Working with an Interpreter: Before the Genetic Counseling Session Begins
Every hospital and clinic has varying procedures for identifying the preferred language of patients and providing interpreters if needed, so please take some time to familiarize yourself with your employer’s protocol for accomplishing the above steps. When searching for more information from your employer, tips for locating interpreter services include searching for Interpreter Services, Translation Services, Guest Services or Patient Customer Service. Depending on the amount of resources your employer has allotted to Interpreter Services, you may find a range of services offered from over-the-phone interpreting, to live Medical Interpreters for face-to-face sessions, to in-house Medical Interpreters who are available for helping you communicate with patients who are at home (for scheduling referrals, making appointments, or discussing test results). Some institutions offer internet-based video interpreting. While this technology is expensive, it allows for the same visual cues as live interpreting. Although our case mainly focuses on how to work with medical interpreters during live face-to-face sessions, many of the same principles apply to other methods of interpreting. For more information about working with interpreters, see the Interpreters and Translators section under Resources for this case.
In order to determine if Julie’s family still requires interpreter services, a good place to start would be to check the hospital’s general medical records to see if there is a recent notation about the language needs of the family. Most hospitals have a standard procedure for determining if an interpreter is needed or declined by the family. If Julie is not able to obtain this information from medical records, Julie may want to use her Spanish-speaking skills and call the family to confirm the appointment. The other goal of this phone conversation is to ask which language the family would prefer to conduct the session in (in English, or in Spanish, using an interpreter).
Most hospitals determine the preferred language of the patient upon scheduling and if the patient requires an interpreter, it may be the responsibility of the genetic counselor to schedule an interpreter for the session. Although individual hospitals have different policies about scheduling, it is important to schedule with the interpreter as far in advance as possible in order to ensure that an appropriate interpreter is available. Additionally, when scheduling an interpreter appointment, be sure to give the scheduler an idea of how long the appointment might be. Working with a family who requires an interpreter will typically take more time, so if possible, schedule a longer appointment than you usually would for the same indication (up to twice as long, depending on the interpreter). It is also important to keep in mind that individuals from some cultures may be more comfortable with certain kinds of medical providers (including interpreters). Therefore, if possible, choose an interpreter who meets the needs of the patient, by considering matching for age, sex and cultural background. If the patient does not feel comfortable with the interpreter, they may be reluctant to disclose sensitive medical or personal information that could be essential to the genetic counseling session.
Once an interpreter has been assigned to the case, the genetic counselor may want to speak to the interpreter by phone or in person, well before the scheduled genetic counseling appointment. Pre-session contracting with the interpreter helps the two professionals develop rapport and review the technical terminology that will be necessary for a specific counseling session. If the interpreter is not familiar with any essential terminology or concepts, the genetic counselor can explain them, and/or provide reading material, to help the interpreter prepare for the session. This pre-session meeting helps keep the focus of the upcoming counseling session on providing the best possible client-centered care.
When the patient arrives with the interpreter for his or her appointment, the single most important step for a successful session is taking time to contract with the interpreter alone before seeing the patient. During this time, you should address the following topics:
• The role of the interpreter, the role of the genetic counselor and the roles of any other providers that will be involved in the session
• The interpreter’s style: does s/he prefer to translate simultaneously or after you have said a short segment? What exactly does s/he translate: is it word-for-word or the idea of the information?
• If you are a bilingual provider, take this time to share your level of fluency with the interpreter and discuss how this will be handled in the session
• Give a general overview of the indication for referral to the interpreter and ask them about their familiarity with the indication.
• Depending on the expertise of the interpreter, it may be useful to review some medical terms and/or medical genetics terminology, as relevant to the case, if that jargon absolutely necessary for the session.
• Ask the interpreter about their familiarity with this patient, and if they have worked with either this patient or this patient population before.
• If you are lucky, the medical interpreter may be more of a cultural broker [see below] and can give you additional insight into the family and cultural guidance in interacting with them.
