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.