Medical Interpreters: Dilemmas And Best Practices For Effective Communication

Immigrants with limited English proficiency

Medical interpreters are referred to as professionals who provide different types of languages services to their clients who are non English speaking. This ultimately helps in the proper communication with different healthcare staffs so that the client and his family members as well as the healthcare professionals may involve in a crystal clear discussion thereby clarifying any doubts, queries and other information regarding the different interventions and the caring plans of the nurses (Juckett and Unger 2014). The interpreter’s main duty is to act as instruments that are responsible for translating the words and sentences form one form of language to another and therefore the main principle that they should maintain is that of utilitarian. However, they face dilemma with handling immigrant clients and their conversations with the doctors (Vanderwielen et al. 2014). Often it occurs that the doctors say many statements which are not professionals or expresses their negative feeling over the immigrant individuals. Moreover, the physicians and nurses also portray many discussions that show their biasness towards their own culture and do not provide respect to the culture of the immigrants. In such situations, the interpreters become confused and face dilemma that whether they should translate and convey the negative feelings of the doctors and nurses with the statement o the patients. The main duty of the interpreters is that they should completely reflect the entire statement of the healthcare professionals with the exact feeling that has associated with the dialogues. However, to his own knowledge and medical code of ethics, he should never be culturally biased towards patients and should always communicate with patient by maintaining dignity and autonomy (Rice 2014). Hence they face ethical dilemma that whether they should display the negative and biased feeling of the healthcare professionals to the patients that had been said in original or communicate with the patient by omitting the negative parts and providing the statement with autonomy and dignity which was actually not shown by the healthcare professionals.

Medical tourism is mainly defined as the new concept of tourism which has originated due to the increase of urgency of the patients travelling over to other countries other than their own country. This is mainly done to obtain medical treatments which might not be well developed in their own country or when their own country is not specialized enough to hold sensitive and difficult treatments (Cohen 2014). They manly travel to get the best evidence based treatments which might not be provided within their own country. Also, it is seen that often developed countries have costly healthcare treatments and therefore many people also travel form such regions to others countries where treatments are cheaper. Hence, for such traveler’s medical tourism had gradually came in to the industrial sector which has become a business of profit and loss. Hence, a number of different stakeholders like hotels, transport systems, brokers and many others also make good profits from such business. Medical interpreters also are one of the most important stake holders in the business for they are in high demand by the patients in the foreign land to express their views and demands to the healthcare industry (Wernz 2014). They remain in association with the industry which yields them in finding the number if clients and making good livelihood with the income of business. However, they often face dilemmas when the try to perform their responsibility to their appointed clients. Often medical codes of ethics state that the finance that are to be demanded should be in just with the service, without making a whole in the patient’s pocket and at the same time provide the best service to the patients. However, often such interpreters have to come under certain pressures from the organization heads to take more profits for which they have to charge more or modify the service in a way which can take in more money from the travelers. However, medical codes of practice consider this to be dishonest and can never allow this practice to be incorporated on the basis of humanity and care for human kind. Hence, they often face a dilemma in such a scenario where they fail to decide whether to follow the advices and trends of the medical tourism industry or to follow the codes of ethics of the medical healthcare industry.

Medical Tourism

Do ‘faithful’ interpretation work?

Faithful interpretation mainly defines as the process of interpretation where the interpreter translates the discussions of the speaker in the same form that is spoken by him or her. However, the word faithful can be applied in the scenario when the interpreter discusses the topic spoken by the speaker not exactly in the same words but retaining the same meaning that was spoken (Woo and Schwartz 2014). This actually involves not injecting own opinions as well as not adding or subtracting any information from his own side. The extent of addition, subtraction as well as other manipulations is still a matter of concern in the profession of interpreting as perceived by the interpreters depending upon the value of honesty, trustworthiness and their values and morality. This often makes the profession very complex regarding the relative extent for manipulation that is allowed to still consider the interpretations to be faithful (Blakemore and Gillai 2014). More faithful the interpretation is, it is more beneficial for the stakeholders as they help to maintain accuracy and thereby reduces the chance of more errors. Moreover, faithful interpretation helps the speaker as well as the listener to develop correct ideas about each other and thereby helps to develop correct perceptions about characters, demands, needs, and others. Moreover, faithful interpretation also helps to save a large amount of time and also helps to give the right reflections of people, their status of work, the exact information, the background and other important things (Sellers 2014). Hence, more the faithful interpretation, the better results obtained from the discussions and also help to save the interpreters from any legal and ethical issues.

The right to medical interpreters is the basic rights of patient. This is important because very few people have fluency with English and federal law and state law enforces the liability of assisting patients with limited English skill. Professional medical interpreters help to overcome the linguistic barrier in patient relations. Language barrier has been found to be associated with misdiagnosis and inappropriate treatment of patient (Brisset et al. 2013, 131-140). Hence,  choice of interpretation help shapes health care outcomes in clinical settings. The choice of interpretation may be available to a patient in six different ways. These are as follows:

Simultaneous interpreting- In this process, interpreters translate the sentences into target languages as well as simultaneously listen and translate the next sentence.

Consecutive interpreting- In this style of interpretation, the interpreter stops at the end each of each complete thought and note taking is a key skill in this form of interpretation.

Escort interpreting- This type of interpretations helps a client during travelling or interacting with large group of people.

Whisper interpreting- This is useful when only one client requires interpreting and speaking softly helps client to understand the process.

Over-the-phone interpretation- This is useful when language and distance barriers affects communication process between patients and health care staffs.

On-demand phone interpretation- This is essential when immediate help is needed to communicate across language barrier and reduce risk to patient  (Niroula and Vihin 2016, pp.579-597).

Type of interpretation

One study also gave insight into the various type of medical discourse provided by the interpreters. This included dentistry, physical therapy, home health care and nursing home care. The health care provider’s chance of interpretation is also influenced by factors like time constraints, therapeutic objectives, organizational considerations and coordination of care. However, there is little chance of interpretation during clinical urgency. This leaves them with little choices in deciding the type of interpreters. Many do not regard telephone interpreter as a good solution all the times and during emergency decision making (Hsieh 2015, p. 75).

Medical interpreters and cultural mediators have a complementary role. While the cultural mediators help to address cultural barrier and enable people to better access and use health care services, the interpreters are helpful in narrowing the language gap in care. The boundaries of both this role is almost similar and so often confused by many health care. Cultural medication promotes interculturalism in health service and this task becomes successful after optimally using their skills at community level. This is critical because interpreting service are often patchy in hospital setting. There is also doubt regarding the effectiveness of the service in increasing patient satisfaction level too (Baraldi and Gavioli 2017). Hence, to overcome these limitations, both cultural mediators and role interpreters are required to make health care access easier for people from culturally different background.

Medical interpreters help those patients who lack proficiency in local language of a country or region. They play a role in bridging the language barrier and transfer meaning too patients. However, as bilingual staffs act as interpreters, the transmission of information is not accurate and confidentiality issue arises. Culture also act as an issue because many family discouraged disclosure of disease or diagnosis to patients (Kale and Syed, 2010). Therefore, in the lack of linguistic equivalency, cultural belief clash. Due to this issue, it is important for interpreters to act as cultural  mediators and articulate the difference in cultural beliefs of patient before communicating medical information to patients and family members. This helps in transition of cultural information in care (Baraldi and Gavioli 2017). Hence, considering the cultural aspects of clients during interpretation can be regarded something as beyond medical interpretation. In this aspect, they have a dual role of overcoming both language and cultural barriers in interpretation.

To get success in the complementary task of role-cultural mediators, interpretation can use cultural mediator model to facilitate effective conversation with patient group. This increases the chance of visits by those group of patients who might not visit otherwise. The interpreter can adapt their expanded roles by means of training too. Adequate training may help them connect the skill of cultural mediator to that of traditional approach of case management (). Currently, with the rise in disparities particularly in ethnic groups, cultural mediator role in medical interpretatation is more in demand. With this knowledge, they can manage issues of power and solidarity and maintain good relations between speakers of less dominant languages.

The expanded role of cultural mediators and interpretation has enabled health care organizations to avoid the problems that used to arise due to linguistic and cultural differences between patients and health care providers. Difference in cultural beliefs and values also hindered the establishment of the cooperative relationship in health care. Hence, risky communications becomes inherent when participants and interpreters lack common grounds and beliefs of interaction. Therefore, with expanded skills, language interpreters can make cultural adjustments in interpretations and maintain patient autonomy by means of better transfer of necessary medical information. Cultural mediator interpreters make several adjustment during the interpretation process so as to allow patients take control over interactions. They give power particularly to socially marginalized people. They generally do not ask much questions or evoke physician (Kirmayer, Guzder and Rousseau 2013). Hence, cultural mediators know that not speaking does not means that they do not want to know and receiving sufficient information helps them in getting involved in medical decisions.

References

Baraldi, C. and Gavioli, L., 2017. Intercultural mediation and “(non) professional” interpreting in Italian healthcare institutions. Non-Professional Interpreting and Translation: State of the Art and Future of an Emerging Field of Research, 129, p.83.

Blakemore, D. and Gallai, F., 2014. Discourse markers in free indirect style and interpreting. Journal of Pragmatics, 60, pp.106-120.

Brisset, C., Leanza, Y. and Laforest, K., 2013. Working with interpreters in health care: A systematic review and meta-ethnography of qualitative studies. Patient Education and Counseling, 91(2), pp.131-140.

Cohen, I.G., 2014. Patients with passports: medical tourism, law, and ethics. Oxford University Press.

Hsieh, E., 2015. Not just “getting by”: factors influencing providers’ choice of interpreters. Journal of general internal medicine, 30(1), p.75.

Juckett, G. and Unger, K., 2014. Appropriate use of medical interpreters. American family physician, 90(7).

Kale, E. and Syed, H.R., 2010. Language barriers and the use of interpreters in the public health services. A questionnaire-based survey. Patient education and counseling, 81(2), pp.187-191.

Kirmayer, L., Guzder, J. and Rousseau, C. eds., 2013. Cultural consultation: Encountering the other in mental health care. Springer Science & Business Media.

Niroula, A. and Vihinen, M., 2016. Variation interpretation predictors: principles, types, performance, and choice. Human mutation, 37(6), pp.579-597.

Rice, S., 2014. Hospitals often ignore policies on using qualified medical interpreters. Modern Care.

Sellers, M.N.S., 2014. What is the Rule of Law and Why is It so Important?.

VanderWielen, L.M., Enurah, A.S., Rho, H.Y., Nagarkatti-Gude, D.R., Michelsen-King, P., Crossman, S.H. and Vanderbilt, A.A., 2014. Medical interpreters: improvements to address access, equity, and quality of care for limited-English-proficient patients. Academic Medicine, 89(10), pp.1324-1327.

Wernz, C., Thakur Wernz, P. and Phusavat, K., 2014. Service convergence and service integration in medical tourism. Industrial Management & Data Systems, 114(7), pp.1094-1106.

Woo, E. and Schwartz, Z., 2014. Towards assessing the knowledge gap in medical tourism. Journal of Quality Assurance in Hospitality & Tourism, 15(2), pp.213-226.