Practical Steps for Using Interpreter

• The interpreter is your crucial clinical tool to obtain data on which diagnoses will be based and action taken.

  You must clarify how the interview is to be conducted, enable the interpreter to function effectively, and maximize the patient’s comfort and confidence in both you and the interpreter.

  Adjusting to a triadic interview can initially feel awkward as our social tendencies to focus on the person speaking have to be overcome and we are unaccustomed to hearing information simultaneously relayed through a third person. With practice, these can be very successful clinical encounters.

• Setup for Success

  • Introductions. In several cultures, the personal attributes and behaviors of the physician are very important, especially to elderly patients. Your introduction must establish both professional credibility and personal connection with the patient. Use the patient’s full formal name (e.g. Mrs. Perez, Mr. Gonzales) to show respect unless he/she gives you permission to use first names or nicknames. Convey a sense of warmth and interest in your greeting. Also introduce yourself by your full name to the patient and all other persons who accompany the patient. Either as part of the introductions or immediately afterwards, specify your role
    e.g. ”Good morning, Mrs. Perez, I am John Smith, a third year medical student, working with Dr. Jones today”
    
  • Language Clarifications. Explain your limitations in the foreign language and the need for an interpreter. Patients frequently appreciate your using common phrases of their language but unless you are fluent, it is foolish to attempt a clinical interview in a foreign language. They may also feel deceived if it becomes obvious during the interview that you have been able to comprehend much of the interchange between the patient and interpreter. Good phrases are:
    “I don’t speak Spanish so I will need help from an interpreter”
    “My Spanish is very limited so I will need help in interpreting”
    
  • Instructing Interpreter. Clarify the relationship between the patient and interpreter – family members, friends, professional interpreter or other? Ask the interpreter to translate exactly what is said by both you and the patient.
    “Please translate everything exactly as I say it and then exactly as she says it”
    “Please tell her everything I say and tell me everything she says, don’t leave anything out or add anything in”
    Stress that they must not edit (shorten) or elaborate (expand) on exactly what is said. State there will be time at the end of the interview for clarifications (see 9 below). Also warn them that you will be focusing on the patient (see item 5), and are not being rude by not looking at them during the conversation. Encourage and thank them in advance for adjusting to the rather awkward interaction.
    
  • Positioning Participants. Patient and physician need to be able to maintain a “normal” clinical communication so should sit facing one another, three to four feet apart (see diagram at top). The interpreter needs to be able to interact with both parties but not disrupt the physician-patient connection. Most experts recommend that the interpreter sit beside but a little further from the physician than the patient.

   

• Sustaining Quality Conversation

  • Focus on the Patient. Even when the interpreter is speaking or is listening to you, try to keep your focus on the patient. Aim to interact with the patient exactly as if the interpreter was not present. Resist the natural tendency to turn to the interpreter when you are speaking or when the interpreter is speaking to you. Keeping the patient as the center of the interaction encourages both the patient and interpreter to provide more complete and accurate information and is the only way you can observe facial expressions and body language during the translations.
  • Use Second Person. Consistently use words and phrases that directly address the patient e.g. “Tell me how you feel?” or “How long did your pain last?” and resist the tendency to slip into using the third person e.g. asking the interpreter “How does she feel?” or “How long did her pain last?”
  • Use Short Sentences with Time to Interpret. Frame questions that are easy to translate i.e. short, unambiguous, and without medical jargon or American “slang” terms. Allow time for translation both to and from the patient before asking follow-up questions. Be alert for warming signs of inappropriate translation e.g. long conversation between patient and interpreter resulting in a short answer to you. If this happens ask what else was said. While translation is occurring keep your focus on the patient watching their expression and body language (see below). Keep your body language appropriate while you are silent.

   

• Complete Conclusions

  • Remember the Special Aspects of a Cultural Competent Interview. Language is only one aspect of culturally-appropriate health care. Integrate the specific questions (e.g. the “ETHNICS” mnemonic) you need to obtain the necessary information for each question and pay attention to cultural aspects of communication and behavior. With elderly patients, pay special attention to encouraging the patient to ask question, to clarifying understanding of the treatment plan, and to confirming follow-up arrangements.
  • Ask for Nuances. At the end of the interview, ask the interpreter if anything was said during the interview that might not have been adequately conveyed by the literal translation. Providing this opportunity at the end of the interview helps avoid interpreters from inserting opinions during the literal translation. It can also be used to check for inaccurate answers that might have been given out of respect for the physician, such as accepting a tentative suggested diagnosis or agreeing to a test that the patient does not intend to undergo.
  • Thank. Thank the patient, interpreter, and other persons present. Make it comfortable for them to contact you and return to your care.

Last Modified: May 31, 2007