Overview of interpreting in medical settings

1. 1
TrIn 3101: Introduction to
Interpreting
Unit 9: Overview of Medical
Interpreting Settings
Dec. 1, 2004

2. 2
Class agenda for Dec. 1, 2004
Turn in assignment #7: Ethical Situation (2 paragraphs – 20
pts)+thought questions: 34-36, 143-44, 140-42, 165-72
Unit 9 goals:
1. Guidelines and linguistic concerns
2. Analyze and discuss at least one case study specifically
related to the health care context
3. Mikkelson/Downy topics
4. Peer discussion for introduction assignment #8
Assignments: Dec. 8 – Self-assessment of Introductions +
videotape (30 pts.)

3. 3
Review: Sight Translation
Sight translate the attached document
from last week into your other
language. Later, discuss the accuracy
of marked words or phrases, delivery,
and fluency. When you are ready, set
your timer to 5 minutes, turn to the
handout and begin.

4. 4
Sight Translation practice
1) Sight translate for your classmate from
English to your other language a paragraph
of unfamiliar reading material from your
text. Reader and observer comment on
difficulties noted (hesitation vs. consistent
flow, voice modulation)
2) Do the same with familiar material or
study a portion of unfamiliar reading
material before interpreting.

5. 5
Interpreting for 3+ groups
Discuss strategies for:
A. a group therapy situation
B. a medical appointment with husband and wife
C. a school conference with teacher,
psychologist, principal and both parents
If time allows, act out one of the situations with
an interpreter.

6. 6
Telephone techniques
Special factors:
Unable to see either
party
Vocal sounds may
be distorted
Conference vs.
single caller
Language line
Using cell phones,
enact an
interpreting
session.

7. 7
Interactional Issues
Discuss interactional issues in medical
situations: stress, high emotional content,
family dynamics, sharing bad news, seeing
pain and death.
Discuss feelings upon entering the situation,
dealing with anxiety, stress, emotionally
charged cases, interpreting for patients or
family members in distress, and coping with
the death of a patient.

8. 8
Interactional Issues
How might the interpreter avoid the
“nodding syndrome” with regard to register?
Is it the interpreter or the provider who must
simplify medical language?
The flowery style and tendency to “go on
and on” of Hispanics may create
communication problems. What problems
may develop and how does the interpreter
cope?

9. 9
Terminology
Discuss resources for medical
terminology for various languages and
ways that interpreters can start their
own terminology banks and resource
files of medical information.

10. 10
Accepting Assignments
1. How do you know whether or not you
are qualified for a medical interpreting
assignment?
2. What skills and knowledge does a
medical interpreter need?
3. What are the Minnesota state
guidelines for medical interpreters?

11. 11
Accepting Assignments
1. What are the repercussions of
accepting jobs that you are not
qualified for?
2. Is some service better than no
service? Under what circumstances?
3. If you hear something that you don’t
understand, what are your options?

12. 12
Cultural and Linguistic Issues
Video: how to work with interpreters
(from the health care provider’s perspective)
Vignette #1: Identify errors
Vignette #2: Identify appropriate
interpreting techniques used
Discussion: Holly Mikkelson article

13. 13
Summary of Tips
…for the health care provider
(Downing pp. 34-36)

14. 14
Guidelines for Working with Interpreters
Use qualified interpreters who know their role,
limitations and responsibilities.
Don’t depend on children, relatives, friends or ad
hoc interpreters (bilingual coworkers) to interpret.
Have a brief pre-interview meeting with the
interpreter.
Establish a good working relationship with the
interpreter.
Plan to allow enough time for the interpreted
session (all utterances are stated twice).

15. 15
Guidelines
Address yourself to the interviewee, not the
interpreter.
Don’t say anything that you don’t want the other
party to hear.
Use words, not gestures, to convey your meaning.
Speak in a normal voice, clearly, and not too fast.
Avoid jargon, technical terms and cultural
references.

16. 16
Guidelines
Keep your utterances short, pausing to
permit the interpretation.
Ask only one question at a time, not chain
questions.
Expect the interpreter to interrupt when
necessary for clarification.
Expect the interpreter to take notes or
consult the dictionary when things get
complicated.

17. 17
Guidelines
Be prepared to repeat yourself in different words if your
message is not understood.
Have a brief post-interview meeting with the interpreter to
assess how things went.
If the interpreter has limited interpreting skills:
Make sure the interpreter understands his/her role before
you begin.
Use the simplest vocabulary that expresses your
meaning.
Speak in short and simple sentences.
Check to see if the message is understood. Ask the
interpreter to repeat the message back to you before
attempting to interpret to the patient.

18. 18
Guidelines
There may be less eye contact with you and more
with the interpreter.
A gesture by the patient may not mean what it
would mean if done by the provider.
Remember: the interpreter is only there because
the patient and health care provider do not speak
the same language
Do not expect the interpreter to function in an
inappropriate manner, i.e., give dismissal
instructions, checking on patients at home, etc.
BE PATIENT!

19. 19
Prior to the interview
Allow extra time for an interpreted patient consultation.
Meet with the interpreter briefly before seeing the patient to
discuss any issues that may arise during the interview.
Ask the interpreter for the correct form of address and the
correct pronunciation of the patient’s name.
Decide on simultaneous or consecutive mode of
interpretation. What do you consider when deciding?
Encourage the interpreter to inform you of any problems
that arise.

20. 20
During the Interview
Introduce yourself to the patient
Address the patient directly
Observe the patient for non-verbal signals
If you need to consult with the interpreter,
explain to the patient what you are doing
Speak slowly and clearly with frequent
pauses
Try to avoid technical jargon or idioms

21. 21
After the Interview
Discuss any linguistic or cultural
issues that arose
Examples?

22. 22
Medical Glossary
Preparation for medical encounters:
1. READ, READ, READ!
2. Make yourself available to listen to and
observe providers as they discuss patient care;
ask to accompany the providers during rounds.
3. Build a resource manual of Web glossaries,
field specific bilingual dictionaries, translated
patient education materials from CDC, etc.
4. Build a network of interpreter colleagues for
consultation and support.

23. 23
Terminology
Discuss resources for medical
terminology for various languages and
ways that interpreters can start their
own terminology banks and resource
files of medical information.

24. 24
False cognates (Medical)
English:
Constipation
(intestinal
blockage)
Drugs
Spanish:
Constipación
(nasal
congestion)
Drogas vs.
medicamentos

25. 25
Register variations (anatomy)
English High English Low TL High TL Low
stomach tummy estómago panza

26. 26
Mayo Job Posting (sample)
Temporary 6 months (Posted 3/01)
Title: Medical Interpreter –
Spanish/Somali/Korean
No benefits, 80 hours/2-weeks, 100FTE, M-F
schedule, day shift, 0 weekends, located Mayo 1st
floor, $13.70/hr.
Job Summary: Accurately transmits messages
between non-English speaking patients and health care
providers or support personnel at Mayo Clinic. Translates
accurate, written version of documents or medical records
upon request. Explains and/or teaches cultural differences
or practices to medical center personnel. Work on as
needed and as available basis. No regular work schedule.
May participate in an on-call rotation. Works with people
from diverse cultures.

27. 27
Job Posting
Qualifications:
Medical interpreters must successfully
demonstrate oral proficiency based on a test
demonstrating fluency in both English and the
target language through the American Council
of Teachers of Foreign Languages (ACTFL). A
ranking of Advanced Low or above is required
for the position. A basic understanding of
medical protocol and terminology is necessary.
Post-secondary education is preferred.

28. 28
Ethical Situation
You are a full-time staff interpreter at a clinic. A patient
calls to schedule an appointment as soon as possible
because she has missed her period and thinks she may
be pregnant. She is scheduled to come in the following
day. The next day, when you are interpreting for her, this
same patient tells the doctor that she is there for birth
control pills. The doctor does not do an examination or
pregnancy test but does write out a prescription for birth
control pills. You, the interpreter, believe that the patient is
pregnant and wants the pills in order to miscarry.

29. 29
Discussion
What are the moral and ethical issues
involved in this case? Should the
interpreter mention her/his concerns to the
doctor or the patient? How should the
interpreter handle information that s/he
receives outside of the interpreted
situation? Using the guide for ethical
decision-making, analyze the situation and
determine possible ways to handle it.

30. 30
Introductions
VCR: Bring your videotape, your evaluation
sheet and a classmate or two to view your
recorded introduction skit.
Both you and your partner(s) discuss which
aspects were done appropriately and suggest
ways to improve the content and/or presentation.
Interpreters take notes of all suggestions by
classmate reviewers.

31. 31
Homework for Dec. 8, 2004
1. Assignment #8—Bring your
completed evaluation (blue sheet) for
your introductions and the recorded
videotape (30 pts)
2. Browse at least 10 medical websites
from the handout.
3. Locate on the internet an ACTFL
site with a speaking evaluation rubric.