Article from the Boston Globe’s On Call Magazine, July 2000

By Helen Osborne, M.Ed., OTR/L
President of Health Literacy Consulting

By this time next year, every acute-care hospital in the Commonwealth will be required by law to provide interpreter services in connection with all emergency care for non-English speaking patients. But regardless of where the clinical encounter occurs, it is to everyone’s benefit, the patient’s and yours, to work with trained medical interpreters. Trained medical interpreters and translators help healthcare providers and patients get beyond language barriers.

“Lydia,” an elderly Russian-speaking woman, was in the hospital, recovering from surgery. Late one evening, Lydia  was making motions on her chest. The night nurse wasn’t sure if Lydia was having chest pain or was trying to tell her something, so she paged the medical interpreter to clarify. Over the phone, the interpreter asked the patient if she was having chest pain. Lydia responded, “My heart hurts because my daughter hasn’t come to visit me, and I’m feeling sad.” Once she had that piece of information, the nurse was able to intervene to help Lydia deal with her sadness.

Lydia is not an exception. Last year, there were more than 35,000 medical interactions at the Beth Israel Deaconess Medical Center in Boston just between ambulatory non-English speaking patients and English-speaking healthcare providers. Collectively, these patients spoke more than thirty languages — most frequently Russian, Chinese, and Spanish. Somehow, they needed to get beyond the language barrier to tell healthcare workers their concerns and to understand what was being said to them. Using the services of trained medical interpreters and translators is just good patient care.

Making Sure the Message Gets Through

“Translating is taking what’s written in one language and converting it into a written format in another language,” explains Shari Gold-Gomez, manager of the interpreter services at Beth Israel Deaconess. “And interpreting is taking what is said and converting it verbally into the target language.” In order to communicate medical information effectively, the interpreter or translator needs to know more than the words. Effective communication requires being able to put the words into an appropriate cultural context. But there is also more than language and culture to consider.

Using trained medical interpreters offers several advantages over relying on family members, friends, and volunteers who are bilingual. Professional interpreters are trained in medical vocabulary so they understand the words they need to communicate. They also are instructed in ethics and confidentiality. Perhaps most importantly, they understand how to maintain neutrality and do not impose their personal views while interpreting.

If you are not in the habit of working with medical interpreters, here are some guidelines you can follow.

1)      Request interpreter services. Ediss Gandelman, director of community benefits at Beth Israel Deaconess, notes that clinicians often express a reluctance to call for an interpreter – feeling they are imposing. “If there are interpreters on the payroll, then they are paid to be there and to help,” she says. Make sure to ask for their help when communicating with non-English speaking patients.

2)      Know the difference between a trained interpreter and an untrained volunteer. Untrained people may get themselves in trouble, says Gold-Gomez, when they do not make it clear what information they do not know. For example, a trained interpreter will consult with a health professional or look up an unfamiliar term in the dictionary. An untrained volunteer may be reluctant to do so for fear of looking incompetent.

3)      Communicate with the patient, not the interpreter. Look and speak directly at the patient, even when an interpreter is present. Not only do you show respect this way, but you also have an opportunity to pick up on the patient’s non-verbal cues. If you forget to speak directly to the patient, the trained interpreter is likely to remind you.

4)      As you would if you were giving instructions in English, verify the patient’s understanding. Ask the patient to say back important information and complicated instructions. Ask questions that require more than a yes or no answer. For instance, ask, “How would you take this medicine?” rather than “Do you understand what to do?”

5)      Notice signs of difficulty. Despite language differences, it is still the healthcare provider’s responsibility to make sure that medical information is clearly communicated. If, for example, there are lengthy conversations between the interpreter and patient and only one-word answers to you, there might be a problem. Notice if the patient reacts in a way that is unexpected or seems unusually agitated. If you are suspicious that your message is not being interpreted accurately, says Gold-Gomez, check with a different interpreter.

6)      Learn how to use the telephone as an alternative to face-to-face meetings. While desirable, it may not always be possible for the patient, healthcare provider, and interpreter to meet face-to-face. Speaker phones and conference calls can be useful alternatives. Be sensitive to issues of confidentiality, however, when using these methods.

7)      For routine communication, such as greeting patients or finding out if they are hungry, consider using translated tools consisting of basic phrases. Make sure, however, that the patient can read in his or her native language, that the tool is translated correctly, and that the font is large enough to be clearly seen.

8)      Appreciate that there are differences within language groups. Just as there are different words in English for carbonated beverages, such as “soda” and “pop,” there are also differences in other language groups. Spanish, for example, is spoken in over twenty different countries; the translated word that is understood as “neighborhood” in one Spanish-speaking country means “ghetto” in another. Gandelman recommends that interpreters and translators agree on a glossary of words to use.

9)      Prepare to implement the Emergency Room Interpreter Bill in July 2001. Find out the interpreter policies that are already in place at your facility, and help design linguistic systems if you don’t already have them. There is no one sanctioned system; some facilities use only professional interpreters while others use a combination of professionals and trained employee-volunteers. “Have clear expectations,” says Gandelman, “set some standards, and be thoughtful about it.”

Where to Find Out More

Printed Sources

An Act Requiring Competent Interpreter Services in the Delivery of Certain Acute Health Care Services. The Commonwealth of Massachusetts. Chapter 66, H 4917. Signed into law by Governor Cellucci on April 14, 2000.

Perkins, J., Simon, H., Cheng, F., Olso, K., Vera, Y. (1998) Ensuring Linguistic Access in Health Care Settings: Legal Rights and Responsibilities. National Health Law Program for the Henry J. Kaiser Family Foundation.

Video

The Professional Interpreter. Vancouver Community College and Surrey Delta Immigrant Services Society. 1998. This film highlights the value of professionally trained interpreters.

Web Resources

• American Translator Association, www.atanet.org
• Cross Cultural Health Care Program, www.xculture.org
• Massachusetts Medical Interpreter Association, www.mmia.org

Other Resources

• Shari Gold-Gomez, manager of the interpreter services at Beth Israel Deaconess Medical Center, can be reached at sgomez@bidmc.harvard.edu.
• Ediss Gandelman, director of community benefits at Beth Israel Deaconess Medical Center, can be reached at egandelm@caregroup.harvard.edu.

This acronym, C-U-L-T-U-R-E, is taken from Interpreter Services Quick Tips, Beth Israel Deaconess Medical Center, 1998. Use it as a reminder of how to work with medical interpreters.

Clarify your role and the role of the interpreter

Uphold your role as care-giver; do not ask interpreter to do so

Look at and speak directly to the patient

Talk slowly and clearly

Understand cultural differences

Remember and respect that the interpreter has a patient schedule to follow

Eye contact with patient, not interpreter