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INTERPRETING FOR WELL
VISITS
FAMILY MEDICINE, WOMEN’S CLINIC
& DENTAL CLINIC VISITS
Eliana Lobo
LOBO LANGUAGE ACCESS
Eliana Lobo, M.A.,
CoreCHITM
Trainer of Trainers of Healthcare
Interpreters (ToT)
TODAY’S PRESENTER: ELIANA
LOBO
• Eliana Lobo is a nationally certified CoreCHITM Portuguese medical
interpreter, and DSHS Certified medical interpreter, with two
M.A.s from Brown University:
• Bilingual Education
• Portuguese& Brazilian Studies
• Formerly a medical trauma center interpreter services Supervisor
& Trainer, Spanish & Portuguese Translations Supervisor, National
Director of Interpreter Quality, and currently Director of Lobo
Language Access in Tacoma
• Since 2013, Eliana has helped create and host over 30 national
webinars on effective medical interpreter training via the NCIHC’s
“Home for Trainers” webinar workgroup
• Currently Chair of the Standards and Training Committee of
NCIHC and NCIHC Board member
• Adjunct Professor of Professional Medical Interpreting at
Highline College, WA
LEARNING OBJECTIVES:
INTERPRETING FOR WELL VISITS
• Learn the proper protocols for filling out patient
forms
• Categories of forms
• How to maintain confidentiality in crowded waiting
rooms
• Patient history process
• Learn how to handle lengthy sight translation
requests
• CALL tool strategy
• Review and Revise Your Pre-Session
• Short but complete, every time, and you will be better able to
manage the flow
• Common Clinic Protocols, Topics and Terminology
• Family Medicine
• Women’s Clinic
SHOULD INTERPRETERS FILL
OUT FORMS WHEN ASKED?
4
This Photo by Unknown Author is licensed under CC BY-NC
GUIDELINES FOR SIGHT TRANSLATION
BY HEALTHCARE INTERPRETERS
Patients typically receive four types of documents in healthcare
settings, which interpreters are at times asked to sight translate:
• Documents that provide general background to how an institution functions
(e.g. HIPAA, patient manuals, patient bill of rights)
• Documents with key information about the patient’s condition that he or she
may want to access later (e.g. patient education materials)
• Documents that contain specific instructions for patient care (e.g. prescriptions,
preparation for procedures, discharge instructions)
• Legal documents (e.g. financial agreements, consent forms, advance directives)
Not all of these are appropriate for sight translation.
As a general rule, the NCIHC recommends strict limits on the
length and complexity of documents that interpreters should
be asked to sight translate.
GUIDELINES FOR SIGHT TRANSLATION
BY HEALTHCARE INTERPRETERS
1.Documents containing general background information
(patient bill of rights, HIPAA) or educational materials are
often quite long, so are not appropriate for sight translation
• Sight translating these documents is both time consuming and
probably fruitless, as the patient is unlikely to remember
something that was read aloud
2.Documents with specific instructions are appropriate for
sight translation, with the provider present, so that the
patient’s questions can be answered by the provider,
not the interpreter!
3.Legal documents, such as consent forms, should be
translated professionally and then, if necessary, read aloud
by the interpreter for the benefit of the client/patient
HIPAA COMPLIANCE FOR
LANGUAGE SERVICE PROVIDERS
 Foreign language interpreters are considered business
associates under HIPAA legislation because they are not
employed by the clinic, medical facility, or hospital utilizing
their services
 The sharing of patient information with a business associate
(interpreter) is only intended for the specific purpose as
stated in a business contract between a provider and
hospital or clinic
 If you are a staff interpreter working in a hospital or clinic,
you should know your workplace protocols to insure patient
privacy
PATIENT PRIVACY & AVOIDING
BEING ALONE WITH THE
PATIENT
Standards say that interpreters should never be alone with patients.
If the provider leaves, you should step out of the examination room
and wait outside. This helps avoid side conversations as well as the
very common occurrence of having the patient unburden themselves
to the interpreter about their medical condition and/or concerns.
As a general guideline, this is a good rule. However, it is not written in stone,
and there needs to be flexibility if we are putting patients first. There are
many occasions when being alone with the patient is unavoidable.
One of the most common circumstances is when the patient arrives for their
first visit to the clinic. The receptionist will give the interpreter a stack of
forms and say, “Please help the patient fill these out”.
What should you do? / What does the professional
interpreter do?
FILLING OUT FORMS
Should you fill out the forms for the patient, as
you while sight translating the questions?
I have three recommendations:
1.The patient should check the boxes for yes or
no, as you interpret each one and move
through the form
2.If the patient doesn’t know what a certain
condition or disease is, move on to the next
question!
• Your job is to interpret, not explain medical
conditions or diseases. Once you are with the
provider you can ask the provider to explain what
the patient did not understand, and you will
interpret the Q&A
3.The patient should fill in their personal data
such as name, address, date of birth
PATIENT HISTORY PROCESS
Follow these steps when interpreting for patients in
waiting room:
• Introduce yourself
• Interpret for the receptionist and the patient
• Sit near the receptionist if you can
• Sight translate forms
• Decide who will write the answers
• Write down any patient questions as you go through the
forms, then skip to the next question
• Interpret any patient questions to receptionist
• Return forms to receptionist, who will hand off to the
M.A.
• Avoid sitting with the patient while waiting after
STRATEGY WHEN ASKED TO FILL
OUT PATIENT DOCUMENTATION
/ FORMS
What do you do when you are handed
a stack of pages to sight translate?
• Ask the receptionist to explain the
document and what it says, while you
interpret?
• Wait, and ask the provider to explain
the document and what it says, while
you interpret?
• Cite the NCIHC standard?
SIGHT TRANSLATION & THE CALL
TOOL
Use these four criteria to help you decide when
to perform a sight translation of any additional
materials:
Known as the CALL Tool
Complex
language
Advanced
terminolog
y
Legal
language
Long
document
s
THE IMPORTANCE OF THE PRE-
SESSION
The Pre-Session is a great place to establish the
hand signal or method you will use to interrupt
the flow when needed, to ensure accuracy. Even
with providers who do not customarily utilize the
Pre-Session, you can establish many things in a
few short sentences:
• “Hi, I’m Eliana, your Portuguese/English interpreter”
(Greeting, Introduction, and confirmation of
Language)
• “I encourage you to speak directly to each other in
first person. Know that I will interpret everything
said, and, keep it confidential”
(1st person, all utterances will be interpreted, and a
reminder of confidentiality/HIPAA)
• “This is the hand signal I will use if I need clarification
or repetition, —demonstrate the hand signal as you
THE IMPORTANCE OF THE PRE-
SESSION
It is important to be able to manage expectations
on both sides, and the pre-session helps do this
by establishing boundaries and constraints. It’s
also good customer service!
• It is important that the interpreter feels
comfortable managing the flow of the encounter,
so establishing that
pre-arranged signal or word to do so upfront is
always beneficial
• It is important that the patient feels comfortable
disclosing personal information, so highlighting
privacy/confidentiality is always a good thing to
BREAKOUT ROOM #1
PRE-SESSION PRACTICE
Lobo Language Access - 2022 15
FAMILY MEDICINE
ADULT & PEDIATRIC CHECK-
UPS
Medical History
• Provider will ask the patient
about lifestyle behaviors
• Smoking
• Excessive alcohol use
• Sexual health
• Diet & Exercise
• The provider will also check
• Vaccination status
• Personal medical history
and
• Family medical history
• Takes Vital Signs
• Blood
Pressure
• Heart Rate
• Respiration
Rate
• Temperature
• Oxygenation
• Physical Exams
• Heart Exam
• Lung Exam
• Head and Neck
Exam
• Abdominal
Exam
• Neurological
Exam
• Dermatological
Exam
• Extremities
Exam
• General
Appearance
Provider usually asks questions
about:
ANNUAL PHYSICAL FOR ADULTS
ANNUAL PHYSICALS FOR MEN
An annual physical exam for men might also
include:
• Testicular Exam
• provider checks testicles for lumps or changes in size
• Hernia Exam
• the famous "turn your head and cough" checks for a
weakness in the abdominal wall between the intestines
and scrotum
• Penis Exam
• The provider might notice evidence of sexually
transmitted infections such as warts or ulcers on the
penis
• Prostate Exam
• Provider inserts a lubricated, gloved, finger into the
rectum to feel the prostate’s size
ANNUAL PHYSICALS FOR
WOMEN
An annual physical exam for women might
also include:
• Pelvic Exam
• PAP test (tests for cervical cancer)
• HPV test (tests for human papilloma virus which
can
cause genital warts and in some cases, cancer)
• Breast Exam
• Mammogram referral
Remember to always step behind the curtain
when the patient undresses!
WOMEN’S CLINIC
ANNUAL CHECK-UPS & FAMILY
PLANNING
WHAT IS A WELL-WOMAN VISIT?
A well-woman visit focuses on the woman,
her body, and her reproductive health
• Well-woman visits are also known as
• gynecological exams
• pelvic exams
• annual exams
• These visits are an important part of
preventative health care
WHAT HAPPENS DURING A GYN
VISIT?
What happens during a well-woman visits (also
called well woman exams) depends on a few
things, like the woman’s age, her sexual history,
and medical history
• It’s a good idea for the first well-woman visit to take
place at around the age 13 to 15
• It may just be a talk with the doctor plus a regular
physical exam
• The provider will check height, weight and blood pressure
• Menstrual cycle will be discussed, especially if the
patient has heavy, painful, or irregular periods
• If the patient is under18, certain immunizations, like
the HPV vaccine, will be offered
• Around age 21, women will begin needing regular
pelvic exams, Pap tests, and breast examinations.
WHAT HAPPENS DURING A PELVIC
EXAM?
1.The external exam — The doctor or nurse will look at
the vulva and the opening of the vagina. They’re
checking for signs of cysts, abnormal discharge,
genital warts, irritation, or other issues
2.The speculum exam — The doctor will use a speculum
to examine the patient’s vagina and cervical opening
a. The doctor will then take a small sample of cells from the
patient’s cervix.
This sample will be sent to a lab for a Pap test to see if there
are any
pre-cancerous cells or cancer in the cervix
b. If the doctor or nurse is testing for STDs (like chlamydia or
During a pelvic exam, a doctor or nurse examines the
patient’s vulva and internal reproductive organs: vagina,
cervix, ovaries, fallopian tubes, and uterus. There are usually
four parts comprising a pelvic exam:
PELVIC EXAM: INTERNAL EXAM
3. The bimanual exam — During this part of the exam, the
doctor or nurse will put 1or 2 gloved and lubricated fingers
into the patient’s vagina while gently pressing on the
patient’s lower abdomen with their other hand. The
provider is checking for
a. the size, shape, and position of the uterus
b. tenderness or pain — which might mean infection or another
condition
c. enlarged ovaries, fallopian tubes, ovarian cysts, or tumors
4. The rectovaginal exam —doctor or nurse places a gloved
finger into the rectum. This checks the muscles between
the vagina and the anus, and checks for tumors behind the
During a pelvic exam, a doctor or nurse examines
the patient’s vulva and internal reproductive organs:
vagina, cervix, ovaries, fallopian tubes, and uterus.
BIRTH CONTROL, FAMILY PLANNING & STD
TESTING
• When was your last period?
• How often do you have periods?
• How long do they last?
• Do you ever bleed/spot between
periods?
• Do you have any unusual pain, itching,
or discharge from your vagina or
vulva?
• What medical problems do other
members of your family have?
• Do you have any other medical
conditions?
• Are you sexually active?
• Do you have sex with men, women,
or both?
• Is sex ever painful?
• Do you bleed during or after sex?
• Are you using birth control?
• Do you think you might be pregnant?
• Do you want to get pregnant?
• What do you do to prevent STDs?
If the woman is sexually active (meaning engaging in vaginal, anal, or oral sex),
birth control and STD testing will be discussed.
Common questions include:
MAMMOGRAMS
• Patient must undress above the waist
• The facility will provide a robe
• A technologist will position the
patient’s breasts for the mammogram
• To get a high-quality picture, the breast must be flattened
• The technologist places the patient’s breast on the machine’s
plate
• The plastic upper plate is lowered to compress the breast for a
few seconds while the technologist takes a picture.
• The whole procedure takes about 20 minutes
• The actual breast compression only lasts a few seconds
• Sometimes when patient’s breasts are compressed, it can be
painful
• Two views of each breast are taken for a screening
BONE DENSITY
STUDIES
What is a bone density study?
• A bone density test determines if the
patient has osteoporosis, which is a
disorder characterized by bones that
are more fragile and more likely to break
• A bone density test uses X-rays to measure how many
grams of calcium/other bone minerals are packed into
a segment of bone
• The most commonly tested bones are the spine, hip and
the forearm
• A bone density test of the hip and spine uses a central
BONE DENSITY STUDIES
Although osteoporosis is more common in older
women, men also can develop the condition. A
doctor may recommend a bone density test if the
patient has:
• Lost height. People who have lost at least 1.6 inches (4
centimeters) in height may have compression fractures in their
spines, for which osteoporosis is one of the main causes
• Fractured a bone. Fragility fractures occur when a bone becomes
so fragile that it breaks much more easily than expected.
• Taken certain drugs. Long-term use of steroid medications, such
as prednisone, interferes with the bone-rebuilding process —
which can lead to osteoporosis.
• Received a transplant. People who have received an organ or bone
marrow transplant are at higher risk of osteoporosis, partly
because anti-rejection drugs also interfere with the bone-
rebuilding process.
• Had a drop in hormone levels. In addition to the natural drop in
hormones that occurs after menopause, women's estrogen may
PEDIATRICS
ONE-WEEK AND ONE MONTH WELL VISITS
PEDIATRIC VISITS
Generally, well-baby and well-child visits are for
check-ups, immunizations, and clearance to
participate in athletics.
Well-baby visits begin as early as one week followed up by
the one month visit. This first well-baby visit is usually
injection-free. However, if the baby did not receive the
CDC-recommended HepB (hepatitis B) vaccine at birth,
s/he should receive it now.
• Common topics (prepare your word equivalents
ahead of time) of discussion include:
• Vaccinations such as, DPT and MMR
• Milestones for development
• Percentiles on growth and weight charts
THE FIRST WEEK WELL-BABY
VISIT
In addition to taking measurements and doing a
complete physical exam, the pediatrician will:
• Check to see how the umbilical stump is healing
• Check baby’s circumcision, if he had one
• Check for newborn jaundice
DEVELOPMENTAL MILESTONES
At this visit (or very soon after), babies may
already be able to:
• Move arms and legs on both sides of the body
equally well.
• Focus on objects within 8 to 15 inches
• Lift head briefly when on tummy
Developmental milestones like these follow roughly
the same timeline for most babies during their first
year of life.
MATHEMATICAL CONCEPTS AND
CONVERSION
As mentioned, frequent topics in Pediatrics
include:
• Milestones for development which
typically cover at what ages a baby can
accomplish a specific task, such as
sitting, crawling, cruising, climbing,
walking, babbling and talking
• Percentiles on growth and weight charts,
understanding the difference between
• Percentage vs. percentile
• Height, weight, circumference
MATHEMATICAL CONCEPTS AND
CONVERSION
Often, the nurses and medical assistants do
not know how to convert values into metric
for parents.
Moms really want to know what their child’s
temperature is! Keep your formulas handy
on your phone or notepad, or better yet,
use an app.
• https://freeappsforme.com/unit-converter-apps
• https://play.google.com/store/apps/details?id=c
om.wighthat.MetricConversion&hl=en_US&gl=US
• https://play.google.com/store/apps/details?id=c
MATHEMATICAL CONCEPTS AND
CONVERSION
•Converting from Fahrenheit to Celsius
•(32°F − 32) × 5/9 = 0°C
•Converting from Celsius to Fahrenheit
•(0°C × 9/5) + 32 = 32°F
•Converting from metric to imperial
standards
• Ounces to Milliliters (1 ounce of fluid =
29.5735 ml)
• Pounds to Kilos (1 pound = 0.453592 kilos),
or
• Kilos to Pounds (1 kilo = 2.20462 pounds)
• Inches to centimeters (1 inch = 2.54 cm)
MATHEMATICAL CONCEPTS AND
CONVERSION
• Percentage vs. Percentile
• The concept of percentages is very familiar to most
people, because we come across them frequently in our
daily lives. For example, our assignments at school were
graded with percentages. However, ‘percentile’ is a similar
word that has an entirely different meaning
• While percentages indicate how well a person performed
on a test, percentiles indicate how well that individual
performed compared to others. It’s a more complicated
concept than a percentage.
• The percentile is a comparative score, whereas the
percentage is based on individual scores
• Mean vs. Average
• Average, is the sum of all the values divided by the
number of values
• A mean is defined as the mathematical average of the
WHAT DOES THE PEDIATRICIAN
LOOK FOR?
The doctor will also look for reflexes that are
standard issue at birth and are signs that a baby’s
new nervous system and brain are working well.
• These include the rooting and sucking reflex
• ensures baby can locate and secure the food source
• The Moro reflex (also called “startling,” which is that
jumpy reaction when baby is laid down on his back or is
startled by a noise or other sensation)
• The tonic neck reflex (this one makes a baby look like
he’s fencing)
• The grasp reflex (baby’s fingers will curl up in a grasp
when his palm is stroked), and
• The stepping reflex (baby appears to take steps when
BABY'S 1-MONTH CHECKUP: WHAT TO
EXPECT
You Can Expect Your Baby's Doctor to:
• Check that baby's umbilical cord stump has fallen off,
and that baby's belly button is healing properly
• Examine your baby boy's penis if he was circumcised
• Give your baby a hepatitis B vaccine
• The shot is usually given in the hospital at 2 days and then at
1 month
and again at 6 months of age
• Some pediatricians give it at birth, then at 2 and 6 months
• Check baby's weight and height
• Ask for details about the baby’s feeding schedule
Remember to always step behind the curtain once the pediatric
patient
IMMUNIZATIONS
IMMUNIZATIONS
• The vaccines covered in this webinar are those
most likely to be given during the well visits during
infancy and early childhood.
• Other vaccines (including measles, mumps, and
rubella; varicella; rotavirus; influenza; and hepatitis
A) are also routinely recommended during the first
five years of life
• Know terminology equivalents
for all of the above common
childhood diseases
• Be prepared to interpret the
vaccination protocols
• the timeline for future
BREAKOUT ROOM #2
INTERPRETER DIALOG PRACTICE
SCENARIO IN PEDIATRICS WITH METRIC TO IMPERIAL
CONVERSION
05/21/19
Lobo Language Access - 2019 41
DENTAL CLINIC
WHAT HAPPENS DURING A DENTAL
CHECK-UP?
There are two parts to a regular dental visit or
check-up,
the examination and cleaning, and possibly oral
prophylaxis
• The dental professional will check for cavities
• X-rays might be taken to detect cavities
• Remember to always step outside when the
patient is having
X-rays taken!
• Stand where the tech stands
• The exam will also include
• Checking for plaque and tartar on the patient’s teeth
• Gums will be checked with a special tool to measure the
depth of
INTERPRETING DURING A DENTAL
VISIT
Most of the interpreting done during a dental visit occurs
just before and just after the patient lies back in the
dentist’s chair. After all, from then on, the patient doesn’t
actually talk much. But I encourage interpreters to interpret
everything the Dentist and the Dental Assistant say to each
other while treating the patient.
Be attentive so you can be aware when the patient signals pain or
distress (or just plain fear) and keep that communication going
between patient and provider!
• Questions before treatment involve history, prior treatments and
descriptions of symptoms and pain
• Questions post treatment revolve around post-care, scheduling
return visits and what to expect given the nature of the specific
treatment received
• After cavities are filled, dental assistants often demonstrate how to
properly floss
• Often for pediatric patients, a fluoride coating is applied to the teeth
RESTORATIVE DENTISTRY
• Veneers
• Tooth Whitening
• Bridges
• Dentures
• Implants
All of the above require healthy teeth and
surrounding gums before the patient can begin
treatment
ORTHODONTIA
Types of Braces
• Traditional metal braces: metal bracket
attached to teeth, with a metal archwire attached to the
brackets
• If the patient has an overbite or underbite, they may
also need to wear rubber bands that connect from
the bottom to the top rows of teeth
• Clear braces: offer a more discreet appearance
• The only really visible part of the braces is the thin
metal archwire that helps to shift teeth into proper
alignment
• Invisible braces: clear plastic trays that fit over teeth
without looking all that noticeable
• The orthodontist provides a new set every few
PUT PATIENTS FIRST!
Remember, the first step to building trust is
respect
• Respect your patient’s privacy by asking for a
private area to fill out forms if most of the
people in the waiting room also speak your
patient’s language
• Always step behind the curtain when your patient undresses
• Always step away when X-rays are being taken
• Always check for understanding
Have a short and sweet pre-session prepared and,
• USE IT EVERY BEFORE EVERY ENCOUNTER!
• Remember to use the CALL tool for sight
translation requests
• Keep working on your terminology equivalents
BREAKOUT ROOM #3
INTERPRETER DIALOG PRACTICE
SCENARIO IN ADULT MEDICINE
Lobo Language Access - 2022 48
RESOURCES & GLOSSARIES
1. Johns Hopkins Medicine, Glossary for Pediatric Health
https://www.hopkinsmedicine.org/healthlibrary/conditions/pediatrics/glossary_-_pediatrics_85,P01018
2. CMS Government Glossary
https://www.cms.gov/apps/glossary/default.asp?Language=English&Letter=P
3. Society of Teachers of Family Medicine Glossary
https://www.stfm.org/about/about/glossary/
4. Sexual Health Glossary
http://www.ashasexualhealth.org/sexual-health-glossary
5. Johns Hopkins Medicine, Glossary for Gynecological Health
https://www.hopkinsmedicine.org/healthlibrary/conditions/gynecological_health/glossary_-
_gynecological_health_85,P00562
6. Glossary of Dental Health Terms
https://www.webmd.com/oral-health/dental-health-glossary#1
7. Orthodontic Glossary: Oral B
https://oralb.com/en-us/oral-health/orthodontic-glossary
REFERENCES USED FOR THIS WEBINAR
1. NCIHC Sight Translation and Written Translation Guidelines for Healthcare Interpreters
https://www.ncihc.org/assets/documents/publications/Translation_Guidelines_for_Interpreters_FINAL0
42709.pdf
2. HIPAA Compliance for Language Service Providers
https://interpretersunlimited.com/uncategorized/hipaa-compliance-language-service-providers/
3. Annual Physical Examinations for Adults
https://www.webmd.com/a-to-z-guides/annual-physical-examinations#1
4. What is a well-woman visit?
https://www.plannedparenthood.org/learn/health-and-wellness/well-woman-visit
5. Mammograms: What to Know Before You Go
https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-
detection/mammograms/mammograms-what-to-know-before-you-go.html
6. Bone Density Tests
https://www.mayoclinic.org/tests-procedures/bone-density-test/about/pac-20385273
7.The First-Week Well-Baby Visit
https://www.whattoexpect.com/first-year/health-and-safety/first-week-well-baby-visit
8.Baby's 1-Month Checkup: What to Expect
https://www.webmd.com/parenting/baby/babys-1-month-checkup-what-to-expect#1
9.Your Child's First Vaccines
https://www.cdc.gov/vaccines/hcp/vis/vis-statements/multi.html
10.Why a Regular Dental Check Up is Important?
https://www.dentalcare.com/en-us/patient-education/patient-materials/why-are-regular-
dental-visits-important
11.What to Expect Once You Have Braces
https://www.absolutedental.com/blog/what-to-expect-once-you-have-braces
REFERENCES USED FOR THIS
WEBINAR
CLINIC BULLETIN BOARDS & RESOURCE
AREAS
Public health clinics are a
great, and often overlooked
resource
Texts covering a wide range
of subjects, and often in
several languages, are FREE
to the public!
WHERE ELSE CAN I FIND FREE PRACTICE
MATERIAL?
CLINIC BULLETIN BOARDS
Public health clinics provide resources from the
community as well health information materials in the
form of pamphlets and posters
11/14
/2022
Lobo Language Access
5
3
WHERE ELSE CAN I FIND PRACTICE MATERIAL?
WHERE ELSE CAN I FIND FREE PRACTICE
MATERIAL?
Clinic Exam Rooms
Look for written
materials in
different areas
throughout the
clinic or hospital.
Sometimes, you
can find them on
the back of the
CLINIC BULLETIN BOARDS & RESOURCE
AREAS
Public health clinics provide resources from the
community as well as from pharmaceutical
vendors, who often distribute educational
materials in the form of pamphlets and
informational posters along with products sold to
the clinic
WHERE ELSE CAN I FIND FREE PRACTICE MATERIAL?
QUESTIONS?
INTERPRETERTRAINER@OUTLOOK.C
OM
56

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Interpreting for Well Visits_ELobo.pptx

  • 1. INTERPRETING FOR WELL VISITS FAMILY MEDICINE, WOMEN’S CLINIC & DENTAL CLINIC VISITS Eliana Lobo LOBO LANGUAGE ACCESS
  • 2. Eliana Lobo, M.A., CoreCHITM Trainer of Trainers of Healthcare Interpreters (ToT) TODAY’S PRESENTER: ELIANA LOBO • Eliana Lobo is a nationally certified CoreCHITM Portuguese medical interpreter, and DSHS Certified medical interpreter, with two M.A.s from Brown University: • Bilingual Education • Portuguese& Brazilian Studies • Formerly a medical trauma center interpreter services Supervisor & Trainer, Spanish & Portuguese Translations Supervisor, National Director of Interpreter Quality, and currently Director of Lobo Language Access in Tacoma • Since 2013, Eliana has helped create and host over 30 national webinars on effective medical interpreter training via the NCIHC’s “Home for Trainers” webinar workgroup • Currently Chair of the Standards and Training Committee of NCIHC and NCIHC Board member • Adjunct Professor of Professional Medical Interpreting at Highline College, WA
  • 3. LEARNING OBJECTIVES: INTERPRETING FOR WELL VISITS • Learn the proper protocols for filling out patient forms • Categories of forms • How to maintain confidentiality in crowded waiting rooms • Patient history process • Learn how to handle lengthy sight translation requests • CALL tool strategy • Review and Revise Your Pre-Session • Short but complete, every time, and you will be better able to manage the flow • Common Clinic Protocols, Topics and Terminology • Family Medicine • Women’s Clinic
  • 4. SHOULD INTERPRETERS FILL OUT FORMS WHEN ASKED? 4 This Photo by Unknown Author is licensed under CC BY-NC
  • 5. GUIDELINES FOR SIGHT TRANSLATION BY HEALTHCARE INTERPRETERS Patients typically receive four types of documents in healthcare settings, which interpreters are at times asked to sight translate: • Documents that provide general background to how an institution functions (e.g. HIPAA, patient manuals, patient bill of rights) • Documents with key information about the patient’s condition that he or she may want to access later (e.g. patient education materials) • Documents that contain specific instructions for patient care (e.g. prescriptions, preparation for procedures, discharge instructions) • Legal documents (e.g. financial agreements, consent forms, advance directives) Not all of these are appropriate for sight translation. As a general rule, the NCIHC recommends strict limits on the length and complexity of documents that interpreters should be asked to sight translate.
  • 6. GUIDELINES FOR SIGHT TRANSLATION BY HEALTHCARE INTERPRETERS 1.Documents containing general background information (patient bill of rights, HIPAA) or educational materials are often quite long, so are not appropriate for sight translation • Sight translating these documents is both time consuming and probably fruitless, as the patient is unlikely to remember something that was read aloud 2.Documents with specific instructions are appropriate for sight translation, with the provider present, so that the patient’s questions can be answered by the provider, not the interpreter! 3.Legal documents, such as consent forms, should be translated professionally and then, if necessary, read aloud by the interpreter for the benefit of the client/patient
  • 7. HIPAA COMPLIANCE FOR LANGUAGE SERVICE PROVIDERS  Foreign language interpreters are considered business associates under HIPAA legislation because they are not employed by the clinic, medical facility, or hospital utilizing their services  The sharing of patient information with a business associate (interpreter) is only intended for the specific purpose as stated in a business contract between a provider and hospital or clinic  If you are a staff interpreter working in a hospital or clinic, you should know your workplace protocols to insure patient privacy
  • 8. PATIENT PRIVACY & AVOIDING BEING ALONE WITH THE PATIENT Standards say that interpreters should never be alone with patients. If the provider leaves, you should step out of the examination room and wait outside. This helps avoid side conversations as well as the very common occurrence of having the patient unburden themselves to the interpreter about their medical condition and/or concerns. As a general guideline, this is a good rule. However, it is not written in stone, and there needs to be flexibility if we are putting patients first. There are many occasions when being alone with the patient is unavoidable. One of the most common circumstances is when the patient arrives for their first visit to the clinic. The receptionist will give the interpreter a stack of forms and say, “Please help the patient fill these out”. What should you do? / What does the professional interpreter do?
  • 9. FILLING OUT FORMS Should you fill out the forms for the patient, as you while sight translating the questions? I have three recommendations: 1.The patient should check the boxes for yes or no, as you interpret each one and move through the form 2.If the patient doesn’t know what a certain condition or disease is, move on to the next question! • Your job is to interpret, not explain medical conditions or diseases. Once you are with the provider you can ask the provider to explain what the patient did not understand, and you will interpret the Q&A 3.The patient should fill in their personal data such as name, address, date of birth
  • 10. PATIENT HISTORY PROCESS Follow these steps when interpreting for patients in waiting room: • Introduce yourself • Interpret for the receptionist and the patient • Sit near the receptionist if you can • Sight translate forms • Decide who will write the answers • Write down any patient questions as you go through the forms, then skip to the next question • Interpret any patient questions to receptionist • Return forms to receptionist, who will hand off to the M.A. • Avoid sitting with the patient while waiting after
  • 11. STRATEGY WHEN ASKED TO FILL OUT PATIENT DOCUMENTATION / FORMS What do you do when you are handed a stack of pages to sight translate? • Ask the receptionist to explain the document and what it says, while you interpret? • Wait, and ask the provider to explain the document and what it says, while you interpret? • Cite the NCIHC standard?
  • 12. SIGHT TRANSLATION & THE CALL TOOL Use these four criteria to help you decide when to perform a sight translation of any additional materials: Known as the CALL Tool Complex language Advanced terminolog y Legal language Long document s
  • 13. THE IMPORTANCE OF THE PRE- SESSION The Pre-Session is a great place to establish the hand signal or method you will use to interrupt the flow when needed, to ensure accuracy. Even with providers who do not customarily utilize the Pre-Session, you can establish many things in a few short sentences: • “Hi, I’m Eliana, your Portuguese/English interpreter” (Greeting, Introduction, and confirmation of Language) • “I encourage you to speak directly to each other in first person. Know that I will interpret everything said, and, keep it confidential” (1st person, all utterances will be interpreted, and a reminder of confidentiality/HIPAA) • “This is the hand signal I will use if I need clarification or repetition, —demonstrate the hand signal as you
  • 14. THE IMPORTANCE OF THE PRE- SESSION It is important to be able to manage expectations on both sides, and the pre-session helps do this by establishing boundaries and constraints. It’s also good customer service! • It is important that the interpreter feels comfortable managing the flow of the encounter, so establishing that pre-arranged signal or word to do so upfront is always beneficial • It is important that the patient feels comfortable disclosing personal information, so highlighting privacy/confidentiality is always a good thing to
  • 15. BREAKOUT ROOM #1 PRE-SESSION PRACTICE Lobo Language Access - 2022 15
  • 16. FAMILY MEDICINE ADULT & PEDIATRIC CHECK- UPS
  • 17. Medical History • Provider will ask the patient about lifestyle behaviors • Smoking • Excessive alcohol use • Sexual health • Diet & Exercise • The provider will also check • Vaccination status • Personal medical history and • Family medical history • Takes Vital Signs • Blood Pressure • Heart Rate • Respiration Rate • Temperature • Oxygenation • Physical Exams • Heart Exam • Lung Exam • Head and Neck Exam • Abdominal Exam • Neurological Exam • Dermatological Exam • Extremities Exam • General Appearance Provider usually asks questions about: ANNUAL PHYSICAL FOR ADULTS
  • 18. ANNUAL PHYSICALS FOR MEN An annual physical exam for men might also include: • Testicular Exam • provider checks testicles for lumps or changes in size • Hernia Exam • the famous "turn your head and cough" checks for a weakness in the abdominal wall between the intestines and scrotum • Penis Exam • The provider might notice evidence of sexually transmitted infections such as warts or ulcers on the penis • Prostate Exam • Provider inserts a lubricated, gloved, finger into the rectum to feel the prostate’s size
  • 19. ANNUAL PHYSICALS FOR WOMEN An annual physical exam for women might also include: • Pelvic Exam • PAP test (tests for cervical cancer) • HPV test (tests for human papilloma virus which can cause genital warts and in some cases, cancer) • Breast Exam • Mammogram referral Remember to always step behind the curtain when the patient undresses!
  • 21. WHAT IS A WELL-WOMAN VISIT? A well-woman visit focuses on the woman, her body, and her reproductive health • Well-woman visits are also known as • gynecological exams • pelvic exams • annual exams • These visits are an important part of preventative health care
  • 22. WHAT HAPPENS DURING A GYN VISIT? What happens during a well-woman visits (also called well woman exams) depends on a few things, like the woman’s age, her sexual history, and medical history • It’s a good idea for the first well-woman visit to take place at around the age 13 to 15 • It may just be a talk with the doctor plus a regular physical exam • The provider will check height, weight and blood pressure • Menstrual cycle will be discussed, especially if the patient has heavy, painful, or irregular periods • If the patient is under18, certain immunizations, like the HPV vaccine, will be offered • Around age 21, women will begin needing regular pelvic exams, Pap tests, and breast examinations.
  • 23. WHAT HAPPENS DURING A PELVIC EXAM? 1.The external exam — The doctor or nurse will look at the vulva and the opening of the vagina. They’re checking for signs of cysts, abnormal discharge, genital warts, irritation, or other issues 2.The speculum exam — The doctor will use a speculum to examine the patient’s vagina and cervical opening a. The doctor will then take a small sample of cells from the patient’s cervix. This sample will be sent to a lab for a Pap test to see if there are any pre-cancerous cells or cancer in the cervix b. If the doctor or nurse is testing for STDs (like chlamydia or During a pelvic exam, a doctor or nurse examines the patient’s vulva and internal reproductive organs: vagina, cervix, ovaries, fallopian tubes, and uterus. There are usually four parts comprising a pelvic exam:
  • 24. PELVIC EXAM: INTERNAL EXAM 3. The bimanual exam — During this part of the exam, the doctor or nurse will put 1or 2 gloved and lubricated fingers into the patient’s vagina while gently pressing on the patient’s lower abdomen with their other hand. The provider is checking for a. the size, shape, and position of the uterus b. tenderness or pain — which might mean infection or another condition c. enlarged ovaries, fallopian tubes, ovarian cysts, or tumors 4. The rectovaginal exam —doctor or nurse places a gloved finger into the rectum. This checks the muscles between the vagina and the anus, and checks for tumors behind the During a pelvic exam, a doctor or nurse examines the patient’s vulva and internal reproductive organs: vagina, cervix, ovaries, fallopian tubes, and uterus.
  • 25. BIRTH CONTROL, FAMILY PLANNING & STD TESTING • When was your last period? • How often do you have periods? • How long do they last? • Do you ever bleed/spot between periods? • Do you have any unusual pain, itching, or discharge from your vagina or vulva? • What medical problems do other members of your family have? • Do you have any other medical conditions? • Are you sexually active? • Do you have sex with men, women, or both? • Is sex ever painful? • Do you bleed during or after sex? • Are you using birth control? • Do you think you might be pregnant? • Do you want to get pregnant? • What do you do to prevent STDs? If the woman is sexually active (meaning engaging in vaginal, anal, or oral sex), birth control and STD testing will be discussed. Common questions include:
  • 26. MAMMOGRAMS • Patient must undress above the waist • The facility will provide a robe • A technologist will position the patient’s breasts for the mammogram • To get a high-quality picture, the breast must be flattened • The technologist places the patient’s breast on the machine’s plate • The plastic upper plate is lowered to compress the breast for a few seconds while the technologist takes a picture. • The whole procedure takes about 20 minutes • The actual breast compression only lasts a few seconds • Sometimes when patient’s breasts are compressed, it can be painful • Two views of each breast are taken for a screening
  • 27. BONE DENSITY STUDIES What is a bone density study? • A bone density test determines if the patient has osteoporosis, which is a disorder characterized by bones that are more fragile and more likely to break • A bone density test uses X-rays to measure how many grams of calcium/other bone minerals are packed into a segment of bone • The most commonly tested bones are the spine, hip and the forearm • A bone density test of the hip and spine uses a central
  • 28. BONE DENSITY STUDIES Although osteoporosis is more common in older women, men also can develop the condition. A doctor may recommend a bone density test if the patient has: • Lost height. People who have lost at least 1.6 inches (4 centimeters) in height may have compression fractures in their spines, for which osteoporosis is one of the main causes • Fractured a bone. Fragility fractures occur when a bone becomes so fragile that it breaks much more easily than expected. • Taken certain drugs. Long-term use of steroid medications, such as prednisone, interferes with the bone-rebuilding process — which can lead to osteoporosis. • Received a transplant. People who have received an organ or bone marrow transplant are at higher risk of osteoporosis, partly because anti-rejection drugs also interfere with the bone- rebuilding process. • Had a drop in hormone levels. In addition to the natural drop in hormones that occurs after menopause, women's estrogen may
  • 29. PEDIATRICS ONE-WEEK AND ONE MONTH WELL VISITS
  • 30. PEDIATRIC VISITS Generally, well-baby and well-child visits are for check-ups, immunizations, and clearance to participate in athletics. Well-baby visits begin as early as one week followed up by the one month visit. This first well-baby visit is usually injection-free. However, if the baby did not receive the CDC-recommended HepB (hepatitis B) vaccine at birth, s/he should receive it now. • Common topics (prepare your word equivalents ahead of time) of discussion include: • Vaccinations such as, DPT and MMR • Milestones for development • Percentiles on growth and weight charts
  • 31. THE FIRST WEEK WELL-BABY VISIT In addition to taking measurements and doing a complete physical exam, the pediatrician will: • Check to see how the umbilical stump is healing • Check baby’s circumcision, if he had one • Check for newborn jaundice
  • 32. DEVELOPMENTAL MILESTONES At this visit (or very soon after), babies may already be able to: • Move arms and legs on both sides of the body equally well. • Focus on objects within 8 to 15 inches • Lift head briefly when on tummy Developmental milestones like these follow roughly the same timeline for most babies during their first year of life.
  • 33. MATHEMATICAL CONCEPTS AND CONVERSION As mentioned, frequent topics in Pediatrics include: • Milestones for development which typically cover at what ages a baby can accomplish a specific task, such as sitting, crawling, cruising, climbing, walking, babbling and talking • Percentiles on growth and weight charts, understanding the difference between • Percentage vs. percentile • Height, weight, circumference
  • 34. MATHEMATICAL CONCEPTS AND CONVERSION Often, the nurses and medical assistants do not know how to convert values into metric for parents. Moms really want to know what their child’s temperature is! Keep your formulas handy on your phone or notepad, or better yet, use an app. • https://freeappsforme.com/unit-converter-apps • https://play.google.com/store/apps/details?id=c om.wighthat.MetricConversion&hl=en_US&gl=US • https://play.google.com/store/apps/details?id=c
  • 35. MATHEMATICAL CONCEPTS AND CONVERSION •Converting from Fahrenheit to Celsius •(32°F − 32) × 5/9 = 0°C •Converting from Celsius to Fahrenheit •(0°C × 9/5) + 32 = 32°F •Converting from metric to imperial standards • Ounces to Milliliters (1 ounce of fluid = 29.5735 ml) • Pounds to Kilos (1 pound = 0.453592 kilos), or • Kilos to Pounds (1 kilo = 2.20462 pounds) • Inches to centimeters (1 inch = 2.54 cm)
  • 36. MATHEMATICAL CONCEPTS AND CONVERSION • Percentage vs. Percentile • The concept of percentages is very familiar to most people, because we come across them frequently in our daily lives. For example, our assignments at school were graded with percentages. However, ‘percentile’ is a similar word that has an entirely different meaning • While percentages indicate how well a person performed on a test, percentiles indicate how well that individual performed compared to others. It’s a more complicated concept than a percentage. • The percentile is a comparative score, whereas the percentage is based on individual scores • Mean vs. Average • Average, is the sum of all the values divided by the number of values • A mean is defined as the mathematical average of the
  • 37. WHAT DOES THE PEDIATRICIAN LOOK FOR? The doctor will also look for reflexes that are standard issue at birth and are signs that a baby’s new nervous system and brain are working well. • These include the rooting and sucking reflex • ensures baby can locate and secure the food source • The Moro reflex (also called “startling,” which is that jumpy reaction when baby is laid down on his back or is startled by a noise or other sensation) • The tonic neck reflex (this one makes a baby look like he’s fencing) • The grasp reflex (baby’s fingers will curl up in a grasp when his palm is stroked), and • The stepping reflex (baby appears to take steps when
  • 38. BABY'S 1-MONTH CHECKUP: WHAT TO EXPECT You Can Expect Your Baby's Doctor to: • Check that baby's umbilical cord stump has fallen off, and that baby's belly button is healing properly • Examine your baby boy's penis if he was circumcised • Give your baby a hepatitis B vaccine • The shot is usually given in the hospital at 2 days and then at 1 month and again at 6 months of age • Some pediatricians give it at birth, then at 2 and 6 months • Check baby's weight and height • Ask for details about the baby’s feeding schedule Remember to always step behind the curtain once the pediatric patient
  • 40. IMMUNIZATIONS • The vaccines covered in this webinar are those most likely to be given during the well visits during infancy and early childhood. • Other vaccines (including measles, mumps, and rubella; varicella; rotavirus; influenza; and hepatitis A) are also routinely recommended during the first five years of life • Know terminology equivalents for all of the above common childhood diseases • Be prepared to interpret the vaccination protocols • the timeline for future
  • 41. BREAKOUT ROOM #2 INTERPRETER DIALOG PRACTICE SCENARIO IN PEDIATRICS WITH METRIC TO IMPERIAL CONVERSION 05/21/19 Lobo Language Access - 2019 41
  • 43. WHAT HAPPENS DURING A DENTAL CHECK-UP? There are two parts to a regular dental visit or check-up, the examination and cleaning, and possibly oral prophylaxis • The dental professional will check for cavities • X-rays might be taken to detect cavities • Remember to always step outside when the patient is having X-rays taken! • Stand where the tech stands • The exam will also include • Checking for plaque and tartar on the patient’s teeth • Gums will be checked with a special tool to measure the depth of
  • 44. INTERPRETING DURING A DENTAL VISIT Most of the interpreting done during a dental visit occurs just before and just after the patient lies back in the dentist’s chair. After all, from then on, the patient doesn’t actually talk much. But I encourage interpreters to interpret everything the Dentist and the Dental Assistant say to each other while treating the patient. Be attentive so you can be aware when the patient signals pain or distress (or just plain fear) and keep that communication going between patient and provider! • Questions before treatment involve history, prior treatments and descriptions of symptoms and pain • Questions post treatment revolve around post-care, scheduling return visits and what to expect given the nature of the specific treatment received • After cavities are filled, dental assistants often demonstrate how to properly floss • Often for pediatric patients, a fluoride coating is applied to the teeth
  • 45. RESTORATIVE DENTISTRY • Veneers • Tooth Whitening • Bridges • Dentures • Implants All of the above require healthy teeth and surrounding gums before the patient can begin treatment
  • 46. ORTHODONTIA Types of Braces • Traditional metal braces: metal bracket attached to teeth, with a metal archwire attached to the brackets • If the patient has an overbite or underbite, they may also need to wear rubber bands that connect from the bottom to the top rows of teeth • Clear braces: offer a more discreet appearance • The only really visible part of the braces is the thin metal archwire that helps to shift teeth into proper alignment • Invisible braces: clear plastic trays that fit over teeth without looking all that noticeable • The orthodontist provides a new set every few
  • 47. PUT PATIENTS FIRST! Remember, the first step to building trust is respect • Respect your patient’s privacy by asking for a private area to fill out forms if most of the people in the waiting room also speak your patient’s language • Always step behind the curtain when your patient undresses • Always step away when X-rays are being taken • Always check for understanding Have a short and sweet pre-session prepared and, • USE IT EVERY BEFORE EVERY ENCOUNTER! • Remember to use the CALL tool for sight translation requests • Keep working on your terminology equivalents
  • 48. BREAKOUT ROOM #3 INTERPRETER DIALOG PRACTICE SCENARIO IN ADULT MEDICINE Lobo Language Access - 2022 48
  • 49. RESOURCES & GLOSSARIES 1. Johns Hopkins Medicine, Glossary for Pediatric Health https://www.hopkinsmedicine.org/healthlibrary/conditions/pediatrics/glossary_-_pediatrics_85,P01018 2. CMS Government Glossary https://www.cms.gov/apps/glossary/default.asp?Language=English&Letter=P 3. Society of Teachers of Family Medicine Glossary https://www.stfm.org/about/about/glossary/ 4. Sexual Health Glossary http://www.ashasexualhealth.org/sexual-health-glossary 5. Johns Hopkins Medicine, Glossary for Gynecological Health https://www.hopkinsmedicine.org/healthlibrary/conditions/gynecological_health/glossary_- _gynecological_health_85,P00562 6. Glossary of Dental Health Terms https://www.webmd.com/oral-health/dental-health-glossary#1 7. Orthodontic Glossary: Oral B https://oralb.com/en-us/oral-health/orthodontic-glossary
  • 50. REFERENCES USED FOR THIS WEBINAR 1. NCIHC Sight Translation and Written Translation Guidelines for Healthcare Interpreters https://www.ncihc.org/assets/documents/publications/Translation_Guidelines_for_Interpreters_FINAL0 42709.pdf 2. HIPAA Compliance for Language Service Providers https://interpretersunlimited.com/uncategorized/hipaa-compliance-language-service-providers/ 3. Annual Physical Examinations for Adults https://www.webmd.com/a-to-z-guides/annual-physical-examinations#1 4. What is a well-woman visit? https://www.plannedparenthood.org/learn/health-and-wellness/well-woman-visit 5. Mammograms: What to Know Before You Go https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early- detection/mammograms/mammograms-what-to-know-before-you-go.html 6. Bone Density Tests https://www.mayoclinic.org/tests-procedures/bone-density-test/about/pac-20385273
  • 51. 7.The First-Week Well-Baby Visit https://www.whattoexpect.com/first-year/health-and-safety/first-week-well-baby-visit 8.Baby's 1-Month Checkup: What to Expect https://www.webmd.com/parenting/baby/babys-1-month-checkup-what-to-expect#1 9.Your Child's First Vaccines https://www.cdc.gov/vaccines/hcp/vis/vis-statements/multi.html 10.Why a Regular Dental Check Up is Important? https://www.dentalcare.com/en-us/patient-education/patient-materials/why-are-regular- dental-visits-important 11.What to Expect Once You Have Braces https://www.absolutedental.com/blog/what-to-expect-once-you-have-braces REFERENCES USED FOR THIS WEBINAR
  • 52. CLINIC BULLETIN BOARDS & RESOURCE AREAS Public health clinics are a great, and often overlooked resource Texts covering a wide range of subjects, and often in several languages, are FREE to the public! WHERE ELSE CAN I FIND FREE PRACTICE MATERIAL?
  • 53. CLINIC BULLETIN BOARDS Public health clinics provide resources from the community as well health information materials in the form of pamphlets and posters 11/14 /2022 Lobo Language Access 5 3 WHERE ELSE CAN I FIND PRACTICE MATERIAL?
  • 54. WHERE ELSE CAN I FIND FREE PRACTICE MATERIAL? Clinic Exam Rooms Look for written materials in different areas throughout the clinic or hospital. Sometimes, you can find them on the back of the
  • 55. CLINIC BULLETIN BOARDS & RESOURCE AREAS Public health clinics provide resources from the community as well as from pharmaceutical vendors, who often distribute educational materials in the form of pamphlets and informational posters along with products sold to the clinic WHERE ELSE CAN I FIND FREE PRACTICE MATERIAL?