Addressing the Language Barrier - Medical Interpreters

[Ashley Hay, BSN, RN, BSN, RN]

A language barrier can add even more complexity to the situation. However, ensuring proper translation between you and your patient is crucial to all involved in the conversation. It is imperative that the provider, patient, and caregiver are all able to understand what is being told to them as well as ask informed questions.Medical interpreters have a difficult job. They are responsible for actively listening, interpreting and relaying back medically complex information. According to an article from verywell.com, "Interpreters can work in hospitals, clinics, or medical offices, with the greatest demand being in urban areas where the population tends to be more diverse. They may also work in courtrooms, conferences, and other non-medical settings." Author Santiago adds, "medical interpreters may decrease the physician's malpractice liability and risk. Bridging the language gap can decrease the opportunities for medical mistakes to happen."

Several types of medical interpreter services and devices exist. Which one will work best for your patient's needs?

Types of Medical Interpreter Services/Devices

Live Interpreter

These are on-site/in-house interpreters. This is considered an ideal choice for interpretation as they can sit face-to-face to provide their services. This can sometimes help to comfort the patient, who is relaying their personal information to a third party. Unfortunately, this service typically does not have a large pool of interpreters. The patient may have to wait for an interpreter to become available and certain languages may not be available.

Double Phones

This can be a very efficient way for you and your patient to speak to each other seamlessly, despite not having an interpreter physically in the room. Both you and your patient each have a cellular phone. Once the call to the interpretation line is placed, you can both speak directly to each other through the interpreter, without having to pass one phone back and forth between you.

Telephone Hotline

Many hospitals have an interpreter hotline service available for use. If you do not have access to the double phone system noted above, the land-line phone can be passed between the two of you - or better yet, use speakerphone feature to include all caregivers on the conversation. Most of these telephone service lines offer 24/7 availability.

Video conferencing system

Some hospitals have a mobile tablet type system that allows for you to call into an interpreter service line with the added benefit of being able to see your interpreter. This can be the next best option if an in-house interpreter is unavailable or a more rarely spoken language is needed.

What's Not Ideal

Having friends, family members, or even other providers who aren't certified to translate medical terminology may sometimes seem like a quick fix to a simple problem. However, there is very little room for error when explaining complex medical terminology and many who are not certified may not be familiar with all terminology - especially in two languages. Some hospital systems have even developed policies/standards against using family members or other non-certified persons for translation.More information on medical interpreter certification can be found here.

General Tips When Working With a Translator

• Speak slowly and clearly
• Only speak 1-2 sentences at a time (allowing translator to capture and relay all necessary information)
• Avoid using slang or abbreviated terms
• Re-word sentences if needed for the interpreter (so that it can be best translated)
• Speak directly to the patient (not the interpreter - this may feel awkward at first but it helps to confer body language & facial expressions)

What are you experiences with using medical interpreters & devices?

References:

Overview of Medical Interpreters' Careers

The National Board of Certification for Medical Interpreters

[brillohead, ADN, RN]

We have the double-phone system and also a video system for sign language in my hospital.

IME, patients still prefer to use family/friends to translate, even when we've explained that it's not the best option.

We have a regular patient who is deaf-mute who prefers writing and "generic sign language" (pointing/gesturing) to using the video screen for ASL. I've had patients who speak Chinese, Burmese, and Spanish all prefer to use the family-and-friends method instead of the double-phone system. We chart the patient's refusal and just get on as best we can.

I do require the use of the phone system for signing an informed consent, however.

[Nalon1 RN/EMT-P, BSN, RN]

We recently got tablets with video interpreter services. It is awesome.

patients seem a lot more comfortable using the video service vs telephone. I like it more too, as do most staff.

Having the interpreter being able to see what is going on also helps them to translate, and helps with the sometimes awkward silent moments that happen, on the phone, they tend to ask "are you still there", vs with video, they can see what you are doing.

It is policy where I work that translation lines be used (and now have a place to specifically chart the interpreter name and ID #), even if family/patient refuses, we need the interpreter on when discussion medical items, even if family interprets. Since getting the video option though, I have not had any patients of families refuse.

[MunoRN, RN]

Situations that involve consenting to procedures, particularly high risk procedures or where a careful consideration of risks vs benefits on the part of the patient is required certainly need to be translated by certified medical translators.

However I strongly disagree that utilizing immediately available family members for routine translation is "not idea". Utilizing off-site translation services is time consuming and really isn't practical to use multiple times an hour, family members on the other hand can ensure that every single symptom, need to go to the bathroom, etc is communicated, which results in much better care.

[traumaRUs, MSN, APRN]

In the end, its always important to follow your facility's policy and procedures.

And...medical interpreters can provide a transcript of the conversation which can come in handy

[Leader25, ASN, BSN, RN]

We use pacific interpreters on phone for all patients,family is a no no.you record the number code of the service in the patients,chart,this protects you and they cant say they were never told or taught something.If staff wants to interpret they must pass an exam given by special dept.