Introduction
Note: A production error mixed up two of the Vietnamese phrases, update is pending.
This language learning tool (see resource in sidebar) features videos of native speakers saying phrases of courtesy in nine languages. These phrases of greeting, introduction, acknowledgment, departure and for emergency situations in a clinical setting can be played at a normal speed and at a slow speed.
In the provider-patient relationship, the path to positive health outcomes begins with a human connection. Developing rapport lays the foundation for each successive stage of the visit — from agenda setting and gathering information, to sharing information and involving patients in creating their treatment plan.
Language barriers make each one of these steps more difficult. Professional interpreters play a crucial role in helping providers and patients communicate, but the important work of making a connection still falls to the caregiver. Nevertheless, we often fall short. In his sociolinguistic analysis of the interpreted encounter, Aranguri reports that there is “virtually no rapport-building or ‘small talk,'”1 a finding corroborated by other studies.2
The goal of this tool is to provide a jumping-off point for developing rapport in the interpreted health encounter. Using phrases of courtesy in a patient’s own language shows interest and respect, allows at least a few moments of direct connection between patient and provider, and hopefully sends the conversation for a brief sojourn into social waters with the interpreter as navigator. Making a connection in this way is not just courtesy, but lays the foundation for the highest standard of care, a standard we wish to see extended to all patients, regardless of their English proficiency.
Using This Tool
Phrases of Courtesy in Nine Languages is a tool to help providers develop rapport during the interpreted visit. I suggest you start with a couple of phrases in just one language for patients and families you see in clinic or in the hospital. Once you’ve had a chance to practice on your own in front of the computer, the ideal situation is to have a chance to practice once or twice with an interpreter who speaks the target language, or another colleague on staff.
Some have asked how these particular nine languages were chosen; they are the most commonly interpreted languages in Washington State.
As you use the tool, EthnoMed would love to hear from you. How have you been using it? When has it been most useful? What have your experiences been? Send us a comment.
Methods
After a the creation of a pilot site, the first discussions on which phrases to use took place at Seattle’s Harborview Medical Center between Eliana Lobo, Yetta Levine, and Benji Perin. With these preliminary phrases, we contacted various clinical staff, including nurses and physicians who work at Harborview Medical Center, to get feedback and ask for more ideas. These providers gave us many insights. Firstly, we dropped any phrases that could prompt an entry into conversation, such as “How are you?” In the case of a language barrier requiring an interpreter, we agreed that reciprocal conversation and information gathering should take place through the professional interpreter. Also, more than one provider suggested including the phrase, “an interpreter has been called.”
Once we decided on the phrases, we met with three experts for each language, one after another, allowing each consultant to build upon the previous interpretation. On numerous occasions we sent the final interpretations back to the first two interpreters for comment. Twice, with Amharic and Tigrigna, after an initial meeting to work on the phrases, three interpreters collaborated as a group on a final set of interpreted phrases.
Throughout these iterative discussions, we wanted there to be room for interpreters to add a phrase if one seemed like a great fit, or throw one out entirely if it didn’t feel culturally appropriate. In both Russian and Vietnamese, “It’s good to see you again” was cut, and there are a variety of phrases specific to only one language, for example, “Welcome” in Oromo and “Pleasure to work with you” in Spanish.
In one case, Tigrigna, we faced an unexpected challenge: we had to create interpretations that would be perceived as nationality-neutral, as Tigrigna is spoken in both Ethiopia and Eritrea. The expertise offered by the team of interpreters on this issue was invaluable.
A final note on “interpretation” vs. “translation”: throughout the process, we encouraged interpreters to choose phrases in their languages that communicated the message and meaning of the original phrase in a way that would sound natural to the listener. For this reason, we consider the resulting phrases more interpretations than direct translations. In cases where the interpreted phrase in the target language diverges from a direct translation, we have made a note in parentheses so that a user knows exactly what he or she is saying.
Author’s Acknowledgements
First and foremost, a huge thanks to Yetta Levine, EthnoMed’s former student-author program coordinator, and Eliana Lobo, former Supervisor in Interpreter Services at Seattle’s Harborview Medical Center. They provided unflagging encouragement and support for this project from start to finish.
When I came up with the idea for this website, I knew that it would be valuable only if the quality of the translations was excellent, in the right register, and tailored to the professional setting of the medical encounter. Achieving this depended on the expertise of three experts per language to create a culturally appropriate interpretation of each phrase that was as easy as possible to say. In short, this tool was possible only because of the thoughtfulness and insight of the excellent interpreter staff at Harborview Medical Center, in addition to several other language experts in the community. Our language experts: Anab Abdullahi, Gammada Abraham, Tina Chang, Bogale Demse, Mekonnen Gebretsadik, Araceli Gonzalez-Medel, Tsehay Haile, Esther Hung, Jennifer Huong, Rodwell Kov, Larry Liu, Kim Lundgren, Barbara Mazina, Cuong Nguyen, Loan Nguyen-Phan, Anna Putsima, Daniel Sparler, Sam Verkhovsky, Rosa Villalobos, and Tsega Woldetatios.
Thanks also to Linda Golley, Manager, University of Washington Medical Center Interpreter Services Department, for valuable feedback and connections to interpreters. She has long been using the term “Phrases of Civility” to describe the aims of this website in her work with interpreters and providers.
Thanks also to Patrick Roberts at the University of Washington’s Student Technology Fee Loan Program for arranging the use of video equipment, to Martine Pierre-Louis, Director of Interpreter Services, Harborview Medical Center, and to the rest of the EthnoMed team for their support: Ann Marchand, Christine Wilson Owens, and Dr. Carey Jackson.
About the Author
Benji Perin is currently a second year medical student at the University of Washington. The seeds for the idea of “Phrases of Courtesy in Nine Languages” were planted while he was working part-time as a DSHS-certified Spanish interpreter at Seattle Children’s. Like many interpreters, he observed that when a provider made an effort to introduce him or herself and say hello in the patient’s language, it often created a very positive, warm, and welcoming environment. It became clear that such a linguistic gesture was a powerful way to begin developing rapport with patients who don’t speak English.
Later, as a volunteer in the Emergency Services Department at Seattle’s Harborview Medical Center, Benji saw how patients could seem terribly isolated by their limited English proficiency. Often he wished he could say a few crucial phrases in Vietnamese, Amharic, or Somali to a patient waiting anxiously for the results of a test on the medical side, or to a scared patient surrounded by medical personnel and strapped to a backboard on the trauma side. What he wanted was a website with a carefully edited selection of phrases in the most commonly interpreted languages, including audio, with interpretations made specifically for the professional medical encounter. Not finding what he was looking for, he decided to build it.
References
- Aranguri C., Davidson B, Ramirez R. “Patterns of communication through interpreters: a detailed sociolinguistic analysis.” Journal of General Internal Medicine. 2006 Jun;21(6):623-9.
- Ngo-Metzger Q, Sorkin DH, Phillips RS, Greenfield S, Massagli MP, Clarridge B, Kaplan SH. “Providing high-quality care for limited English proficient patients: the importance of language concordance and interpreter use.” Journal of General Internal Medicine. 2007 Nov;22 Suppl 2:324-30.