Often, I hear complaints about good interpreters because they rigidly stick to their job description. This blog might get me in trouble with some of my colleagues, but I think it is worth a discussion.
Completing medical forms
There have been times that I have been told that a certain interpreter refused to help fill out a medical form. They stated that it isn’t in the job description. They would interpret what the forms say, but someone else must fill it out.
Basically, this is true. Certified healthcare interpreters must be proficient in consecutive, simultaneous and sight interpreting. Consecutive interpreting takes turns with the speaker while simultaneous is occurring while the other is speaking. Sight translation is the ability to read a form written in English in to the other language.
A professional interpreter might choose to avoid liability and refuse to fill out a form himself, and there is a foundation for that reasoning. However, I don’t have a problem filling out a form with the answers the patient gives me. I make sure he signs and initials everything and if there is a place that shows that I filled it out for him, I sign that part.
One suggestion though, if you are going to do this. Make sure you are a good speller and it is legible. Hey, maybe that’s another reason why some might refuse to do it as well!
Correcting the Physician
Professional interpreters are encouraged to request that the healthcare professional speak to the patient and look at them. I have heard complaints that the interpreter keeps reminding a doctor of this to the point where the doctor gets annoyed.
Interpreter ethics typically require the interpreter to speak in the first person as if he is the person he is interpreting for. The interpreter will ask the doctor and patient to look at and address each other directly. This is a way for respect to be shown. It would be rude to look at the interpreter and speak with him ignoring the patient.
I can’t tell you how many times I have explained this to the doctor only for him to forget and revert to bad habits. He will look at me and say, “Ask him how long he has been feeling that way.” Instead of reminding the doctor again, I simply look at the patient and ask him the question in the first person. Another tip that may be helpful is to look at the patient while the doctor speaks and look at the doctor while the patient speaks.
Ignoring the interpreter and speaking directly to the patient can be a difficult habit to develop for some healthcare professionals. My purpose as a healthcare interpreter is to serve as a conduit of information not to be an annoying stickler for the rules.
Dealing with the Pharmacy
I often get request from adjusters and case managers to accompany the patient to the pharmacy and even provide them with the workers’ comp. information needed to process the prescription. This is another added service I often perform. Of course, my clock continues so I am compensated for it.
Some interpreters feel that dealing with the pharmacy goes beyond interpreting and will refuse to do it. Perhaps the reason I choose to accept this additional assignment is that I have seen patients return home after surgery unable to obtain pain medication for a couple of days. They suffer in agony. I know this is easily avoidable with just a little assistance.
Transportation
Hospital interpreters typically enter the room when the healthcare professional enters, and they exit when they exit. Video healthcare interpreters do the same. This is to limit contact with the patient. They do this to avoid becoming emotionally biased by the patient’s tragic circumstances.
However, it is very common in workers comp for the interpreter to also provide transport or non-emergency taxi service for the patient. This is another service that I provide as well. Although ethics require interpreters to be unbiased, there is no specific ethical guideline that says we cannot also transport a patient. The hospitals limit contact with the patient in that way because that is how they interpret the ethical guidelines (and it may also be hospital policy).
Workers’ comp. interpreters have a challenge in this area because they likely spend so much time with the patient. The risk of becoming unbiased is real. So, we must take many steps, including constant reminders and ethical considerations to stay professional.
These are the top four services that don’t fit a professional interpreters job description that I offer but don’t blame anyone for refusing to do them. I enjoyed writing this so much that I just might have enough to do a part two on this subject.
I agree with you 100%. You have to enable our patients to get onto the road to wellness and sometimes interpreting is not enough. Bravo! I applaud you for going outside of comfort zone. Thank you for doing so.
Laura Onofre, CHI
Do you not mean “the risk of becoming BIASED”?
I would be fired if I did many of the things you described in your blog l. My hospital has a very strict job description for our healthcare interpreters.
Ethical and attachment issues aside, I can’t even begin to fathom liability issues that would ensue if one transported a patient and ended up in an accident. Personal car insurance would consider this a commercial activity and not cover either your or your patient’s accident-related medical bills.
Pharmacies have to provide interpreting and translation services because they accept federal funds and they do it via phone.
As a far as forms, I believe that different hospitals and clinics have their own and it is important to follow them.
I totally understand what you are saying. If I were a hospital interpreter, I would do things differently. Workers comp is a very different world. Interestingly, the ethical guidelines does not follow specific rules. Hospitals develop guidelines based on the hospital needs and the ethical code. In my opinion they tend to follow the very best in standards.
My company provides transportation, but I also spend a lot of money on commercial auto insurance and my workers comp rates are higher due to providing transportation.
I agree that pharmacies should provide interpreters, but unfortunately this isn’t the case with many of them. For this reason many of the insurance companies pay us for the additional service of providing an interpreter to insure the patient gets his meds.
When it comes to forms, you are right, most hospitals and hospital affiliated clinics are good. However, I travel all over the state and you might be shocked by how many medical locations only have English forms.
I can say this, workers comp is like the wild west for medical interpreters. We make an effort to regularly provide training for all our subs. that training includes a ton of discussion on ethics and we often role play common scenarios that come up. As a business owner I have to figure out a way to fill a need for my customers and provide any value added service while at the same time maintain the ethical standards.
Thank you for your comments and I agree with them for your specific setting.
Hi JAlfonso,
I admire your goodwill on sharing your opinions and the services you offer to patients. However, some of your practices violate some of our Code of Ethics and Standards of Practice. These Code of Ethics and Standards of Practice were well-researched and developed by academics and experts in our profession, and while I agree these are more like guidelines than concrete rules, I still view them as a solid foundation to adhere to.
Completing Medical Forms
As certified healthcare interpreters know, we are tested for sight translation. The National Council on Interpreting in Health Care (NCIHC) published an entire segment on this very subject. Basically it states interpreters are expected to know the basics of translation, and capable of sight translating forms, except for legal documents or consent forms (which need to be professionally translated by a professional translator).
When it comes to assisting patients fill out forms, we as interpreters are able to sight translate the questions, and allow the patient to write down their answers. If the answer requires a written sentence, the patient may write down the answer in their language, and the interpreter translate the answer on a separate sheet, referencing the question, and adding a footnote stating the interpreter rendered the translation.
It is strongly advisable to write down the answers for the patient, as doing so is stepping outside of our Role Boundaries, which is one of our Code of Ethics. Furthermore, the risk of liability increases when answering for the patient in written form. We should keep in mind the answers belong to the patient, and allow the patient to participate in their health process as if there wasn’t a language barrier. We as interpreters are there to remove the language barrier.
If the patient has a question about the form, the interpreter can accompany the patient with a staff member to ask the question, and interpret accordingly.
You can read more about NCIHC on Sight Translation here https://www.ncihc.org/assets/documents/publications/Translation_Guidelines_for_Interpreters_FINAL042709.pdf
Correcting the Physician
The pre-session is critical in every encounter, disclosing to parties they should direct their conversation to each other, and not the interpreter, as the interpreter is NOT part of the conversation. I understand many times speakers overlook this aspect, and include the interpreter in the conversation. Some individuals completely refuse to speak to the other party directly. Instead of trying to force parties by directing to each other with frequent reminders, there are less invasive and effect tactics to accomplish that with body language, positioning, and continuing to interpret in first person, to the point the parties will naturally begin to direct to each other.
The end goal is to facilitate communication, not to hinder it.
Dealing with the Pharmacy
I understand staff expectations of the interpreters is to go beyond the scope of their duties, such as accompany patients to the pharmacy and assist in accomplishing such tasks. Interpreters are expected to respect Role Boundaries, and never act as an adviser, patient aid, relative, and/or navigator.
If a patient doesn’t know where the pharmacy is or has a question, instead of answering the question (as it will be a violation to our Role Boundaries and Impartiality), we can be proactive in our approach. Instead of answering “Sorry I am only the interpreter and cannot help you”, we may offer a more effective way to proceed by saying “Let’s find a staff member who can answer your question, and I’ll interpret for you.”
Accompany patients to the proper departments is within our limits, if is an extension of an interpreted encounter. If we are accompanying patients to pharmacy, we proceed as interpreters by interpreting for the patient and the pharmacy staff, just as any encounter, and not by explaining or speaking for the patient at the pharmacy counter. Again, we are there as conduits to remove the language barrier.
Transportation
The reason interpreters exit rooms when providers exit is to maintain Impartiality and Role Boundaries, which are two of our Code of Ethics. Is a good idea on brushing up on these two ethics to understand why is crucial to maintain these two roles, which is accomplished by exiting the room when providers do. It may seem rude to leave the patient alone, but a simple comment to the patient such as “excuse me, I’ll return when a provider does” conveys politeness.
Offering transportation services is definitely outside our scope, as it violates Role Boundaries (patients now perceive us as driver, which we are not), Impartiality (having no one to interpret to, we are now inclined to start a conversation with the patient) and Professionalism (patients may now perceive interpreters are laborers rather than professionals). Transporting patients also creates a huge risk of liability in case of an unforeseen accident. I appreciate your business of offering additional services to achieve a competitive edge, which there is nothing wrong with that, but must be rendered appropriately where interpreters are not assigned as drivers if hired to interpret for the client. Hiring drivers would be the best solution for offering transportation services for your clients, instead of using interpreters to render services outside of their scope.
I think truly understanding the”why we must follow” our Code of Ethics and Standards of Practice will yield better outcomes to challenges without compromising our goal as communication conduits and diminish the risks from practices outside our scope as interpreters.
Again I appreciate sharing your opinions on these topics, as it creates for a healthy discussion among colleagues.
Thank you for putting the human touch in interpreting. According to the IMIA Standards of Practice there are many tasks interpreters have beyond interpreting. I strongly advise all interpreters to reread it and to evaluate their practice from the perspective of being communication facilitators versus conduits. The IMIA standards does not prescribe to the conduit model because early on, back in the 80s, it saw that medical interpreting was a practice profession, not a technical one. The IMIA Standard was initially developed by doing a job task analysis, so it is grounded in the practice, and not theories or rules. Research has confirmed that Medical interpreters facilitate communication, requiring the act of interpreting along with many other behaviors, responsibilities, skills and tasks. Limiting the interpreter to a conduit model is like saying a teacher is stepping out of his/her role when they are not ‘teaching’. As we all know, the teaching profession requires many other tasks and responsibilities beyond the act of teaching.