they don’t understand terms you use or the terms aren’t easily interpreted. Tell them to also inform you if it seems that the patient is expressing a cultural idea or concept that they think you may not understand.
- Decide where each party will be positioned. For spoken interpretation, consider positioning where the patient can look at the provider and hear the interpreter. For Sign Language (and especially for tactile), the patient will need to be able to look at (and possibly be in physical contact with) the interpreter.
- Share the context and the nature of the visit.”Nasara is coming in to see me today for a follow-up visit. She has been depressed and I will be discussing this first”. Or, “Anh is a new patient to our clinic. I will be asking him many questions about his past health and his family and then will do a complete physical examination”. Again, this is especially helpful for remote (telephonic or video) interpretation.
- Determine if there are any time constraints on the interpreter. Many in-person interpreters are assigned for a set amount of time and it is helpful to determine ahead of time how much you will be able to cover in this visit.
- Ask the interpreter if they have any questions or concerns that they want to share with you before the visit (consider discussing this without the patient/family present).
5. Direct questions to the patient, not to the interpreter unless they are meant for the interpreter. For example, ask “How are you feeling today?” rather than “Can you ask him how he’s feeling today?” If you are going to pause and ask the interpreter a question in English, tell the patient that this is what you will be doing.
6. Conduct a post-visit conference with the interpreter outside the room if you have concerns about the encounter. This is particularly helpful if the communication was unclear as the interpreter may have insight into the patient’s linguistic ability.
7. Use on-line and local resources to learn more about your patients’ linguistic and cultural background so you are better informed about caring for them and their community!
Brief Guidelines
Harborview Medical Center (Seattle WA) provides interpretation for over 100 languages, and has created small laminated cards for staff badges with some brief guidelines about working with interpreters.
- Briefly check in with the interpreter, informing them of the goal of visit and asking for cultural input.
- Assure the patient that we are ALL bound by confidentiality.
- Once the visit begins, all communication will be interpreted.
- Speak directly to the patient.
- Ask one question at a time, avoiding the use of jargon, slang or metaphor(s).
- Briefly check-in with the interpreter after the visit, asking for additional cultural input. Share feedback about the interpretation process.
If making similar cards for your health center, also include contact information (telephone and/or web site) for your Interpreter Services.