Expert Commentary by Gloria A. Sanchez-Araiza, MS, MPH, CGC
Project Manager
OB/GYN Department
Otay Mesa MOB
Phone: (619) 210-4048
Fax: (619) 662-5225
Email: Gloria.A.Sanchez@kp.org
Tie line 275
Genetic Counseling with Medical Interpreters
This case raises several issues confronting genetic counselors in their daily practice. It is a case example relevant to our times and exemplifies the need for changes within the genetic counseling profession in response to demographic shifts and legislation requiring that all people have access to culturally sensitive competent health care in their preferred language.
We often take the more complex path as we ponder how to respond to a situation. In many situations it is best to take the simpler route, to not overcomplicate the ‘problem.’
The issue: Does this family currently need interpreter services? The simplest, most direct, least complicated path to answer this question is to use the organization’s language phone line interpreter system. The family can be contacted with the assistance of a language phone line interpreter who can ask them if they want to have a bilingual Spanish/English interpreter present at their genetic counseling appointment. If their response is no, the issues raised in this case example are no longer ‘issues.’ If their response is yes then this question has been answered and the genetic counselor can now move toward resolution of the other issues. As an additional benefit, the initial contact with the assistance of a language phone line interpreter can be used as an introduction for the genetic counselor and a means of initiating rapport with the patient/family.
Before proceeding I want to address whether this family needs an interpreter’s services. Sometimes patient’s have received interpreter services although they are bilingual Spanish/English speakers. The assignment of an interpreter may have occurred due to their Spanish surname or Spanish accent. Example: A patient phones in to schedule a genetic counseling appointment; the patient initiates the conversation in English and a bilingual Spanish/English receptionist making note of the patient’s Spanish accent switches the communication from English to Spanish. This is a culturally sensitive response on the part of the receptionist – a response perceived to be a respectful one within the cultural context. The end result, however, may be that the receptionist has now identified this patient as a Spanish speaker, labels the patient as such, and the patient will now receive interpreting services when she/he attends an appointment. The patient may perceive the presence of an interpreter at her/his appointment as a respectful acknowledgement of her/his culture and may not inform the genetic counselor of her/his English speaking skills. In the case example, the genetic counselor has noted that the patient and his family used an interpreter in the past but wants to evaluate their ‘…current need for interpret services.’ It is important to evaluate a patient’s current needs for these services to verify that their language preferences and skills have been accurately documented. It is also important to avoid the presumption that immigration from Mexico is synonymous with ‘Spanish speaking only.’
Julie’s desire to provide genetic counseling and interpreter services may be well intentioned but brings to mind the idiom ‘First do no harm.’ Is the patient’s well being the primary consideration, or is the primary consideration Julie’s desire to use this as an opportunity to exercise her Spanish speaking skills? Julie has lived abroad and studied Spanish for many years. Was her experience abroad limited to one or more Spanish speaking countries? Did this experience include Mexico ? How well versed is she in the dialects among the Spanish speaking countries. Is she well versed and skilled in interpreting medical terminology. Has she been approved by her institution to provide interpreter services? Is she a Qualified Bilingual Speaker (QBS) in Spanish/English? Has she passed the appropriate tests? Is she certified? Is interpreting included in her job description? A professional who decides to provide interpreter services without appropriate approval is subject to institutional, professional, and legal sanctions that can adversely affect her/his professional reputation and standing, may result in her/his termination, and may subject her/him to legal actions. The primary consideration should be the patient. Without appropriate approval, there is no assurance that Julie can accurately interpret the medical information for this patient and their family. There is the potential for misinterpreting medical information that may adversely impact the well being of the patient and their family.
Since Julie has some level Spanish language skills and an apparent desire to use these skills, this case provides her with an opportunity to explore the interpreter services available through her institution, interact with interpreters sanctioned by her institution, and to learn about QBS certification or other means of certification. She can use this case to work with other interpreters, learn about their interpreting styles, and educate them about genetic counseling using educational resources and training sessions. This also provides an opportunity for the interpreters to share information with her about how they became certified – QBS programs/tests, state certification programs, exams, etc. They can also provide information about resources for interpreter and/or translation services within their institution and bilingual educational resources, and help her improve her Spanish medical terminology skills. If Julie is truly interested in providing quality interpreter services and has the ‘patient’s well being’ as her primary concern, she will seek certification through the appropriate channels.
Gloria A. Sanchez-Araiza - a native of San Antonio, Texas - is of Mexican and Native American ancestry. She obtained Master's degrees in Genetic Counseling and Epidemiology with minors in Health Education and Biostatistics from the Universities of California in Berkeley and Los Angeles. She is board certified in Genetic Counseling and is a Founding Member of the American College of Medical Genetics (ACMG). As a genetic counselor for almost 3 decades, Ms Sanchez-Araiza provided genetic, prenatal diagnosis, breast cancer and teratogen counseling, and follow-up services for referrals from the California State Expanded Alpha-Fetoprotein (AFP) and Newborn Hemoglobin screening programs primarily for Spanish speaking patients and their families. Currently, Ms Sanchez-Araiza is a Project Manager in the Department of Obstetrics and Gynecology at Kaiser Permanente in San Diego, California.
