Interpreting Standards

Definitions

Interpreter: A person who translates orally from one language to another.

Translator: A person who translates written messages from one language to another.

Limited English Proficiency: Individuals who, because English is not their primary language, have a limited ability to speak, read, write, or understand the English Language.

Trained/certified interpreter: A person who has received appropriate/intensive training and experience to interpret with skill and accuracy and who has been assessed for such professional capabilities.

Westside dual-role interpreters: WFH staff who have received training in the fundamentals of medical interpretation, but have not received the degree of training that would result in certification, and who serve in the role of interpreter in addition to their primary job function. Generally this is medical assistants providing translation for providers.

Ad hoc interpreter: A family member, friend, or staff member who have not received medical interpretation training.

Conduit interpretation: Literal interpretation in the first person (using “I”) without omissions, editing, polishing, or outside conversations.

Interpretation options

If a patient is identified as having Limited English Proficiency, the preference of interpretation in order is:

1. In-person trained/certified interpreter
2. Westside dual-role interpreters (typically MAs)
3. Language line (remote trained/certified interpreter)
4. Ad hoc interpreter (family member, friend) (Not preferred; only if other methods not available)

Westside does not use children to interpret, even if they seem capable of doing so.

Use of a minor (under age 18) as an interpreter is only acceptable in emergency situations.

Technique

Interpretation at Westside should be done in a conduit fashion.

The provider should:

• Position self so that he or she faces the patient rather than the interpreter.
• Talk with the patient in the first person (using “I”).
  • Unless seeking clarification about interpretation (such as connotations of words, cultural issues, etc.), should not direct questions to the interpreter.
• Maintain direct eye contact with the patient.
• Ask the patient to repeat any instructions and explanations given to insure that they are understood.
• Ask the medical interpreter to clarify in her/his own words whenever a misunderstanding due to cultural differences might occur.

The interpreter should:

• Interpret in a conduit fashion.
• Let the provider know if he/she thinks that there may be cultural issues that the provider should be aware of.
• Let the provider know if he/she does not know the word/terminology to interpret a question directly. The provider may explain the concept that he/she is trying to assess, and give the interpreter permission to try to get this information. Alternatively the provider may choose to rephrase the question.

The interpreter should not:

• Edit or summarize information.
• Hold side conversations with the patient.

If a trained medical interpreter is not available:

If use of an ad hoc interpreter is necessary:

• First, assess the interpreter’s level of English proficiency and its sufficiency for the type of interaction expected.
  • Ask the ad hoc interpreter if he/she is comfortable with the situation in which he/she will serve as an interpreter.
  • Test his/her proficiency with a basic conversation (e.g., Where are you from? How long have you been in the U.S?).
  • Based upon the type of patient appointment, ask if the interpreter can describe specific anatomy or body functions relevant to the interaction.
• Instruct the interpreter to interpret exactly what the patient says and not to edit or summarize any information.
• Never use a minor (under age 18) to interpret personal information unless in an emergency situation.
• Always be aware of potential issues of confidentiality or conflicts of interest between the patient and the ad hoc interpreter.

Issues with using an ad hoc interpreter:

• Use of a minor (under age 18) as an interpreter is only acceptable in emergency situations.
• The use of a family member to interpret for a person with LEP cannot be required.
• Respect the patient’s desire to use an interpreter of his/her own choosing and document the request.
• Family members routinely edit, add, or change the message, and they may try to control the interaction between the patient and the provider instead of facilitating it.
• The fact that a family member or employee is bilingual does not guarantee that the person has the capability to interpret medical language at the level needed.
• Consider issues of conflict of interest/privacy if the ad hoc interpreter and patient know each other:
  • E.g., in situations where you suspect domestic violence/child abuse and a family member may be the perpetrator.
  • E.g., when discussing sensitive issues associated with new diagnoses, STDs, drug use, end of life care, etc.

Documentation of interpreting

If an interpreter was used for a visit, this should be documented in the patient’s chart. This should include the interpreter’s name, their qualification as an interpreter (such as Westside dual-role interpreter, language line, certified interpreter, or bilingual family member.)