Translators and interpreters face a common problem: lack of clarity in the source message. Interpreters have a standard formula for addressing this: “the interpreter requests clarification”. Although translators deal with the same issue, a standard formula is missing. We deal with acronyms that are company-specific, missing terms, etc. and clarify them with clients over email. In the middle of email chains, however, it is easy to lose track of the changes and of our role. We need a better, more rigorous, method of recording these conversations.
Issues to consider when filling out forms
a. Medical providers need the medical intake forms in a language they can understand. Typically, medical interpreters have been involved in this process,
b. Medical interpreters have a limited scope of practice. They are not expected to give medical advice (explain the meaning of medical terms, which can be construed as giving medical advice), or have side conversations (this can happen often while filling out forms).
The first things the provider notices are your timeliness and your appearance.
Check in with the provider on time, but…
Never check in early to any appointment. Go elsewhere until 10 min. before the appointment and then check in. Hospitals/clinics do not want to pay for checked in time earlier than 10 min. before an appointment.
Interaction with the LEP:
Once you check in: If the LEP is there, introduce yourself very briefly and keep a professional distance, with a courteous demeanor.
How did I start interpreting?
Years ago, I was on a ship. I was thoroughly bilingual in all four skills: reading, writing, listening and speaking. I had gone to med school for a couple of years, gone to secretarial school for a year, graduated from college in Argentina as an elementary school teacher, and I had taken the British Proficiency class when I was 15. After that, I had been a member of an Anglo-Argentine drama group: the Suburban Players.
These are facts. I had the linguistic proficiency. Then I joined a missionary ship, the MV Logos. I was there in Tierra del Fuego, when it shipwrecked. But I spent 15 months going around Latin America interpreting for the ship community, a group of 140 people from 40 countries from all continents. They needed “translators”. That really meant both things: translators and interpreters. So I joined. I worked 40 hours a week in the purser’s office, helping with customs and immigration paperwork in every country in Latin America. In my free time, I interpreted at public events on a daily basis. Pretty soon, I was one of the “preferred interpreters” and was busy seven evenings a week besides doing my day job.
As the interpreting market diversifies, I get questions from people every day.
First of all, you can screen clients before making a commitment. For example, the ATA doesn’t accredit companies. It certifies translators, not interpreters. Advertising claims using the ATA name inaccurately are meant to mislead people. Be careful. Check www.paymentpractices.net, and check the Blue Board on www.proz.com to see what people say about their experience working with a company.
You should also ask questions before the appointment. I use the following worksheets for interpreting and translation projects. They are based on the ASTM Standards for Interpreting and Translation. I developed them to avoid a lot of the problems listed below, and others I am not listing.
I have been asked to do some remarkably unusual things at interpreting assignments. Here are some examples of decisions I have actually had to make. We usually don’t know about them until they happen.
Problem: Interpret for someone in a waiting room, before going in to the doctor’s office, so the patient could sign a HIPAA consent form for another person to be present at his appointments. Should I do this? Continue reading
The Interpreter is prepared for all assignments
The interpreter discloses skill limitations with respect to particular assignments
What information do interpreters need? How is it possible disclose skill limitations to decline an appointment, for example, without knowing the nature of an assignment ahead of time?
The following chart details some logistical and subject matter issues the interpreter needs to know before arriving at the appointment.
As interpreters, we are constantly learning. We learn from every encounter we have every day. However, it is so easy to get carried away and discuss things in a subjective way! As interpreters, we interpret messages delivered from one person to another, and the interpersonal issues sometimes…
Our ASL (American Sign Language) colleagues have developed a system called Demand-Control Schema, and they have meetings called “Supervision” to discuss cases. In these “Supervisions” they discuss encounters looking at the Demands (the challenges of the situation) and the controls (the things the interpreter could have done) in non-judgmental ways.
This presentation is a very basic outline of the DC-S approach, which helps maintain confidentiality as we share information in the interest of learning from each other.
For more information on DC-S, see the Demand Control Schema website!
Those interested in signing up for the 10-week class, receiving articles, or other information, can sign up for their mailing list at this link.
According to the Cultural and Linguistic Appropriate Services Standards, published by the Office of Minority Health, US Department of Health and Human Services, in April of 2013, Standard 7 says: Ensure the competence of individuals providing language assistance.
The skills listed are:
- Active listening: Interpreters must listen more intensely than anyone else, in order to faithfully render the message.
- Message conversion: This skill involves analysis of the message and how to find equivalent ways to express it in the target language. High levels of language proficiency in the source and target languages are a prerequisite for this skill!
- Clear and understandable speech delivery: To develop this skill, interpreters may need to work outside of class, listen to each other for clarity, focus on diction, critique each other’s clarity of speech, etc.
- Medical terminology: Anatomy, physiology, diagnosis, prevention, treatment, management of illness and disease. Participants need to develop research skills in their non-English language to see how these topics are discussed in that language, beyond the simple use of a bilingual dictionary. Participants will be able to develop their own terminology database, write their own short articles on medical topics in both languages, and give short presentations on medical topics in both languages on short notice.
- Sociolinguistics: The following areas are very complex and a short class can only introduce these topics.
- Familiarity with regionalisms and slang in both languages
- Ability to communicate at various levels of formality
- Understanding of colloquialisms and idiomatic expressions in all working languages
- Key concepts in health care: confidentiality, informed consent, patients’ rights. Legal concepts are beyond the scope of what a 64-hour class can cover in depth, but this course does provide an introduction to these topics.
In a 64-hour course, we must assume that students come with strong language proficiency. In class, we will be able to teach problem-solving strategies for all these areas, but will not be able to teach all the answers to any of them! A successful class will be one where students leave with the tools to continue learning with partners and colleagues, ready to continue studying in future workshops.
These concepts are introduced through lectures, readings, and occasionally guest speakers, student presentations and videos. They are reinforced with homework, role-plays and class discussions.
Interpreting role-playing is practiced in every session! Students gradually become confident enough to evaluate each other and interpret several sentences at a time, consecutively. Students ask questions by email and in class. Some of the discussions lead to blog posts! Sometimes the students write blog posts.
The Minnesota Department of Health gives these recommendations for working with a healthcare interpreter.
As professional interpreters, we often introduce ourselves telling the provider… “and please speak directly to each other. I am simply here to be your voice in the other person’s language, saying exactly what you say.”
Often, doctors inadvertently lapse into this type of conversation…
Dr: Please tell the patient to sit down.
Interpreter: The doctor just asked you to sit down.
[Patient sits down.]
Doctor: Please ask the patient why she came.
Interpreter: The doctor would like to know why you are here.
Patient: Interpreter, what do you think I should tell the doctor? I don’t really know how to explain this…
Now, picture this conversation:
Doctor: Mary, good afternoon.
Interpreter: Good afternoon, Mary.
Mary: Good afternoon, Doctor.
Interpreter: Good afternoon, Doctor.
Doctor: Please sit down, Mary.
Interpreter: Please sit down, Mary.
[Mary sits down.]
Doctor: What brings you here today, Mary?
Interpreter: What brings you here today, Mary?
Mary: Well, Doctor, I was walking down the street, and there was a patch of mud. I slipped, and I think I might have broken something. It hurts a lot. I have had a lot of trouble walking…
Interpreter: Well, Doctor, I was walking down the street, and there was a patch of mud. I slipped, and I think I might have broken something. It hurts a lot. I have had a lot of trouble walking…
What differences do we see in these conversations?
- The interpreter is much more unobtrusive in the second one. The interpreter can stay out of side conversations effortlessly.
- The message conversion is much simpler, and therefore much more accurate!
- The patient is much more respected. The patient is treated just the same way as any other English-speaking patient. This helps the patient participate in his/her own decisions and avoid leaning on the interpreter for decision-making and security.
To encourage this direct communication, interpreters may use a variety of strategies:
- Gestures, to remind the parties to communicate directly with each other
- Visually positioning themselves so they are in the line of sight to encourage direct communication between the parties: people address the person they are looking at, so interpreters position themselves in a way to avoid neck strain on the part of the speakers.
- Maintaining the register and the tone of voice, so the conversation is a true conversation
- Interrupting the conversation as little as possible: using note-taking to allow the parties to express as complete of a thought as possible before interrupting the flow of their thinking.
- Wearing clothing that does not attract attention to the interpreter.
- Stepping out of the room every time the provider steps out of the room: when there is nobody who does not speak a language the patient does not understand, the interpreter is not needed. These may be good moments for the interpreter to clarify issues with the provider, if needed.
As interpreters, our goal is, as the Oregon Court Interpreters say, “to put the non-English speaker on the same footing as an English speaker”.
According to CLAS Standard 5, one of the purposes of language assistance is
To help individuals understand their care and service options and participate in decisions regarding their health and health care
The Oregon Law states that interpreters must follow the Standards of Practice of the National Council for Health Care Interpreters. On page 13, Standard of Practice #12 states:
The Interpreter promotes direct communication among all parties in the encounter.
For example, an interpreter may tell the patient and provider to address each other, rather than the interpreter.
Related ethical principle: Interpreters treat all parties with respect.
First of all, why test for language proficiency?
We are not generally reliable judges of our own abilities. This Wikipedia article shows that many studies reveal that we have a tendency to overestimate ourselves. The Oregon Healthcare Interpreters law requires that Qualified interpreters have proof of language proficiency. The ACTFL exam is one way to determine that.
Therefore, judging our own skills in our use of language is very unlikely to be accurate. However, some tasks must be carried out by people with proven skills. For example, if interpreters lack the necessary linguistic ability, the risk of misinterpretations which would result in potential misdiagnosis is very high.
Interpreting and translation involve more than language proficiency! A language proficiency test is not an interpreting certification! It takes more than language proficiency to be a translator or an interpreter. However, if we can’t speak in Spanish, we can’t interpret into Spanish. And if we can’t write in Spanish, we can’t translate into Spanish. These tests do not cover all the issues related to translation. They do NOT cover the skills involved in transferring a message accurately from one language to another so the message has the same meaning in the target language. However, language proficiency is a foundational skill.
The ILR (Interagency Language Roundtable) developed a 5 point scale to evaluate language proficiency. The ILR is a collaborative effort of Federal, academic and NGO language specialists. Each skill level is designed to evaluate the practical abilities of a person at that level. The ACTFL (American Council on the Teaching of Foreign Languages) adapted this scale for use in academic settings and the two organizations currently work together to ensure that the two systems are complementary.
Language skills can be classified as follows:
The ILR also has a scale for translation and another one for interpreting. However, the ACTFL does not have tests for these skills.
A spoken language interpreter hears a message in one language (L1) and accurately and faithfully renders it in another language (L2). In a dialog setting, such as a doctor’s office, a meeting with a teacher, an interview, or a deposition, the interpreter must have very high skills in both listening and speaking in both languages: L1 and L2.
Interpreters are also required to perform sight translation: read a document in L1 and render it orally in L2. Therefore, their reading skills are important.
Translators, on the other hand, take a written message in L1 and deliver a written rendition of that message in L2. Therefore, a translator must have very strong skills in reading for L1 and in writing for L2. The ILR has links for self assessment of these skills on this page.
Learn more about the ACTFL scale here.
Language Testing International (LTI) is the Language Proficiency testing center endorsed by the ACTFL. The following are links to the ACTFL demo tests for these skills.
- Oral Proficiency interview (tests speaking) (by computer): OPIc: http://opicdemo.actfltesting.org
- Listening Proficiency Test: http://lptdemo.actfltesting.org
- Written Proficiency Test: http://wptdemo.actfltesting.org
- Reading Proficiency Test: http://rptdemo.actfltesting.org
This chart compares the ILR and ACTFL scales, with brief definitions, and lists the levels requried for interpreters in different fields.
The “paperwork” end of the testing process with LTI is:
Computer-based OPI: Can be taken independently by logging in to https://www.profluentplus.com/ and clicking on the Get Certified button. You will pay for it with your own credit card, and continue the process independently. About a week later, you can log in to the system and get your score.
All other tests have to be administered through someone with a client account at LTI. The process for the client is:
- The account owner (AO) sends a request to LTI and chooses a proctor. The AO has to provide the following information:
- Testee’s name and email
- Proctor’s name and email. The proctor may be the Account Owner or some other person designated by the AO. The proctor must be someone who is not related to the testee. This could be a supervisor at work, a teacher at school, etc.
- LTI sends the AO the information about the scheduling, and the AO communicates with the proctor and the testee.
- For the telephonic OPI, which requires a live tester from LTI, the AO must choose two three hour blocks of time, because LTI has to see when a live tester is available.
- For computer generated tests (all others), the test is scheduled instantly and must be completed within two weeks of its creation.
- Results: LTI sends the results to the Account Owner, who then forwards them to the testee. This can take a week.
Payment: the AO is responsible for payment to LTI for all tests except the OPIc (computer generated OPI).
Medical providers are required to have proof that those who work with them have HIPAA training. The Department of Health and Human Services has published a summary of HIPAA.
Interpreters are Business Associates under HIPAA. I believe that voluntary compliance will help interpreters demonstrate that they are proactive about complying with HIPAA requirements and will also help interpreters understand the legal boundaries of the information they can share.
The HIPAA Group, Inc. has been in business for more than 12 years and serves hundreds of universities and thousands of healthcare entities and business associates. This is a link to their Compliance Guide for Business Associates and Covered Entities.
This is a link to the course description for the online course for Business Associates, which applies to medical interpreters. This is the link to register. The cost is $25 and it takes about an hour to complete it. They issue a certificate of successful completion immediately, online.
Students have told me that medical providers object to the use of notepads in the interpreting session. I have spoken to my neighbor, a physical therapist, and she told me that the HIPAA regulations are becoming more and more stringent. Medical offices are continually watching out for potential leaks of protected information.
However, interpreters need to be able to use note taking to ensure accuracy and completeness. In court interpreting, specifically in a deposition, attorneys have the same concern. The following solution has always been accepted by the providers I have worked with, and my neighbor said it would be acceptable to her as well.
1. Walk into the session with your notepad and pen in hand, ready to use them. Do not wait until the session is underway to get them out of your bag!
2. In your introduction, introduce your notepad. “As an interpreter, I am committed to providing an accurate and complete rendition of your message. To ensure that, I use my notepad. I am also committed to patient confidentiality. To ensure that, I always tear the used pages out of my notepad at the end of the session and give them to the provider before I leave the room.”
3. At the end of the session, give the provider the notes, even if there is almost nothing on the page. If they ask what to do with them, say, “My professional protocol is to give you the notes from the interpreter session so you can dispose of them in a manner consistent with HIPAA protocols. This way we avoid spillage of confidential information.”
If you follow these steps, you should not have any problems with the use of a notepad. Make sure the notepad you use has no extra information. In other words, your interpreting notepad only has blank pages. You can use another notebook to take notes you have to keep. Your working notebook, for notes you have to keep, never comes out of your bag during the interpreting session.