I wrote this article after reading the PubMed article ”Training Healthcare Professionals To Work With Interpreters” by Aarti Bansal, which pointed out the issue of inadequate provision of training to providers on how to work with interpreters. Also, I asked my remote interpreting colleagues ”What would you tell a provider if you had the opportunity to coach them on remote medical interpretation?”. Interestingly, many on-demand remote interpreters stated that their main concern was ”providers not treating remote interpreters like people.”
This article summarizes the advice of my colleagues and my own to help providers not only communicate more effectively and collaboratively with the interpreter but also provide a better service to their patients with Limited English Proficiency (LEP).
1. Let the telephone or video remote interpreter introduce themself at the beginning of the call
The beginning of the call is an important part of the session because the interpreter will introduce themself and briefly instruct the patient and the provider on how to communicate through the interpreter. This is called a presession.
During the presession, please provide the following information to the interpreter:
1) Your name
2) The name of the patient (in pediatric visits, share the name of the parent and the children)
3) The reason for the visit (if you know)
4) Relevant contextual information (for example, if there are multiple people in the room, let the interpreter know so they are not confused when they hear another voice if the patient is non-verbal if the patient is an elderly person that cannot hear well, etc.)
Unless in case of emergency, always greet the interpreter and do not skip the presession since this gives key information to the interpreter and helps to have a smooth session.
2. Speak in short, clear sentences and pause often
Interpretation requires processing a lot of information beyond typical dialogue, especially when you’re providing critical information such as medication names, dosages, procedures, numbers, etc. Additionally, the interpreter may take notes as you speak to remember everything accurately and completely. You can aid the interpreter’s memory by speaking in short, clear sentences and conveying a few ideas at a time. This can also help your patient with Limited English Proficiency (LEP) understand the information better.
3. Use descriptive language
A telephone interpreter can’t see what you’re doing in the room. A video interpreter has a limited view of the room. Visual cues are important to interpret messages. Whenever you’re sharing information with visual input, for example, when you’re showing the patient a chart or giving instructions on how to use a medical device, be as descriptive as possible for the interpreter and comment on what you’re doing. Imagine that the interpreter is blind, and you have to give them verbal descriptions.
4. Use simple language, and limit the use of idioms and jokes
Jokes and idioms don’t always translate well into the other language and sometimes require additional explanation to provide the patient with the cultural framework to understand you.
5. Speak directly to the patient
Communicate directly to the patient and make eye contact with them, not the interpreter. Instead of saying, ‘’tell her/him/them’’ or ‘’tell the patient’’, use direct speech as in regular conversation. This shows respect and acknowledgment for the patient. Also, if there are multiple people in the room, when you say ‘’tell her/him/them’’, the interpreter may not know which person you’re referring to. Always let the interpreter know who you are speaking to if there are multiple speakers.
6. Position the telephone or video monitor strategically
The position of the telephone or video monitor is a key point for remote communication. If the telephone or video monitor is too far away from the speakers, the interpreter may not be able to hear them or see them properly and need to ask for repetitions frequently. Position the video monitor so that the interpreter can see and hear both the provider and patient or the person you’ll be communicating with.
Whenever the patient undresses or during physical exams, move the monitor away from the patient so the interpreter can give the patient privacy by not seeing them.
7. Be aware of audio and video issues
You and the patient can probably hear each other perfectly when you’re face to face, but for a remote interpreter, this is not always the case. Multiple factors may affect the interpreter’s ability to hear you remotely. Besides the position of the telephone or video monitor, audio and video quality connections may vary depending on your location, internet connection, the acoustics of the room, background noises from typing, people, or machines, brief audio glitches, etc., even if the interpreter has the best equipment to interpret.
For these reasons, please speak clearly, articulate every word, and stand close to the phone or video monitor. The speakerphone may sound echoey; try to avoid using it, if possible. If patients are soft-spoken or their voice volume is low, move the phone or video monitor closer to them, if possible. The interpreter may also alert you to these technical issues during the session so you can work with them to get good audio and video quality or connect you to an interpreter with a better connection if needed. It may be helpful for you to become familiar with the telephone or video monitor you’ll use during the session so you know how to turn the volume up or down or adjust any other settings.
8. Take turns to speak and limit overlapping speech
Remote interpreters can only interpret for one speaker at a time after every speaker pauses; this is called consecutive interpretation. When the speakers don’t wait for interpretation or multiple people speak at the same time, it may create confusion and misunderstandings. Respecting turn-taking will help you communicate more clearly. Even if you have some basic knowledge of the language, do not try to practice the language during an interpreting session since you may miss important nuances and details of the message.
9. Keep in mind that the interpreter will interpret everything that you say as you say it
Per the ethical principle of transparency, interpreters are required to interpret everything that is said during the session, including any side conversations or comments. As such, only say what you would like the interpreter to interpret to the patient.
10. Thank the interpreter after the session is over and debrief if needed and possible
Interpreters are very appreciative of acknowledgment and compliments. Always say goodbye to the interpreter before hanging up the phone or video call. Oftentimes, during virtual communication, politeness and rapport are more easily overlooked. Try to bring the human touch to remote interpreting encounters by working together with the interpreter, following the recommendations outlined before. This also helps you provide a better service to your patients.
Additionally, if a session is particularly challenging, you may debrief with the interpreter after the session is over. This is called a post-session. During a post-session, you may give feedback or advice to the interpreter or simply compliment them for doing a great job. The interpreter can also do the same for you. You may also ask questions to the interpreter relevant to communicating in an interpreting encounter.
Thank you for reading this far!