Addressing Language Access Issues in Your Practice: A Toolkit for ...

11 CALIFORNIA ACADEMY OF FAMILY PHYSICIANS
Dedicated interpreters
Dedicated interpreters are those whose only reason for being at your practice is to interpret. Dedicated interpreters
can be contracted in a number of ways:
Agency interpreters are contracted by a language agency, which in turn has a contract with you. Language agencies
are private companies, both nonprofit and for-profit, that provide interpreting and sometimes translation services
for a fee. Whenever you need an interpreter, you call the agency, and the agency will provide an interpreter (on-site
or over the phone) whom it has evaluated. A good agency can send you highly qualified professional interpreters,
while taking over the work of recruiting, screening, contracting and dispatching for you. Of course, there is a cost
attached, and agency interpreters are, at least on the face of things, the most expensive of the models. Nevertheless,
it is a good idea to know what agencies are available in case you have an urgent need. And you may find that some
services, such as telephonic interpreter services, are not as expensive as you expected.
A reputable telephonic interpreting agency can provide a trained interpreter over the phone, in any number of languages,
often in a minute or less. The service is usually charged by the minute and billed monthly. This technology
solves many of the logistical problems of working with on-site interpreters: physicians do not have to wait for the
interpreter, offices do not have to pay interpreters for waiting time or no-shows, and the boundaries of the interpreter
are more easily enforced.
Some interpreters, however, feel that their inability to see the speaker when working over the phone limits the accuracy
of their interpreting. In addition, intervening (whether to clarify a term to check to see if the patient understood,
or to provide a cultural framework for what was said) is very difficult over the phone. Telephonic interpreters
are also unable to provide additional services to patients, such as helping them acclimatize to the unfamiliar
setting of the office, helping them fill out forms, and helping them make appointments.
For more information you may want to read “How to Choose and Use a Language Agency” (Roat, C. The California
Endowment, 2002), downloadable for free at www.calendow.org; Reference Library, click on Publications, then on
Cultural Competence.
TIP: Working with trained interpreters, on-site
• Greet the patient first, not the interpreter.
• During the medical interview, speak directly to the patient, not to the interpreter: “Tell me why you came in today” instead of “Ask
her why she came in today.”
• A professional interpreter will use the first person in interpreting, reflecting exactly what the patient said: e.g. “My stomach hurts”
instead of “She says her stomach hurts.” This allows you to hear the patient’s “voice” most accurately and deal with the patient
directly.
• Speak at an even pace in relatively short segments; pause often to allow the interpreter to interpret. You do not need to speak
especially slowly; this actually makes a competent interpreter’s job more difficult.
• Don’t say anything that you don’t want interpreted; it is the interpreter’s job to interpret everything.
• If you must address the interpreter about an issue of communication or culture, let the patient know first what you are going to be
discussing with the interpreter.
• Speak in: Standard English (avoid slang)
Layman’s terms (avoid medical terminology and jargon)
Straightforward sentence structure
Complete sentences and ideas
• Ask one question at a time.
• Ask the interpreter to point out potential cultural misunderstandings that may arise. Respect an interpreter’s judgment that a
particular question is culturally inappropriate and either rephrase the question or ask the interpreter’s help in eliciting the information
in a more appropriate way.
• Do not hold the interpreter responsible for what the patient says or doesn’t say. The interpreter is the medium, not the source, of
the message.
• Avoid interrupting the interpretation. Many concepts you express have no linguistic, or conceptual equivalent in other languages
The interpreter may have to paint word pictures of many terms you use. This may take longer than your original speech.
• Don’t make assumptions about the patient’s education level. An inability to speak English does not necessarily indicate a lack of
education.
• Acknowledge the interpreter as a professional in communication. Respect his or her role.