Roles of the Medical Interpreter

Question 1

Role of Conduit/Message Converter: Definition

Answer 1

Interpreters:

• listen to both speakers
• observe body language
• convert the meaning of all messages from one language to another

without unnecessary additions, deletions, or changes in meaning

Question 2

Role of Conduit/Message Converter: How is this role performed?

Answer 2

• Interpreters must:*
• Manage the flow of communication between all the parties present.

HOW?

• Intervene (verbally or nonverbally) when parties speak too fast or fail to allow the interpreter time to interpret.
• Manage turn-taking, indicating to individuals speaking at the same time that they will be heard in sequential order or that a party must be allowed to finish speaking.

Question 3

Role of Clarifier: Definition

Answer 3

Interpreters:

are alert for possible words or concepts that might lead to a misunderstanding.

Question 4

Role of Clarifier: How is the role performed?

Answer 4

• When there is evidence that any of the parties may be confused, *
• interpreters may need to:*
• Interrupt the communication process
• Alert the parties that the interpreter is seeing signs of confusion from one or more of the parties and identify the confusing word or concept.
• Request or assist the speaker of a word or concept unfamiliar to the listener or interpreter to restate the unfamiliar word or concept in a simpler way.
• Explore ways to assist speakers to describe concepts using analogies, or “word pictures” when there are no linguistic equivalents in either language.

Question 5

Role of Clarifier: Two Important Tips to Remember

Answer 5

1. When interpreters begin speaking in their own voice, it is critical they clearly state to both parties that the message is from the interpreter. (For example, the interpreter may interject, “The interpreter would like to say…”)​​
2. Interpreters should allow the patient and provider adequate opportunity to communicate common understandings without intervening. Wait until you’re asked for help to clarify before interrupting the flow of the communication.

Question 6

Role of Culture Broker: Definition

Answer 6

The cultural broker role goes beyond word clarification to include a range of
actions that typically relate to an interpreter’s ultimate purpose of facilitating
communication between parties not sharing a common culture. Interpreters
are alert to cultural words or concepts that might lead to a misunderstanding,
triggering a shift to the cultural broker role.

Interpreters have a fundamental role in
helping both parties understand each other’s explanations on health and illness.

Question 7

Role of Culture Broker: Why is it needed?

Answer 7

• Culture and language are inseparable.
• Concepts and words sometimes exist in one language but not another.
• Finding equivalent expressions is complex.
• Cultural beliefs about health and illness around the world vary significantly from the biomedical perspective.
• Many traditional health beliefs, practices, and healers lack equivalent terms.
• Patients/providers may perceive remarks as culturally inappropriate. This occurs even though no disrespect was intended by either party. It happens more frequently when patient and provider do not share a common understanding of illness and medical treatment.

Question 8

Role of Culture Broker: How is the role performed?

Answer 8

When there is evidence that any of the parties may
be confused by cultural differences, interpreters need to:

• Interrupt the communication process with a word, comment, or a gesture
• Alert both parties to potential miscommunication or misunderstanding (Interpreters may say, for example, “As an interpreter, I think that there may be potential danger for miscommunication/ misunderstanding.…”)
• Suggest cultural concerns that could be impeding mutual understanding
• Assist the patient in explaining the cultural concept to the provider, or the provider in explaining the biomedical concept. When requested, interpreters also need to explain the cultural custom, health belief or practice of the patient to the provider, or educate the patient on the biomedical concept.

Question 9

Role of Patient Advocate: Definition

Answer 9

An individual patient’s health and well-being is at the heart of the patient
advocate role. Healthcare interpreters enter into the patient advocate role
when they actively support change in the interest of patient health and wellbeing.
Interpreters require a clear rationale for the need to advocate on behalf of patients.

Question 10

Role of Patient Advocate: Why is advocacy necessary?

Answer 10

• Limited-English speakers can face major cultural and linguistic barriers in accessing and utilizing services at all levels of the healthcare system
• Individuals with LEP find it difficult to advocate for their own right to the same level of care as English-speaking patients.
• Interpreters are often the only individuals in a position to advocate on behalf of an individual patient.

However, the Patient Advocate role must remain an optional role for each
individual healthcare interpreter in light of the high skill level skill required
and the potential risk to both patient and interpreter.

Question 11

Role of Patient Advocate: Things to Consider Before Intervening

Answer 11

• What changes are required to meet the needs of the patient?
• What options exist for the patient?
• Who can potentially carry out the positive changes?
• Is the patient in agreement with this course of action?

In undertaking patient advocacy, interpreters must carefully balance the ethics
of patient autonomy and impartiality with the need for supporting patient
well-being.

Question 12

Role of Patient Advocate: Examples of Advocacy Situations

Answer 12

Simple Situations:

• Suggesting that the patient needs an interpreter scheduled for follow-up appointments
• Giving the patient information needed to lodge a complaint with the U.S. Department of Health and Human Services Office for Civil Rights.
• Educating patients about their right to linguistically accessible services and about healthcare policy and culture.

More Controversial Situations:

• Assisting patients in filling out a grievance form
• Seeking resolution for a systemic problem

Question 13

Role of Patient Advocate: Potential Risks and Benefts of Intervening

Answer 13

Potential Benefits

May be readily apparent to the interpreter, since the decision to intervene often stems from the interpreter’s interest in having patient needs better met.

Potential Risks

• The healthcare provider or staff member may resent the interpreter’s efforts.
• They might react in a way that actually diminishes quality of care or access for the patient.
• Lasting resentment may have a long-term impact on the interpreter, resulting in a less effective working relationship.
• Depending on the type of patient advocacy intervention and whether the action is discussed with the patient, interpreters also risk usurping patient autonomy in determining how their cases are handled.

Question 14

Role of Patient Advocate: Witnessing Discrimination of a Patient

Answer 14

When interpreters witness discrimination by healthcare providers or staff
members, interpreters may need to:

• Remind the parties of the ethical principle requiring interpretation of everything said in the interaction.
• Ask the parties to explain the intentions of their comments or actions, to eliminate the possibility that the perception of discrimination is not, in fact, a misunderstanding.
• Provide the patient with the appropriate information or resources, or refer them to other staff for further assistance.
• If the above strategies are not effective, interpreters could document the incident and bring it to the attention of their supervisor or another appropriate department. Institutional policies may limit the actions of interpreters in this role.