Contracting

Working with an Interpreter: During the Genetic Counseling Session

When working with an interpreter, it can be challenging to learn how to adapt your counseling style to maintain the fluency of the session despite accommodating pauses for accurate interpreting. Below are some tips to follow when working with an interpreter during the session:

  • Use simple words; avoid jargon and acronyms. Also, limit or avoid technical language unless it is essential to the session.

    • Because medical jargon is often not the same in other languages, using simpler terms can help ensure that your message can be interpreted as accurately as possible. If it is important that the family know a medical term, like the name of a diagnosis, contract with the interpreter before about how to translate that term. If this is not possible, be sure to explain what the term means after presenting it.

  • Realize that everything you say in the session will be interpreted, so do not say things you do not wish your patient to hear.

    • Interpreters are trained to translate every word said by the family and the provider and are not allowed to pick and choose what is translated lest it interfere with the communication during the session. Just as you would when the patient speaks your preferred language, assume that s/he will hear everything that you say.

  • Speak at a moderate pace and do not shout. Also, articulate your words completely.

    • Speak to families in the same tone of voice that you would normally use, but consider slowing down your pace to give the interpreter time to fully understand your whole message. However, going too slow can also interfere with the pace of the interpretation.

  • Face the patient and address him/her directly.

    • Speak to the patient as if the interpreter is not present. It is important to direct your attention at the patient, not the interpreter. Some counselors find this is easier if they ask the interpreter to stand out of eyesight, not between the patient and the counselor. Unless you have specific preferences, interpreters are trained in using their position in the room to best facilitate communication and usually have their own preferences.

  • Do not expect the medical interpreter to lend assistance during the physical exam or to provide any assistance outside of their role as interpreters.

    • Unless the interpreter is a bilingual staff member trained in another allied health field, the interpreter should not be expected to fulfill medical or childcare roles. Medical interpreters often do not carry the same insurance as physicians or nurses, and therefore do not participate in areas of care involving medical procedures.

  • Give your message in small chunks.

    • This allows the interpreter to translate small segments of information at a time (one or two sentences related to the same thought) and ensures that they are able to relay the whole message. If your session is subject to strict time limits, it may be important to re-evaluate what is most essential to get across to the patient because of the extra time involved in interpreting.

  • Be patient and do not interrupt the interpreter while she is translating.

    • Encourage your interpreter to ask for clarification if needed. Be prepared to rephrase or explain ideas further if the interpreter asks for clarification. As interpreters are trained to translate concept-by-concept and not word-for-word, further explanation may be needed to make the concept more explicit and therefore more easily translated.

    • Keep in mind that English is a fairly direct language, so the interpreter may need extra time to relay the message in the grammar and communication pattern of the target language.

  • Never assume that because an individual has limited English proficiency he/she has a lack of education or low health literacy. It's a good idea to repeat important information and verify both literal comprehension and overall understanding regularly throughout the session.

    • Medical logic can vary widely over cultures, so this is especially important if your patient has a non-Western view of what causes illness. For more information on how to assess medical logic, see below.

    • It is extra important to continually monitor the body language of the patient to verify their comprehension and feelings about the information being relayed.

  • Use pictures, demonstrations, video or audiotapes during the session to increase understanding and provide educational material in the languages your patients read.

    • Ensuring that visual aids and educational material are appropriate for patients with LEP involves much more than checking that they are available in the target language. These materials should not just be translated from English versions; they should also be culturally sensitive. This includes using pictures or images of the ethnic group represented by that spoken language. More information on creating culturally sensitive written material in a target language is included in another case.
       
  • Informed consent and other medical forms must be available in the preferred language of the patient.

    • Many health care centers have translated their routinely used forms into the most frequently requested languages, but if the form you are using is not in the target language, the form must be translated by the interpreter during the session so the patient can understand what they are signing. However, not all interpreters are comfortable with performing this task, which is referred to as "sight translation." Therefore, consider working with Translator Services to translate the most commonly used forms in your clinics.

    • Remember that although the interpreter is there to answer language questions, you as the provider are there to interpret the meaning of the document. Explain consent and other forms as you would to any other patient.

    • More information on translation is featured in another case.
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