From Beginning to End: The Interpreted Medical Visit

Did someone call for an interpreter?

Did someone call for an interpreter?

For the first time in months, I took an assignment for a medical interpreting job.  While my language skills are just fine for this setting, I was reminded how difficult this work really is and how flexible we have to be, and it made me remember how nervous I was when I was new.  Mostly because I had no idea what to expect.  These points don’t have anything to do with terminology.  Terminology and asking for clarification is a different matter.  Here’s a basic run-down of what you can expect in an interpreted encounter in the outpatient world.

  • Professional introduction with front desk, patient and family, and clinical staff:  I want to make sure that everyone knows I’m the interpreter.  Not a family member or friend who came with the patient, and not a bilingual staff member getting pulled from her regular duties to interpret.  I like to make sure to introduce myself not only to the patient, but also anyone who’s with the patient (including kids).  This helps quickly build rapport, and can ease any tension that might be there when you’ve got bilingual family members and you’re afraid they’re going to give you a hard time, which by the way, almost never happens.  The patient’s bilingual family members are not there to harass the interpreter–they just want their sister, mom, dad, etc to be okay.  When I introduce myself to the doctor, I ask if he’s ever worked with an interpreter before as a jumping off point.  When doctors aren’t sure how to work with an interpreter, they probably won’t ask, and they’ll be grateful that you brought it up.
  • Waiting with the patient:  It’s time to stop scaring interpreters about being alone with the patient, and to start talking about why we don’t want to be alone with the patient.  Basically, you don’t want to be there when the patient is telling you about her condition and there’s nobody to interpret it to.  You don’t want to affect your neutrality.  You don’t want to confuse role boundaries.  If the patient wants to talk about the weather while sitting in the waiting room, the world will keep spinning.  If she asks you about her condition, politely suggest that she ask that question to the doctor, and you’d be happy to interpret it for her.
  • Sight translation for intake paperwork: There are different ways to do this.  One option is to read to the patient what’s on the form, and show them where to write.  If the patient doesn’t know how to write (sometimes they’ll come right out and tell you, sometimes they’ll just ask you to do the writing, and sometimes the family member will fill it out, in the same way I would fill out paperwork for a sick family member) you can sight translate the form, and write down the patient’s answers.  If they have questions while you’re filling out the form, make sure to encourage them to ask the doctor.
  • Consecutive for the interview: The nurse is asking the patient initial intake questions: What medicines do you take, how much do you weigh, where is your pain, when did it start, what does it feel like, how bad is it on a scale of 1 to 10?  I use consecutive for the questions, as well as for the patient’s answers.
  • Simultaneous for the patient: When the patient is describing her pain in more detail, I move to a simultaneous interpretation, using eye contact with the patient (I know that in training we learn this is a no-no, but it can be used to support good communication) to keep her talking while I interpret.  This way, the doctor can hear her at the same time she’s motioning to different body parts.  Another nice way to use simultaneous is when the patient is going on with a story about what happened.  While note-taking for memory and consecutive is great to allow the speaker more time to speak, when you use simultaneous here, the doctor can have a chance to intervene and redirect the patient, just as he or she would be able to do with an English-speaking patient.
  • Positioning during an in-office exam or procedure: During the interview, I like to sit next to the patient if there’s room.  Wherever I can hear everyone, and they can hear me is a good spot (don’t be afraid to move around as needed, if it’s not drawing attention to you).  If the patient is having an exam or procedure, it’s nice to look at a neutral spot so you’re not staring while their boil gets lanced or their toenails get yanked out.  If they are exposed, go behind the curtain if there is one, and if not, turn around.  I like to actually say (especially with male patients), “I’m turning around now so I can’t see anything.”
  • Sight translation of instructions: I like it when the nurse goes over the instructions with me first, and then I sight translate them to the patient.  It’s a nice touch and helps to maintain transparency if you let the patient know that the nurse is explaining the instructions to you first, before you read them to him or her.  You can sight translate anything to the patient without the nurse explaining it to you first, but you’ll want the nurse there so she can answer any questions you or the patient might have.  Keep in mind that standards for accuracy in sight translation are the same for any other mode of interpreting.
  • Neutrality at the check-out desk:  It might be tempting to fudge a little so that the follow-up appointment is at a time when you’re available to take the assignment, or to tell the check-out person that the patient requested you for the next visit.  It’s an obvious conflict.  Don’t do it.

Here is a bonus tip: Make sure to take a small notebook and something to write with.  (If you need note taking tips, you can check out this post).  I am especially challenged by numbers, and they will come flying at you in the medical setting in the form of phone numbers, addresses, weight, height, dosages, times, and dates.

And one final tip: Smile.  You can be professional and firm with your role boundaries, and friendly.  Take time after the assignment to reflect on what went well, and what could be done differently next time.  Most of all, enjoy the experience of serving others!  I invite you to share anything in the comments that might be helpful to new interpreters.

15 thoughts on “From Beginning to End: The Interpreted Medical Visit

    • thatinterpreter says:

      Hi Ganna! I’ve never interpreted for an AME, but I do have some advice on how to prepare for something you’re unfamiliar with. I like to search the internet for any documents that the patient might receive, and review those to get a feel for terminology. Also Youtube can be really helpful. For example, I recently did an interpretation at the immigration office for the first time, and I found it helpful to watch an informational video on Youtube that explained to clients what to expect. I hope it goes well for you!

  1. David says:

    Hi, I found reading this quite useful as I am considering entering the profession. I am curious and still in the researching stage. I just wanted to thank you here for the work you did in putting this together. it is very useful in moving me forward with this: that is hearing from someone who is in the field at present. I live in China and have a B.A. in Chinese language and am from Virginia originally. Thanks -David

    • thatinterpreter says:

      Thanks for reading and commenting, David! In your search for reading on real-life experiences in interpreting, you might want to check out the National Association for Judiciary Interpreters and Translators (NAJIT) blog as well. Good luck!

  2. Angel says:

    Sorry to get off the subject, but anybody knows of a training class to prepare for the Medical Certification Exam? Thanks for your responses

    • thatinterpreter says:

      Hi Angel, Thanks for stopping by! I would recommend starting by looking at the candidate handbooks on the CCHI and NBCMI websites. In addition, both offer occasional webinars on how to prepare (see their websites for more info). You also might check out the IMIA’s training registry, where you find trainings that are offered online and onsite: http://imiaweb.org/education/trainingnotices.asp If you haven’t checked out my post from October 2014 on prepping for national certification, I’d recommend that as well, as I’ve included some tips for prepping on your own. Maybe someone else will have some additional tips to include here. Good luck!

  3. Rhoda Peachey says:

    Excellent tips and explanations for a professional encounter. Being friendly but professional is a great achievement.

  4. Maria Muñoz Castelló says:

    Hi! My name is Maria and I am a Translation and Interpreting student from Spain. This year I will have my first contact with the interpretation world. I have read your article and I think it is really interesting how all the processes and the techniques are explained here. Moreover, I am very interested at medical subject. I wonder if you can give any advise to someone who has never been an interpreter before.
    Thanks.

    • thatinterpreter says:

      Hi Maria, congratulations on your studies in Translation and Interpreting! As for advice for someone who’s never been an interpreter before, well, there’s not enough space here in the comments section 🙂 For now I will say this: Find a professional association and/or mentor who will support you as you learn. You will need them when you have doubts, or if you want to debrief after something really good or really bad happens. Prepare yourself ahead of time for assignments by reading up on the subject, and looking at terminology. But you can only prepare so much, and at some point you just have to go do it. When you’re going to an assignment, know what the expectations are. Ask questions (if you have a mentor, you will know what questions to ask). And finally, have fun! It should feel like fun on some level. Keep in mind, this is coming from a medical interpreter in the US. My perspective is very different from say, a conference interpreter in Europe. Good luck!

  5. Crystal says:

    Any suggestions on what to do when the doctor leaves the room and you are alone with a client? Almost every time a am alone with a client, they open up and unload their problems. I agree it is important to have some background knowledge and get to know the client, but is it ever appropriate to leave the room when the doctor does so that the client won’t be inclined to ask me questions instead of the doctor? And since doctors are technically our clients too, would it be appropriate to have the same background info from them or sit with the doctor as they read the files or do charting? These are things that cross my mind often as I contemplate the complexity of our work and the need for cross cultural understanding.

    • thatinterpreter says:

      Hey Crystal, Those are great questions and I’ll bet you’re not the only one wondering. My short answer is that generally, you don’t want to be in a situation where you’re getting information (verbal or written) and there’s nobody there to interpret it to. (This applies to spoken language interpreters; ASL interpreters have slightly different protocols). Does it feel uncomfortable or rude to step out of the room with the doctor? I know, I’ve been there! A polite “Excuse me, I’ll be back with the doctor” as I step out and wait in the hall (or wherever) does the trick for me. This will help you maintain your neutrality and roll boundaries. You’re concerned about being ready so that you can do the best interpretation possible (which is great!) but we have to look for ways to prepare that don’t involve one-on-ones with patients and their providers. Reading ahead of time for background knowledge, collecting patient info brochures, and asking other interpreters about their experiences is a great start. A lot of this background knowledge is built over time, so be patient with yourself and be ready to clarify and ask questions as needed.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s