II. Precautions
- Professional Medical Interpreters
- Results in more accurate provider-Patient Communication
- Associated with less Malpractice risk
- Decreases hospital stays
- Increases patient satisfaction
- Medical Interpreters may clarify meaning, and help to frame the responses in cultural context
- Avoid ad hoc, non-professional Medical Interpreters (friends or family)
- Professional Medical Interpreters are preferred and are recommended for every patient
- Children should be avoided as Interpreters due to their lack of understanding of adult issues
- Patients may filter their responses when asked embarrassing questions with a family member or friend interpreting
- Sensitive medical topics may be uncomfortable for patients and their families
- Patients may nod "yes" as a polite gesture, even when they do not understand the question
- Family members and friends may have personal agendas
- May provide unsolicited advice
- May diverge down tangential paths or break confidentiality
- Non-professional Interpreters may misunderstand medical concepts
- Results in errors and in some cases more complicated medical care
- References
- Be aware of medical interpretation pitfalls
- Avoid addressing the patient in the third person or speaking to the Interpreter instead of the patient
- Interpreters should not be witnesses to consent
- Redirect an Interpreter who dominates the interview or answers for the patient
- Patient who decline Interpreter services
- Understand patient's reasons for declining services (e.g. prior experience, perceived cost, privacy)
- Remind patients that they have a legal right to Interpreters at no cost to them
III. Technique
- Preparation
- Allow for additional time for a clinical encounter with a Medical Interpreter
- Anticipate the need for an Interpreter prior to the encounter
- Patients should be notified of trained, professional Medical Interpreter services at no added cost
- Documentation
- Record the Interpreter's name in the documentation
- Process: Video-based Remote Interpreter
- Provider will look directly at the patient for all questions and answers (unless specifically directing the Interpreter)
- Camera/video should be at eye level
- Camera/video position should be optimized to avoid artifact
- Avoid bright windows or bright lights with glare that obscure the screen
- Position the video screen and camera in a triangular layout (with camera at the apex of the triangle)
- Interpreter, patient and provider can all make eye contact with one another
- In American Sign Language (ASL), prioritize the camera position for sign interpretation
- Video should capture the patient and Interpreter's full upper body and hand positions
- Avoid blocking the screen or camera
- Process: In Person Interpreter
- Consider meeting with the Interpreter prior to starting the clinical encounter
- Set goals and review background information
- Request sentence by sentence interpretation to maximize accuracy and avoid repetition
- Interpreter should avoid side conversations
- Interpreter should not answer for the patient
- Interpreter should sit next to or slightly behind the patient
- In very long encounters, allow for a 10 minute break for every hour of interpretation
- Consider meeting with the Interpreter after the encounter
- Review the findings, identifying errors and make corrections
- Consider meeting with the Interpreter prior to starting the clinical encounter
- Communication
- Look at and speak directly to the patient, maintaining eye contact (not the Interpreter)
- Avoid referring to the patient in the third person (refer to them as if you are speaking directly to them)
- Speak in short sentences encompassing a single thought or a single question and no more than three key points at a time
- Avoid off-handed comments you do not wish patients to hear (most patients can speak some english)
- Avoid interupting the Interpreter or patient prior to their finishing a question or response
- Avoid Idioms, acronyms, slang and jokes or humor as they translate poorly
- Have patients demonstrate what they have heard for instructions to confirm understanding (e.g. teach-back method)
- Disposition
- Discharge Instructions in patient's own language (and their reading level) when available
- Consider note to pharmacist in Electronic Prescriptions regarding patient's preferred language
IV. Resources: Translation and Interpreter Services (including Telephone Interpreter Services)
- American Translators Association
- Web-based Interpreter
- Google Language Tools
V. Resources: Cross-Cultural Tools
- UW-Harborview Ethnomed Site
- Hispanic Health
- Cross Cultural Healthcare Program