The Function of Medical Interpreters

1. Medical interpreters as a ‘conduit’

The care settings where medical interpreters primarily work with diverse language speaking backgrounds are clinics, hospitals, nursing homes, physician’s offices, rehabilitation facilities, and mental health clinics. They are known to act as conduits between medical professionals and patients by listening to what the professionals need to communicate and orally carrying out the translation of information into the native language of the patient. The information that is to be communicated has to be layman’s terms so that patients can have a proper understanding of what is being told to him (Avalos, Pennington and Osterberg 2013).  According to Flores et al. (2012) conduit refers to a channel through which something is conveyed. In the medical field, the role of conduit involves acting as the medium for saying what one party has to express to the other party. This is the basic role of the medical interpreter. He is the one who speaks in an exact manner what the medical professionals have to say in other languages that the patients are acquainted with. As a conduit, medical interpreters become the voice of the care providers as well as the patient. It is to be noted that the most recommended role of a medical interpreter is that of a conduit. The interpreter has to listen to the speaker and understand the information that is being communicated, before conveying it as close to the speaker’s register as possible. In this primary role, the interpreter function as a bridge, as he communicates by sticking to the words and its content. As stated by Heish (2006) “It is important to note that often these patients not only need interpreters to help them communicate with physicians, they also need interpreters to help them to communicate with nurses and staff, and to help them get around in the hospital.” 

1. Medical interpreters as passive participants

There if often a lack of active participation in the communication taking place between the two parties. This implies that the interpreter is not supposed to put forward any of his own opinions and thoughts while communicating the piece of information. This is referred to as passive participation (Larrison et al. 2010). The message being transmitted needs to be conveyed as and how expressed by the care provider and no changes are to be made in any stage of communication. This might be crucial in the light of completeness and accuracy of the messages conveyed. This eliminates chances of transmitting erroneous messages, the addition of new information and omission of critical information. The nature of the original message is not drastically changed by any means (Butow et al. 2012). According to Okrainec et al. (2014), professional medical interpreters have the suitable training for playing the default role, that is the conduit model, that is known for adopting a neutral and passive presence as the interpreter faithfully transfers the information from one language to other. Interpreters ave the belief that the role they play requires them to be emotionless, and detached from any emotional thoughts, and they are to avoid any form of interaction with others while executing their role. As passive participants, they would not need to pursue issues diagnostically relevant. Rejection of information offerings of the patient is common. As stated by Heish et al. (2012) “Interpreter-as-conduit has been a prevalent ideology that sets the ethical standard for medical interpreters. Interpreters are expected to serve a neutral, faithful, and passive role in provider-patient interactions.”

1. Medical interpreters in terms of the flow of communication

Passive Participation of Medical Interpreters

The value of referring to medical interpreters to promote communication between patient and healthcare professional is discussed in numerous discussion. Juckett and Unger (2014) argue that the applicability of interpreters in the present medical domain, in contrast to merely permitting the exchange of information, is essential as they need to give attention to the successful flow of information. It is the medical interpreter who is responsible for communicating the needs and responses of both the parties in an efficient manner. What is vital in this regard is that there has to be a smooth flow of information taking place, that is of prime importance. Poor flow of communication is the cause of misunderstandings which are not at all wanted in the medical field. This is because improper communication flow leads to misdiagnosis of a condition, incorrect prescription and miscommunication of the complexity and severity of a medical issue. As stated by VanderWielen et al. (2014), for ensuring that data interpretation is correct, any form of bias is to be eliminated, and specialised knowledge is to be applied by the professionals.  Interpreters are required to demonstrate skilful interventions so that there is no interference with the flow of communication in a triadic medical setting. Hsieh (2011) opines that medical interpreters are to manage the flow of communication for preserving completeness and accuracy and building and rapport between patient and provider. They also need to turn their attention to the dynamics of the interpersonal interaction between provider and patient, such as arising conflicts and tensions. They are to provide assistance in establishing a communication process.

1. Medical interpreters as active participants

Kai, Beavan and Faull (2011) believe that patients in a clinical settings have a different perception of the medical interpreters in comparison to what the professionals perceive of themselves, whom they consider as an integral part of their care process. As per the authors, the theory of bilingual health communication presents that for the patients the communication done through the interpreters is effective and appropriate, thereby giving them the status of active participants. For the patients, they depend to a large extent on the interpreters for conveying their feelings to the healthcare professionals. Additionally, to demonstrating interpreters as active participants in provider-patient interactions, it can be theorised that communicative goals of the patients compel the interpreters to speak for the patients and advocate for their needs and rights. Most importantly, medical interpreters act as the stage managers, determining the stages for other participants, that is other healthcare providers, and managing the stages to evade conflicts between patients and professionals. In words of Cross and Bloomer (2010) an interpreted conversation can be correctly attributed as a “triadic,” i.e., the interpreter is an active participant in a three-party conversation. The active participation of the interpreters might help the patients so that they can understand technical information or any other form of specialised information. Further, interpreters can provide the patients with additional information and second opinions regarding their interventions. Furthermore, they have the potential to shorten the communicative exchange when engaged in a direct communication with the medical professionals. As opined by Sleptsova (2014) “Patients, in general, consider the availability and the quality of interpreting services as very important; the use of the interpreter and the perceived quality of the interpreter’s translation are strongly associated with the quality of care overall”.

1. Medical interpreters as educators

Active Participation of Medical Interpreters

Though the function of the medical interpreter is to allow communication between the service provider and the patient, the nature of participation and involvement of the individual in this process has always been under speculation and debate. For patients admitted at health care settings where the primary language of communication is dissimilar to what the patient is acquainted to, it is the medical interpreter who is relied upon for educating them about the health complications they are facing and the interventions that they be suitable for achieving the desired health outcomes. They are the concerned entities who are committed to foster a culturally competent interpretation of medical information. In addition to solely transferring information, patients are presented with a safe and secured care environment when interpreters take up initiatives to broaden their duties and educate the care consumers on different aspects related to health care (Duncan and Murray 2012). Patients, out of their emotional needs, believe that the goal of interpreters would also encompass educating the patient about the building process of their care process or probably a diagnosed disease of which there is little or no information given before to the patient. For example, a patient suffering from diabetes can be educated about what lifestyle changes can be brought about, what health complications are to be checked for and what dietary requirements are prominent. Changes in health condition can be identified by the interpreters under certain conditions. Patients might want to engage in a discussion about the main goals and values around the quality of life (Burnard 2013).

References 

Avalos, O.H., Pennington, K. and Osterberg, L., 2013. Revolutionizing volunteer interpreter services: an evaluation of an innovative medical interpreter education program. Journal of general internal medicine, 28(12), p.1589.

Burnard, P. (2013). Effective communication skills for health professionals. Springer Science.

Butow, P.N., Lobb, E., Jefford, M., Goldstein, D., Eisenbruch, M., Girgis, A., King, M., Sze, M., Aldridge, L. and Schofield, P., 2012. A bridge between cultures: interpreters’ perspectives of consultations with migrant oncology patients. Supportive Care in Cancer, 20(2), pp.235-244.

Cross, W.M. and Bloomer, M.J., 2010. Extending boundaries: clinical communication with culturally and linguistically diverse mental health clients and carers. International journal of mental health nursing, 19(4), pp.268-277.

Duncan, E.A. and Murray, J., 2012. The barriers and facilitators to routine outcome measurement by allied health professionals in practice: a systematic review. BMC health services research, 12(1), p.96.

Flores, G., Abreu, M., Barone, C.P., Bachur, R. and Lin, H., 2012. Errors of medical interpretation and their potential clinical consequences: a comparison of professional versus ad hoc versus no interpreters. Annals of emergency medicine, 60(5), pp.545-553.

Hsieh, E. and Kramer, E.M., 2012. Medical interpreters as tools: dangers and challenges in the utilitarian approach to interpreters’ roles and functions. Patient education and counseling, 89(1), pp.158-162.

Hsieh, E., 2006. Understanding medical interpreters: Reconceptualizing bilingual health communication. Health communication, 20(2), pp.177-186.

Hsieh, E., 2011. Health literacy and patient empowerment: The role of medical interpreters in bilingual health communication. In L. Cooley (Chair), Voices of Health Communication: Provider Perspectives. Paper session presented at the 97th annual meeting of the National Communication Association, New Orleans, LA.

Juckett, G. and Unger, K., 2014. Appropriate use of medical interpreters. American family physician, 90(7).

Kai, J., Beavan, J. and Faull, C., 2011. Challenges of mediated communication, disclosure and patient autonomy in cross-cultural cancer care. British Journal of Cancer, 105(7), pp.918-924.

Larrison, C.R., Velez-Ortiz, D., Hernandez, P.M., Piedra, L.M. and Goldberg, A., 2010. Brokering language and culture: can ad hoc interpreters fill the language service gap at community health centers?. Social work in public health, 25(3-4), pp.387-407.

Okrainec, K., Miller, M., Holcroft, C., Boivin, J.F. and Greenaway, C., 2014. Assessing the need for a medical interpreter: are all questions created equal?. Journal of Immigrant and Minority Health, 16(4), p.756.

Sleptsova M., Hofer G., Morna G., and Langewitz W., 2014. The Role of the Health Care Interpreter in a Clinical Setting—A Narrative Review, Journal of Community Health Nursing, 31(3), pp.167-184.

VanderWielen, L.M., Enurah, A.S., Rho, H.Y., Nagarkatti-Gude, D.R., Michelsen-King, P., Crossman, S.H. and Vanderbilt, A.A., 2014. Medical interpreters: improvements to address access, equity, and quality of care for limited-English-proficient patients. Academic Medicine, 89(10), pp.1324-1327.