Let's look at this statement: I'm an interpreter.
I'd dare to bet that the understanding of this statement runs the gamut from "I talk with my neighbor all the time so I'm interpreting for my friend" to "I've taken a 40-hour introductory course and I'm certified". This begs the question, “Which one is the best interpreter?”
Both can be true.
Interpreter certification indicates an interpreter understand the principles of medical interpreting, their fluency may have been measured and that they have basic knowledge of medical terminology. Getting certified is a great starting point for the professional Medical Interpreter, but it is definitely not the ending point.
In the first example someone may be natively fluent and can effectively convey the messages sent between doctor and their friend, the patient. They could very well have a basic understanding of medical terminology. Maybe they've researched the code of ethics and have adapted them as best they can when they're helping their friend.
So, which one is the interpreter? The answer can be either, neither, or...
The challenge lies in looking deeper into the function of a medical interpreter. The job requires an interpreter to know their limitations. Broadly speaking they’re not medical professionals. They are not required to take anatomy and the measurable outcome depends solely on the perception of the user and the buyer. Now this is the conundrum.
Healthcare employees, broadly, have a limited understanding of the role interpreting is supposed to have in their system. I'd argue that most don't have any understanding at all. To them interpreters are there to help the patient and the best interpreters are those that are most readily available. All they want is someone who can decipher what the patient is saying so they can treat the patient's symptoms. Period.
Oh, and make it free please!
Here's the problem. Interpreters have a hard time determining their job, users can't define the interpreters job and buyers want it all for free. Right now, the answer to 'What is the role of an interpreter?' is: a widget. It is something that keeps costs down and solves the urgency of zero communication.
Here's the kicker: language service providers sell the widget. They solve the problem that healthcare wants to solve. I can hear the healthcare industry yelling "Give me somebody, anybody, and make it cheap!"
I gotta say, if I were in healthcare and have access to the widget, I'm sold. It's cheap and my employees won't feel desperate. Many buyers are probably thinking, even praying, that if Google can build a really good app their problems would be solved. But here is the real dream: Siri marries Google Translate. Then Google can finally give Siri all she needs to be an interpreter...Right?
That's where we are today. So, are you an interpreter? Can you communicate your value? Do you understand your role well enough to stop your job from going overseas? Will you ever be able to support yourself doing the work you love?
Do not despair. The answer can be yes to all of the above. But first and foremost, we need to lay out an interpreter's job and define the role so it can integrate into healthcare. It can be understood and the value can be clear.
You may be asking yourself: How do you know this Rashelle?
My answer is simple: user experience and patient outcomes. These are the tenants of healthcare and they spend a LOT of money assuring that these numbers come out positive. That's the way they make their money and add value to their stakeholders. That's how they attract the best doctors and why patients choose to give them their business.
Now, let's get back to the original point. You have to be clear about the role of the interpreter and know your boundaries. You can't say 'It's not my job' if you don't know what your job is. You can't say 'I'm an interpreter' if you can't see how you fit into the healthcare system.
And here's a juicy tidbit: It has nothing to do with the patients. Yep, nothing.
If your head is about to explode, please take a deep breath. Follow along and I promise you'll come off your ledge.
At the start we talked about two different kinds of interpreters: the helper and the certified interpreter. Both add value but both take a different approach. The key to the effectiveness of either comes from the practical application of the theory and the skills.
The most fundamental skill required to interpret is language fluency. Interpreting requires you to be able to think critically and analyze situations in a second language. The level of fluency required to interpret demands that you are easily understood by native speakers in your second language.
You need to be able to hold an in-depth conversation about things like politics, family values, religion or the state of our society, and be convincing in your perspective. Now these topics are meant to be a suggestion. The point is analytical discourse and the give and take of such subject matter can indicate your level of fluency. If you can hold these conversations you are able to actively listen and think critically in your second language.
Ok, so now that we have that out of the way let's talk about effective communication. It's easy to use big words and profound concepts to make your point. To you, you may think that there's no possible way someone can't understand you. You used all of the right terminology and anyone who knows anything about what you're talking about will surely understand what you're saying, right?
Wrong.
Effective communicators can judge someone's comprehension if they can pick up other cues. What is the body language of the receiver? Are their eyes glossing over? When you're talking, do you just get 'uh huh' or 'ok' or maybe a head nod yes? Score! They understand! You've received positive confirmation that your message has been received!
Wrong again.
You have done nothing to communicate your message except impress yourself with all your knowledge, wisdom and expertise. You have done nothing to educate the receiver of your message except make them feel dumb and intimidated by your obvious command of the technical components of your subject matter. The 'positive' cues were merely the other person's way of trying to not look dumb and all the while feeling inadequate that they didn't understand something that seems to be obvious by the way you were talking.
As an interpreter, you need to understand the register of the people you're interpreting for. Now here's a very important point, so pay attention.
Many people who specialize in something don't realize how much they know. They surround themselves everyday with others who know as much as they do about a topic. Medical professionals are no different. This can put an interpreter in a real pickle.
When you go to the doctor, do you understand everything they're saying? When they throw out acronyms and facts, are you clear on what they mean and why they're important? If you've worked in medical interpreting for a long time, you may be nodding yes. So, here's another perspective.
When your child or parent or friend goes to the doctor do THEY understand the acronyms and facts and why they're important simply on face value? Probably not.
There is a fundamental approach to handling this as an interpreter. Use first person and let the communication flow. Here's why.
Interpreter intervention can take away responsibility from the provider. Why should they adjust register if you do it for them? It's obvious you're not being faithful to the message because you're clarifying for them. And you're not helping the patient by giving them information that the provider didn't offer. You have to stay out of the way.
What would the encounter look like if there were no language barrier? The patient would have a blank stare and the provider would pick up on that. This has nothing to do with language and everything to do with effective communication. If the provider is speaking in a register the patient can't understand, then let them do their job. Let them pick up on all of the cues they're trained on and establish an understanding of their patient.
In fact, whenever an interpreter takes on this responsibility, you step outside your role. You actually become ineffective because you lose your neutrality and become the expert in the room. You are not. You don't have the medical training of the treatment team and you don't have the intimate knowledge of the patient's conditions, questions, and concerns.
By intervening, you make yourself part of the dynamic. You take away the power of effective communication from the provider and the patient. You stop them from having effective dialogue and establishing trust and understanding. You're blocking what you're trying to achieve by intervening.
We'll talk about how to handle these situations at a later time. The basic takeaway is stay out of the way of the relationship building process. Do not advocate and take away the patient's ability to manage their own situation. Do not give providers a way to skirt their responsibility of connecting with their patients to treat their problems and concerns. This is not your role. Of that I am certain.
© Connecting Cultures Inc. 2018