Quick Interpreting Tip: Screening Conversations

We’ve all run across a situation where we’re tempted to screen a dialogue during an interpreting assignment, whether it’s by omitting information that appears irrelevant and superfluous, or by adding information for further clarity. Before you do so though, remember your role as an interpreter and that it is not your place to decide what is to be rendered and what isn’t. We are merely a conduit and not a filter, so next tine you feel the urge, try to hold your tongue.

Remember: your role as an interpreter is to stay true to the intention of the original message by relaying only everything that is said and nothing that wasn’t said.

Happy interpreting!

Crossing the Line: Is It Okay to Become Friends with My Clients? (Interpreting)

As interpreters, we run in a small circle of limited-English speakers. It’s possible that you would work with the same client over and over again; it’s also possible that you’ll work with a client once and never see him again. Regardless, it’s important to keep a professional relationship, not only through keeping up your skill set, arriving to appointments on time, and interpreting as faithfully as you can, but also through treating your clients as equals and not taking advantage of their vulnerability as limited-English speakers.

One question that interpreters run into revolves around whether it is okay to become friends with a client. Different interpreters have different opinions about this, but most would agree that it’s better to keep business separate from friendship. This is really hard though, especially when clients are always excited to find people who speak their language and want to know more about the person who’s helping them get the services they need.

From my point of view, the main risk of breaking the professional relationship is that the client may have different expectations of the interpreter during appointments. Also, once you become friends, the client may want to show his appreciation in different ways besides just saying “thank you,” such as with gifts. Accepting gifts, is a tricky one.

What can we do to make sure we maintain professionalism with our patients?

1. Keep Your distance. One way to avoid developing a close relationship with your client is through keeping your distance with the client. I know an interpreter who never allows herself to be alone with a client. After she introduces herself as the interpreter and explains how the process will work, she always finds an excuse to sit on the other side of the waiting room (“I need to prepare for a test” or “I need to work on some personal things while we wait”), and in medical interpreting cases, she stands outside the doctor’s office until the doctor walks in, simply to avoid conversation with the client. Without conversation outside of appointments, the interpreter and client won’t ever have a chance to build a personal relationship. And by explaining why she needs to be alone from the client, the client won’t feel like he is being ignored.

2. Clarify Your Role. It’s not always easy to create distance between you and your client. Some clients may feel offended if you’re not willing to socialize with them. If removing yourself from the client’s presence is not possible for you, it’s important to clarify your role as an interpreter early on when you introduce yourself and make reminders during your conversations as well. Make it clear to them that you are there to interpret everything that is said, and nothing that is not said, so if the client discloses information that he wishes to convey to the provider (doctor or lawyer, or whomever), you should remind him to bring it up at the appointment: “make sure to bring this up when you see the doctor (or lawyer), so I can interpret for you.” Personal dialogue between an interpreter and client can lead to expectations that the interpreter will convey everything that’s been said outside of an appointment. By clarifying and reminding the client of your role, you’ll help him remember that you are there to help him communicate, not there to communicate for him.“

3. Use a Higher Power. Clients are often very grateful to have someone who speaks their language to help them get the services they need. Sometimes, they’ll thank you repeatedly, other times, they might want to give you a gift or offer you services, such as a ride, to show their appreciation. Outright refusal of a gift you find inappropriate may hurt a client’s feelings, so it’s important to explain your position in such situations and let the client know that you appreciate the thought, but your agency or company does now allow you to accept gifts from clients. You can use this as an excuse for other uncomfortable situations that come up as well. Explaining your position while using a “higher authority” will make your refusal less personal.

Where should we draw the line?
It’s always difficult to figure out where to draw the line when it comes to building a friendship with a client, but the important thing to keep in mind is that all your actions have implications. In deciding whether to further a relationship or accept a gift from a client, interpreters should make sure that we are not in any way exploiting the patient. By doing so, an interpreter is doing her job to protect herself and also a client, and that’s a part of an interpreter’s professionalism as well.

For a summary of the code of ethics for a medical interpreter, click here.

Good luck!

Code of Ethics for Medical Interpreters

Interpreting is not just about conveying a message from the source language to the target language, it also involves following codes established by the profession. There are different sets of ethics code provided by different interpreting groups, but they are generally similar. Below is a summary of the National Council on Interpreting in Healthcare’s (NSIHC) code of ethics, which can also be found on their website http://www.ncihc.org.

What are ethics? Ethics is a set of principles or values that govern the conduct of members of a profession. It provides guidelines for making judgments about what is acceptable and recommended behavior.

The code of ethics is based on three core values: beneficence, fidelity, and respect for importance of cultures and cultural difference.

     Beneficence. In healthcare interpreting, the patient’s (and his or her family’s) health and well-being is our goal. This goal is shared by the healthcare team, the patient, as well as the interpreter. We all want the patient to get better.

     Fidelity. It is our obligation as interpreter to stay loyal and faithful to the original message conveyed by the patient and the practitioner. When rendering the messages into the target language, our aim is to interpret everything that is said, without distorting the message by making additions or omissions.

     Respect for importance of cultures and cultural difference. Cultural differences can lead to misunderstandings and miscommunication. It is important that interpreters are knowledgeable about the culture of the source and target language.

The nine code of ethics in NISCH are:

     1. Confidentiality. Interpreters need to treat all information during an encounter confidential within the treating team, which includes all professionals within one treatment facility who provide medical care to the patient.

     2. Accuracy and Completeness within Cultural Frameworks. Interpreters need to deliver the complete package. In other words, they should strive to render the message accurately by conveying not only the meaning of the message, but also the spirit (emotion, tone, and gestures) that came with the message, taking into account the message’s cultural context. Interpreters must not omit from, add to, or distort the speaker’s message; even offensive remarks and gestures, body language, and tone of voice must be interpreted. Interpreting does not mean rendering each word, but rendering the meaning of the message.

     3. Impartiality. Maintaining good customer service to both patient and provider is important for a successful professional relationship. An interpreter is simply a conduit, so interpreters should refrain from counseling, advising, or projecting personal biases or beliefs. They should also avoid judging the content of the message of the parties in the interaction; they should keep their values to themselves. Because one’s tone of voice, inflection, and facial expressions can show bias without one’s knowledge, interpreters should take note of their own voices and make sure they are putting emphasis only on words that were emphasized on in the original message.

An interpreter should avoid potential conflicts of interests is at all possible. Interpreting for family members, for example, is highly discouraged as the interpreter may unintentionally show his or her bias opinions, which can interrupt the medical interview.

     4. Professional Boundaries. Developing professional rapport with a patient is acceptable and encouraged  but interpreters should try to avoid personal involvement with their clients, such as building friendships with clients. Interpreters should also avoid taking on other roles while they are interpreting to avoid potential conflicts of interest. For example, an interpreter who is also a nurse should not provide medical recommendations while with the patient; in a situation like this, an interpreter should only focus on acting as a conduit and not as a medical professional.

     5. Cultural Competence. Culture is a central factor in all communication and the understanding of culture is necessary for accurate interpretations. While interpreters are not expected to possess expertise in all cultural nuances, they should strive to continually develop awareness cultural competence in the target and source language cultures, including biomedical cultures.

     6. Trust and Respect. Treat all parties with respect, using proper greetings and titles applicable to specific cultures. Interpreters should also respect the autonomy and expertise of all parties in an encounter.

     7. Advocacy. Advocacy is understood as action taken on behalf of an individual that goes beyond the facilitation of communication, with the intention of supporting good health outcomes. When a patient’s health, well-being, or dignity is at risk, the interpreter may be justified to act as an advocate. Advocating actions should be undertaken only after careful and thoughtful analysis of the situation, and only when other less intrusive actions have not resolved the problem.

     8. Professional Development. Language acquisition and maintenance is a continual process. Just because an interpreter has a lot of experience doesn’t mean there isn’t more to learn. Interpreters should strive to continually further their knowledge in the field/subject matters, language skills, and interpreting skills. They should also strive to further understand the socio-cultural context of the population they serve. Interpreters should also serve as mentors to help those in the same field and participate in professional activities that contribute to the development of the profession.

     9. Professionalism. A good interpreter acts professionally. This includes but is not limited to:
– disclosing skill limitations
– preparing for all assignments and arriving on time
– monitoring his or her own performance and behavior
– does not in any way exploit the vulnerability of the patient (for example, doesn’t accept gifts from patients)

Other code of ethics for medical interpreters can be found:
IMIA Code of Ethics- imiaweb.org
Certification Commission for Healthcare Interpreters (CCHI) – http://www.healthcareinterpretercertification.org/

Sources:
Heartland Alliance Cross-Cultural Interpreters training 10/8/2011
NCIHC Code of Ethics http://www.ncihc.org