Why use interpreters?

What do you think these words mean? Click them to find out...

    

It's possible that you speak Spanish or Slovak and know the meaning of these words. But many might hazard a guess with constipated, embarrassed and angina.

The article below highlights the crucial role of accurate communication for health - and the implications of getting it wrong:

Consider the following scenarios and indicate where you would book an interpreter:

Q1. You are a health visitor advising parents on supporting the healthy development of their young child. Do you think an interpreter is necessary?

YES

NO

Q2. You are a GP. Your patient’s English seems proficient, but you know that the conversation you are going to have will be stressful. Do you think an interpreter is necessary?

YES

NO

Q3. You are a practice nurse; your patient had an interpreter at the last appointment, but it seemed to make little difference to the communication as the patient barely spoke. Interpreter?

YES

NO

Q4. You are a mental health practitioner; you speak some French yourself having studied it at A-level. Your patient is Congolese. Interpreter?

YES

NO

Q5. You are a receptionist. A patient arrives with a family member who says they will interpret. They both seem pretty happy with the situation and it's probably a cultural thing. Interpreter?

YES

NO

A story on the importance of interpreters
In the following short clip, a professional interpreter talks about a real experience which emphasised the importance of her role in patient care.

As you watch, think about the following:

  • What is the key message of the video?
  • What implications does it have for your practice?

Arguments for using interpreters

RIGHTS
  • Equality of access to information and services. 
  • People are entitled to interpreters (non-discriminatory provision).
USEFUL, EFFECTIVE SERVICE

Both parties need to have a clear understanding of each other; better provision means increased efficiency which equals less burden on systems.

STRESS

In times of crisis or stress, a person's English competency may decrease.
It is frightening and confusing not to be able to communicate.

RESEARCH

Multiple studies document that quality of care and satisfaction with care is compromised when professional interpreters are not used.

COST

The cost of missed appointments, increased incidence of unnecessary testing and the use of A&E, return visits and medical errors, a lack of compliance with treatments, inaccurate diagnoses and late entry into care build a significant argument for the use of professional interpreters.

What is a professional interpreter?

Consider whether the following statements are true or false.

Q1. An interpreter is anyone who can speak a second language fluently.

TRUE

FALSE

Q2. An interpreter is not the same as a translator.

TRUE

FALSE

Q3. An interpreter is employed to work on the service user's behalf.

TRUE

FALSE

Q4. A French interpreter will be equally at home interpreting for an Algerian or Congolese family.

TRUE

FALSE

Q5. It is acceptable for an interpreter to know the person they are interpreting for.

TRUE

FALSE

Summary: The professional interpreter

  • Trained and qualified
  • Literal language machine: no additions, no omissions, no editing or polishing of what is said by either side
  • Clarifier: explains or makes word pictures of terms that have no linguistic/understandable equivalent and checks for understanding
  • Culture broker: manages cross-cultural interactions to smooth and assist the communication process

Outside the interview:

  • Advocate: action on behalf of the patient outside the bounds of an interpretive interview to highlight:
  • Models of care as well as quality of communication
  • Systemic barriers such as the complexity of the healthcare system or discrimination

Friends and family

Case study: Marenza

You meet Marenza. You feel that it would be useful to arrange a professional interpreter, but Marenza is not keen.
Why do you think this might be?
What approaches could you use to support service users in these situations?

There are two main issues here:

  1. The lack of knowledge about healthcare systems and entitlements
  2. Myths circulating in the community about the provision and quality of interpreters

Click Marenza's reasons in the panels below to see suggestions for addressing each issue.

"Last time I went to the GP, I needed medication, but the GP wouldn't give it. So the interpreter can't have had very good English to explain my symptoms."

"Last time I went to the GP, I needed medication, but the GP wouldn't give it. So the interpreter can't have had very good English to explain my symptoms."

Ensure staff are trained and aware of the entitlements to interpreters and the increased cost implications of not providing interpreters. Give them the resources they need to share this information e.g.: language identification chart.


"It’s a personal problem really. I don't want my personal information out in the community."

"It’s a personal problem really. I don't want my personal information out in the community."

Put clear, image based, targeted information in prominent places: e.g.: a simple poster in the healthcare reception area, job centre or popular food shop in community languages. State the entitlement to free professional interpreters.


"It's really expensive to get a private interpreter. I won’t to be able to afford this on top of the treatment costs."

"It's really expensive to get a private interpreter. I won’t to be able to afford this on top of the treatment costs."

Ensure staff are aware of the correct booking information to gather, and make a sound interpretive booking e.g. booking checklist.


"I know some people who’ve had interpreters in their asylum claim. They only speak for the authorities – not for us."

"I know some people who’ve had interpreters in their asylum claim. They only speak for the authorities – not for us."

Share information regarding interpreters through engagement with workplaces, community organisations, places of worship, schools, ESOL providers, advisory services etc or through attending community events.


"My friend was told an interpreter had been booked for his physio appointment. But when he turned up, the interpreter was a woman - he said he didn't know who was more embarrassed - him or her."

"My friend was told an interpreter had been booked for his physio appointment. But when he turned up, the interpreter was a woman - he said he didn't know who was more embarrassed - him or her."

Provide welcome packs with clear succinct facts to new arrivals through coordination with housing providers in your locality.


For more information, see the Reducing Barriers To Access module.


Marenza may choose to bring a friend to interpret for her as an ‘ad hoc interpreter’.

There are arguments for and against using family friends as interpreters. 
Select for or against for each argument, then you can check your answers.

Arguments on using family and friends as interpreters:

They are readily available

FOR

AGAINST


They may filter information to protect their relatives or friends

FOR

AGAINST


They are not neutral

FOR

AGAINST


There may be a breach of privacy and confidentiality

FOR

AGAINST


They may try to control instead of facilitate

FOR

AGAINST


They are more likely to advocate and be proactive

FOR

AGAINST


They may be unable to cope with the subject matter, specialised terminology or emotional content

FOR

AGAINST


Their character and attitude is known

FOR

AGAINST


They are more likely to commit errors with potential clinical implications

FOR

AGAINST


Then maybe a lack of professionalism

FOR

AGAINST


There will be no indemnity if mistakes are made

FOR

AGAINST


They maybe more trusted due to shared history and understanding of issues

FOR

AGAINST


 

This exercise considers the use of family and friends as interpreters. Many of the arguments are equally relevant to the use of other ad hoc interpreters such as staff members or passers-by.
Regardless of professional knowledge another staff member is not qualified to act as a professional interpreter.

Negotiating the discussion

It's relatively straightforward to sit in a staff meeting and agree a policy of using professional interpreters. But when faced with a husband insisting on interpreting for his wife, what action could you take?

Click to reveal the scenarios in each case:

Booking the interpreter

The booking process

You've had the discussion; the service user requires an interpreter for the next appointment.
You will need to fill a booking form to request an interpreter from the agency.


The following exercise looks at common errors made in the booking process and makes recommendations to avoid these mistakes. Resolving these issues means that both service provider and user have a better experience in the consultation and resources are saved in the process.

 

 

This booking form lacks important information and detail.
Click on the buttons below for suggestions to avoid common booking mistakes
 

Interpreter booking form


Booking form with highlighted sections


 

As before, click the buttons below to reveal good practice recommendations.

 


Download a PDF of a good example of a booking form 

Booking form with highlighted areas

Running to the consultation

The following exercise deals with the reality of the interpreted session itself and develops a series of good practice guidelines.

The video below presents a service provider's memory of an interpreted session. Imagine you are the service user in the session and, as you watch, consider the following questions:
 

  1. How would you feel by the end of this meeting?
  2. Would you trust the decisions made by the professional regarding your care?
  3. How likely are you to make a second appointment, as advised?

As the service user stated at the end of the video, there were many mistakes.

So, what was it about the interpreted session that reduced communication, trust and engagement?

To answer the following questions either recall the video or watch it again.

In the next video, the service provider discusses her recommendations for interpreted sessions with the benefit of hindsight.

Listen for her ideas on:

  • Pre-consultation checks and preparation
  • Troubleshooting with your team
  • Pre-consultation briefings
  • Room layout
  • Building rapport and active listening
  • Ending the interview and debriefing


Download a PDF of her recommendations

Follow-up and feedback

Best practice summary flow chart

Click the boxes to see the steps:

 

 

Dealing with concerns or feedback about the interpreted session

If you have concerns about the interview or interpreter, you need to take action to ensure they are not repeated.

Who should you speak to in order to solve the following problems? Tick the appropriate choice. You may choose more than one option. Once you have finished click the ‘check’ buttons for a response.

Without follow up, it is impossible to ensure an appropriate service and address problems practically

Problem 1: The interpreters are always late. Who should you speak to?

The interpreting service

Raise it at a staff meeting

The interpreter at debrief

Other

Problem 2: The interpreter has noticed that some patients have concerns about a particular staff member. Who should you speak to?

The interpreting service

Raise it at a staff meeting

The interpreter at debrief

Other

Problem 3: The interpreter does not always fit the booking request. Who should you speak to?

The interpreting service

Raise it at a staff meeting

The interpreter at debrief

Other

Summary

Studies have shown that the use of qualified medical interpreters:

  • Improves patient satisfaction of both disease and treatment
  • Increases delivery of preventative health measures
  • Reduces unmanaged pain
  • Improves patient understanding of both disease and treatment

The correct booking information is essential, as well as the use of appropriate language and the allocation of sufficient time in the interview setting. Pre- and post-consultation briefings/meetings ensure that questions may be raised and answered.

If patients cannot properly communicate their health information, there are risks of:

  • Misdiagnosis
  • Inappropriate treatment
  • Disengagement with services
  • Escalation in cost due to late treatment of more advanced symptoms

These issues may result in the liability risks as well as the delivery of poor healthcare. In an environment of cost-cutting, the cost saving impact of ensuring more appropriate and timely care through using interpreters deserves strong emphasis.