Just kidding. There is no tenth standard of practice, and there is no standard that explicitly states, “Don’t be alone with the patient.” But the way interpreters and interpreter trainers talk, you’d think there was. I am guilty of participating in the creating and reinforcing of this belief.
“Just DON’T do it,” I remember telling interpreter trainees back in 2009, when I was cutting my teeth as an interpreter trainer. “Don’t EVER be alone with the patient.”
Anyone (including my former trainer self) who imagines that interpreting is this mechanical, this robotic, and that the environment is this much under the interpreter’s control is either not a working interpreter, or used to be an interpreter and has conveniently forgotten all about the realities of interpreting, for their own convenience as a trainer: It’s easier to demand that trainees meet unreachable standards and scare them to death of being along with patients than it is to talk about WHY it’s not ideal to be alone with a patient, and what to do when it happens.
The important thing is to not set unreasonable standards. What happens when we insist interpreters never be alone with a patient, and then they find themselves alone with the patient? They inevitably will cross way over the line, since there’s just two possible scenarios we’ve established: Being alone with the patient (good) and not being alone with the patient (bad). But what happens when we explain what the issues are, and what they can do when they do find themselves alone with the patient? This changes the conversation into something useful.
Let’s tackle this first: What really is the problem with being alone with the patient? Because it’s problematic, but we have to know how to talk about it. There’s no standard of practice that says Don’t Be Alone With the Patient. But there are few ethical principles that can be applied here.
First: Confidentiality. The easiest way to not be exposed to confidential information when there’s nobody there to interpret it to, is to not be alone with the patient telling you all about his medical history. Worse, the patient tells you a “secret”, and then tells you not to tell the doctor.
That leads us to role boundaries. The interpreter’s role is to interpret, and that role is blurred in everyone’s eyes when the interpreter is hanging out chatting with the patient. That’s when we get providers thanking us for our “help”, as if we were the patient’s friend doing them a favor by interpreting. Naturally, if the interpreter is seen as a friend or family of the patient, we’re going to be asked to do things that go beyond our role. And what happens when you’re alone with the patient and she just told you all about the reason she’s here, and then the doctor comes in and asks her, “Why are you here?” You got it. The patient is going to turn to you, the interpreter, and say, “I just told you.” Then you’re stuck explaining to the patient that even though she just told you all about it, she still has to tell the doctor herself, while you interpret. Then you’re stuck explaining to the doctor what you’re explaining to the patient. Not ideal.
This then brings us to impartiality. It becomes difficult to remain impartial when now all of a sudden you’re spending all this time alone with the patient, not interpreting. Imagine also the perception of medical staff when the interpreter is there hanging out with the patient chatting during the whole visit. It contributes to the misunderstanding of the interpreter’s role, the interpreter as professional.
Being alone with the patient is a real thing that happens. If it’s unavoidable that I’m alone with the patient in a waiting room, or an open bay and we’re chatting, I always make it a point to tell the provider when he or she approaches us, something like, “Oh, she was just asking me where I learned Spanish and I was telling her I lived abroad in college.” Now this brings the provider into the loop, rather than isolating the patient from the provider and vice versa. I can’t tell you how many times this little trick has actually started a conversation between the provider and patient, while I fade into the background and interpret.
These challenges can be overcome if we explain these things to interpreters. Why not talk more about how you introduce yourself to the patient, so the role is clear? Why not talk about self-awareness, and just being aware of how your own impartiality might be affected, and make sure that doesn’t influence your interpretation?
While you can be certain that at times you will not be able to avoid being alone with the patient, I want to propose some hard-and-fast rules for when it happens. While there might be a time you’ll have to navigate small talk, and redirect the patient to remind them to save their healthcare-related comments for the medical staff, there is no reason EVER I can think of that an interpreter should give advice, or overshare personal information, which includes sitting with the patient and sharing photos, and having such a boisterous conversation that nobody present can ignore it.
When training interpreters who’ve been interpreting without training, I get a lot of push back on this point. They complain that leaving the patient’s room with the medical staff or not sitting next to them in the waiting room feels rude. I get that. I used to do the same thing before I received training. But know what the great thing is? We can change. We can decide that from now on, we’re going to politely excuse ourselves when the doctor says he’s needs to go grab his stethoscope and will “be right back”. Because “be right back” always means “be back after five people have stopped me in the hallway to ask a question and I’ve responded to a bunch of pages”. When we decide to wait in the hallway, we can have some scripted response ready when the nurse says something like, “All the other interpreters wait in the room with the patients.”
The more we’re able to apply ethical principles to our interpreting practice, the better we can be at guiding our newer colleagues, and explaining to providers why we do what we do. Because our ethics and standards are a mystery to most people. But they shouldn’t be a mystery to interpreters.
What do you think? Have you had difficulty with this topic? Are you an ASL interpreter who wants to share how this is different for you? Let us know all about it in the comments!