Medical Interpreter

Care New England/SEIU 1199NE JATC

Rhode Island (SAA)

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Work Process Schedule

Work Process Content

On the Job Training

Anonymous

101

Skills

2.6K

OJT hours

Interpretation

1.2K

When possible, holds a pre-conference to find out the provider’s goals for the encounter and other relevant background information.
Introduces self to provider and patient as follows: -Gives name -Indicates language of interpretation -Checks on whether either provider or patient has worked with interpreter before -Asks if there are any questions about interpreter’s role -Answers any questions
Explains role briefly and succinctly to provider and patient emphasizing: -Goal of ensuring effective provider patient communication -Confidentiality -Accuracy and completeness (i.e. everything said by either will be transmitted) -Use of first person form, especially if provider and/or patient are unfamiliar with this
In the event that a pre-conference cannot be held and/or a full introduction made, at a minimum asks provider to state briefly the goal of the encounter and informs patient and provider that the interpreter is obliged to transmit everything that is said in the encounter to the other party and, therefore, that if either party wishes something to be kept in confidence from the other, it should not be said in the presence of the interpreter
Establishes and asserts the interpreter’s role from the beginning
Provides a clear and well-paced Introduction an is able to adjust the introduction in response to the demands of the situation
Is able to hear and see both patient and provider.
Can be seen and heard by both parties
Arranges spatial configuration to support direct communication between provider and patient
Respects the spatial and visual privacy of the patient when necessary (e.g. stands behind a screen during a physical exam), while maintaining, when possible and/or necessary, enough visual contact to “read the patient’s face”
When possible, speaks to the patient prior to the triadic encounter to assess the patient’s linguistic register and style (e.g. dialect, formality of speech etc.)
Preserves the register and style of language used in the source language when transmitting in the target language
When the issue arises, assesses potential areas of discomfort for the patient (e.g., gender or age of the interpreter) and discusses them with the patient
Is cognizant of body language and/or specific verbalization suggesting discomfort and: -Checks to identify the source of distress -Reassures the patient by providing information about credentials, professionalism, and the ethics of confidentiality -Explains the reality of the situation (e.g., perhaps only one interpreter is available) and tries to put the patient at ease -Offers options to address the discomfort, when available
Uses the mode that best enhances comprehension and least interrupts the speaker’s train of thought, given the demands of the situation
Uses the mode that best preserves accuracy
If the interpreter is competent in simultaneous mode, uses it when it is important that the speaker not be interrupted (e.g., psychiatric interview, periods of high emotion)
Can switch from one mode to the other as needed and can explain the reason for the switch, briefly and unobtrusively, if needed.
Uses modes of interpreting in which competence has been attained
Transmits message accurately, reexpressing the information conveyed in one language into its equivalent in the other language, so that the interpreted message has the potential for eliciting the same response as the original
Transmits message completely (i.e., includes denotative, connotative, and metanotative meaning, taking into account the context, content, function, affect, and register of theoriginal message
Asks for clarification or repetition of information and/or concepts she or he did not understand or did not completely hear
Effectively uses mnemonic devices (e.g. note taking, visualization, etc.) to aid retention of information and accuracy of interpretation
Can explain the ramifications of inaccurate interpreting
Suggests that the patient and provider address each other directly
Uses the first person (“I”) form as the standard, but can switch to the third person, when the first-person form or direct speech causes confusion or is culturally inappropriate
Succeeds in having patient and provider address each other directly
When necessary, cues provider and patient to return to direct communication
Picks up on verbal and nonverbal cues that may indicate the listener is confused or does not understand
Checks whether clarification is needed by the listener
If needed, asks the speaker to explain further or to say the same thing using different terminology
Asks for repetition if message is not understood or not heard, clarifying that it is due to the interpreter’s need
Asks for explanation or asks speaker to say the same thing using other terminology
Verifies the meaning the interpreter understood, especially in situations of possible ambiguity
Manages conversational turn taking so that only one person talks at a time (interpreter can interpret only one voice at a time)
Asks the speaker to pause, when necessary, in order to maintain accuracy and completeness to allow the other party to speak
Asks the speaker to pause in a manner that is least disruptive and most culturally appropriate
Manages the timing of interpretations so that neither party feels or is left out of the communication loop
Clearly indicates when speaking on her or his own behalf
Manages the flow of communication to enhance the patient-provider relationship
Appropriately addresses cultural issues and can assert interpreter’s role when necessary
Remains low profile when communication is going well and there is no reason to intervene
Keeps personal issues (feelings, biases, opinions) out of the triadic interview
Encourages direct communication between patient and provider
Respects and enhances each person’s primary sphere of ‘power’ or expertise (i.e., the patient as an expert on her or his own body with ultimate decision-making power over it; the provider’s medical expertise and power based on knowledge that the patient does not have; the interpreter’s expertise in understanding the two language systems and converting messages from one language to the other)
Can identify and discuss own personal values and beliefs that may create internal conflict in certain medical situations
Can clearly separate own personal values and beliefs from those of the other parties
Is able to withdraw from situations where strongly held personal values and beliefs may interfere with impartiality
Can acknowledge potential areas of conflict within self and articulate them prior to start of the interview especially where no other alternatives are available (e.g., be able to say, “I need you to know this topic may be difficult for me but I will try”)
Remains calm in stressful situations or when there is conflict
Acknowledges when there is conflict or tension between provider and patient
Assists the provider and patient in making conflicts or tensions explicit so that they can work them out between themselves
Lets the parties speak for themselves and does not take sides in the conflict
Identifies own mistakes, stops and corrects own mistakes
When mistakes are pointed out, isable to accept this information and takes steps to learn from the feedback
Encourages the provider to give appropriate instructions, making sure the patient is clear about next steps and has asked any questions she or he may still have
Checks with the patient on the need for an interpreter at any of the follow-up appointments
Observes “closure etiquette” by making closing remarks appropriate to each party
Encourages the provider to make the appropriate referrals
Understands or asks about the institution’s system of service delivery
Makes sure patient gets appointment with the appropriate resources and with an interpreter if needed
Finds out what the protocols are for each institution/health care setting in which work is performed
Knows and uses the protocols for each setting
Follows the documentation policies/ procedures/ guidelines of each institution’s interpreter office, which may include: -Keeping phone log -Documenting all follow-up activities, such as follow-up Appointments -Completing weekly invoice of hours worked -Submitting documentation to the appropriate person or filing documentation in the appropriate place and in a timely manner -Keeping interpreter’s office informed of exact location (i.e., where assigned)
Notifies patients of follow-up, canceled, or rescheduled appointments when requested
Reschedules appointments for patients when requested
When involved in follow-up telephone calls, conveys information back and forth, following established principles of accuracy and completeness

Cultural Interface

600

Observes the rules of cultural etiquette and/or institutional norms (e.g., regarding behavior and language suited to age, gender, hierarchy, status, level of acculturation) appropriate to each party
Adjusts behavior to observe the appropriate rules of cultural etiquette
Pays attention to verbal and nonverbal cues that may indicate implicit cultural content or culturally based miscommunication (e.g., responses that do not fit the transmitted message; display of discomfort or distress when certain topics are brought up)
Assesses the urgency/centrality of the issue, at that point in time in that particular exchange, to the goals and outcomes of the encounter: -Assesses the best time and method by which to raise the issue -Interjects and makes explicit to both parties what the problem might be -Prompts the provider and patient to search for clarity
Shares cultural information with both parties that may be relevant and may help clarify the problem (e.g., says, ‘It’s possible this is what is happening, because often people from … believe that …”)
In cases where ‘untranslatable’* terms are used, assists the speaker in developing an explanation that can be understood by the listener

Ethical Behavior

800

Can explain the boundaries and the meaning of confidentiality, and its implications and consequences
Knows and maintains the clinical parameters of information sharing, in keeping with the policies and procedures of the institution and/or team, for example: -Supervision -Patient conference/continuity of care meetings -Professional meetings, workshops, conferences, [taking responsibility for maintaining the anonymity of the parties by ensuring that any information shared at professional meetings does not contain identifying characteristics (e.g. hospital names, date of encounter, etc.) that can be attached to a specificindividual]
Knows how to respond to questions dealing with confidential matters that may be brought up in the community or health care setting
If privy to information regarding suicidal/homicidal intent, child abuse, or domestic violence, acts on the obligation to transmit such information in keeping with institutional policies, interpreting standards of practice, the code of ethics, and the law
Can explain the concepts of accuracy and completeness, and their implications and consequences
Is committed to transmitting accurately and completely the content and spirit of the original message into the other language without omitting, modifying, condensing, or adding
Is committed to monitoring her or his own interpreting performance
Has the moral fortitude to admit and correct own mistakes
Is aware of and able to identify personal biases and beliefs that may interfere with the ability to be impartial, and has the moral fortitude to withdraw if unable to be impartial
Withdraws or refrains from accepting any assignment where close personal or professional ties or strong personal beliefs may affect impartiality (including conflicts of interest), unless an emergency renders the service necessary
Focuses on the communication between provider and patient and refrains from interjecting personal issues, beliefs, opinions, or biases into the interview
Refrains from counseling or advising
Respects patient’s physical privacy, and maintains spatial/visual privacy of patient, as necessary
Respects patient’s personal/emotional privacy: -Refrains from asking personal probing questions outside the scope of interpreting tasks -Does not use the role of interpreter to influence a social relationship with the patient outside the interpreting encounter -Refrains from becoming personally involved in the patient’s life** ** In small, close-knit communities, it is often not possible for an interpreter to remain personally and socially uninvolved with patients. However, interpreters should always strive to maintain the ethical and professional standards of confidentiality and impartiality while in their role.
Can explain the meaning of professional distance, and its implications and consequences
Is able to balance empathy with the boundaries of the interpreter role
Shows care and concern for patient needs by facilitating the use of appropriate resources
Refrains from becoming personally involved
Does not create expectations in either party that the interpreter role cannot fulfill
Promotes patient self-sufficiency, taking into account the social context of the patient
Monitors own personal agenda and needs and is aware of transference and counter transference issues
Refrains from contact with the patient outside the scope of employment, avoiding personal benefit
Refrains from fulfilling any functions or services that are not part of the interpreter role
Knows competency limits and refrains from interpreting beyond her or his training, level of experience, and skills, unless these limitations are fully understood by the patient and provider and no other source of interpreting is available
Refrains from interpreting in situations where there may be a conflict of interest
Engages in ongoing professional development
On occasions where the interpreter feels strongly that either party’s behavior is affecting access to or quality of service, or compromising either party’s dignity, uses effective strategies to address the situation
If the problem persists, knows and uses institutional policies and procedures relevant to discrimination

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