Health Care Providers:  How to Evaluate Interpreters


Introduction

Clear and unfettered communication is a vital first step in establishing an effective and safe provider—patient relationship.

How many of you have experienced a situation where you ask a patient a question through an interpreter.  The interpreter and patient seem to go back and forth for quite some time, finally, the interpreter says, “yes (or no).”

This situation creates a dilemma for the health care provider, AND for the patient!  You, the provider did not understand what just took place, and the patient is not sure if the interpreter accurately represented what you just asked.  You also can not effectively evaluate the interpreter or the communication process.


Sub-Specialization

At this time, nationally, there is only a sub-specialization of a Special Certificate: Legal (SC:L) for court interpreters.  There is no certification for medical interpreters.  This means that interpreters may be placed in the medical setting without the appropriate qualifications.  

If you or your organization uses an interpreting agency, how can you evaluate the quality of the interpreter you receive?


Agency Interpreter versus Medical Staff Interpreter

Medical Staff:
The ideal situation would be to have an interpreter or interpreters on “staff” at your office or hospital.  You can provide training, they spend time with you, they get to know your patients, and learn how you “do business.”  You also feel more comfortable with them, as you can monitor how they do their job.

Agency:
With an agency interpreter, unless they provide medical training to their staff and you understand how they train their interpreters (are health care providers involved in the training process?), you will not have control over the interpreters’ qualifications, or if they are trained to work in the medical setting.

With an agency, the agency will either have staff interpreters, contract independently with other interpreters, or some combination of the two.  Frequently, agencies charge a flat rate per hour for the interpreter(s) they send out, regardless of skill level.  However, they pay their contracted interpreter(s) differently based on skill and certification level.  Their staff interpreters are often paid a salary, with or without benefits.

Let’s say the agency charges $70/hour for their interpreters.  If they pay a staff interpreter about $15/hour (based on their salary), a “novice” interpreter $20/hour and an “advanced” interpreter $50/hour, they will get more of a “profit” by sending out a staff interpreter, then, the novice interpreter, then, the advanced interpreter.  While there are many agencies that operate ethically and appropriately for the situation, this needs to be researched.  There is a risk that with an agency, their incentive to send out a particular interpreter could be based on profit, not on matching the interpreter to the client or setting.  


The “Invisible” Interpreter or a Team Member?

Let us go back to the original situation above, where the interpreter provided a one-word answer to your question.

In many interpreter training programs, an interpreter is taught to be a “technician.”  They must simply relay information from one person to another.  This MIGHT work for some situations, but not for most.  The concept of the “ideal” interpreter as an “invisible” participant that simply “transmits information from one person to another” does not work well for the medical setting.

When the interpreter is “invisible,” the interpreter has a huge amount of power and control over communication.  However, as health care providers, ultimately, WE are held responsible for communication that does or does not happen.  We are taught to use the “teach back” method to ensure patient understanding.  

To get the “control” out of one person’s hands, namely, the interpreter, and back to the health care provider and patient communication process, we propose another method for effective communication.  With this method, all three team members (provider-interpreter-patient) are able to be involved in the process.


Effective Communication Means Teamwork!

In an interpreting situation, we feel that for effective communication, there needs to be transparency at all times during interpretation.

If the interpreter had explained to the provider and the patient the reason for the continued “back and forth” situation, you would have been able to quickly correct a misunderstanding, if that was the problem.  

As another example, if you, the health care provider ask your patient a question, even if the interpreter understands the medical term used, such as ‘myocardial infarction,’ they should make it clear to you—what they understand the term to mean—and to the patient—confirming the meaning of the word.  Now that each party understands the situation, the interpreting process becomes an effective one.  You and the client are aware of the communication “gap.”  

Likewise, if the interpreter notices that the Deaf or hard of hearing client did not understand the concept, the interpreter should inform you of the situation, so that all three of you can decide what to do next.

This process does not take as much time as people think it does!  A good interpreter is able to do this efficiently, with little impact on the time of the encounter.  This example is just one of many, but it demonstrates that an “invisible” interpreter or facilitator of communication and culture is not an effective communicator.  They truly need to be accepted as a critical part of the medical team.