Interpretation Best Practices (November 2020)

On behalf of the Peds Residency Immigrant Health Task Force (IHTF), we hope you are taking care of yourselves and staying safe. Please see our latest Immigration Health Tip of the Month below, which highlights helpful best practices from our very own UCSF Medical Interpreters! 

Medical interpretation: 

Purpose:  In order to provide equal access and culturally appropriate care to non-English-speaking, speech, hearing, or visually impaired patients, certified Non-English and American Sign Language interpreting services are available 24 hours per day. These include in-person, video and telephone interpreter services. 

Proper use of interpreters, terminology etc.

INTERPRETING: The process of understanding and analyzing a spoken or signed message and re-expressing that message accurately and objectively in another language.  

TRANSLATION: The conversion of a written text into a corresponding written text in a different language.  

TDD/TT/TTY: Telephone Device for the Deaf / Telephone Text/ Teletype 

Most common languages other than English spoken in California:  Spanish, Chinese,Tagalog ,Vietnamese 

Best practices 

  • Get certified by the UCSF interpreting services dept if you’re a fluent bilingual provider. UCSF offers cultural and linguistic testing to bilingual clinicians and staff through the ALTA Clinician Cultural & Linguistic Assessment (CCLA) and the Qualified Bilingual Staff (QBS) tests. Clinicians and staff who obtain a passing score on one of these assessments may speak their non-English language with patients, patients’ family members and caregivers without the use of an approved interpreter.  

Contact [email protected] 

UCSF Interpreting Services Dept: (415) 353-2690 or website 

Documentation:  

  • For patients whose preferred language for discussing health care is not English, the use of an interpreter must be documented in the patient’s EMR and on all critical forms, such as consents, authorizations for surgery, blood transfusions, etc. Documentation of interpreting services should be done by the provider. Include the source of the interpretation (e.g., UCSF staff interpreter, video, telephonic, agency interpreter), the name or identification number of the interpreter and the language. The smart phrase to document the use of an interpreter in APeX is ‘.interpreter’.  
  • Certified Bilingual Providers should always document in the patient’s EMR that they are certified to speak the patient’s preferred language. They can use the ‘.interpreter’ smart phrase and select ‘certified bilingual’ as the source of interpretation. 
  • Certified Bilingual Clinicians and staff may NOT act as medical interpreters for third parties, monolingual colleagues or other providers or staff. Asking bilingual clinicians to act as interpreters in this way is also inappropriate as it may constitute a minority tax. 

 

How to Work with an Interpreter: 

  • Choosing a method 
  • Use in-person interpreters whenever possible for best communication, especially for sensitive topics.  

Before: 

  1. Verify the patient’s preferred language for healthcare in the EHR or use the Language ID Card.   
  2. Allow extra time for the interview when possible.  
  3. If possible, let the interpreter know what to expect before starting the conversation. You can give some background, build rapport, and set goals. Notify them if the conversation may discuss serious and sensitive topics like end of life goals or legal proceedings.  
  4. You can ask the interpreter if they have a preferred style (consecutive or simultaneous) for interpreting or specific requests.  
  5. Ideally, seat the interpreter next to or slightly behind the patient. 

During: 

At the Start: 

  1. Assume, and insist, that everything said in the encounter by anyone present will be interpreted.   
  2. Speak to the patient, not the interpreter: Use 2nd person (Do you…? ), not 3rd person (Does she…?)   
  3. Realize that most patients understand some English, so do not make comments you do not want them to understand 
  4. Cultural considerations: patient nodding, saying ‘yes’, or smiling may indicate listening or respect, rather than understanding.Gestures vary in meaning from culture to culture.   
  5. Prioritize and limit the key points to three or fewer 
  6. Face the patient and maintain eye contact. 
  7. Tips on Language and Speech: 
  8. Humor and idiomatic expression may not translate well – use with caution.   
  9. Keep a comfortable pace allowing time for interpretation (consecutive or simultaneous).  
  10. Speak slowly; rather than loudly.   
  11. Use an appropriate language register; (varying levels of complexity). Low English proficiency is not an indication of low cognition; avoid assumptions about a lack of formal education.   
  12. Organize your thoughts before speaking.  
  13. Sentence fragments, complex sentences, changing your mind mid-sentence can be confusing.  Speak in short sentences or short thought groups. Ask only one question at a time.  
  14. Be prepared to repeat, rephrase and summarize. Be patient.   
  15. Ask the patient to “teach back” to ensure comprehension, as you do with your English-speaking patients. 

 

References:  

UCSF Interpreter Services tips  

American Family Physician article 

 

In the works:  

Thank you to UCSF Interpreting Services Dept for collaboration on this Tip of the Month!