Microlectures

September 16, 2023

Microlecture 014: Should We Think of the Interpreter as an Invisible Person?

“The best thing to do from a medical provider’s perspective to help the MI is to act as if the MI is invisible” says Maria Reira. Ms. Reira is an expert medical interpreter (MI) who interprets in Spanish, Catalan, and German.

Should we behave as if the MI is an invisible presence, a ‘body-less’ voice, so to speak? This means that even if an MI is physically present, we should treat them as we would a telephone interpreter.

Well, I am not sure.

The MI is an important and helpful member in clinical encounters with a patient with Limited English Proficiency. I will likely lose a lot of valuable data if I reduce their role to a mere voice. If I have an MI in my clinical encounter, I rely on them to interpret both the verbal and non-verbal aspects of patient communication.

Do you agree? What would you recommend?

VJ Periyakoil, MD, Stanford University School of Medicine.

Tweet to us: @palliator

September 16, 2023

Microlecture 013: Ethics Of Selective Interpreting

Medical interpretation ethics behoove the interpreter to adhere to their professional code of conduct at all times. This means that the medical interpreter (MI) is obligated to interpret everything said in the clinical encounter with the patient, including any differences of opinion, conflicts, and unpleasant interactions that may occur during the encounter. The MI is not there to censor the conversation or interpret selectively.

That being said, experienced interpreters may ‘call a time out’ and ask for a private conversation with the clinicians to offer their opinion about the best path forward to mitigate conflicts.
VJ Periyakoil, MD, Stanford University School of Medicine.

Tweet to us: @palliator

September 15, 2023

Microlecture 012: How To Introduce Interpreter Services

Introducing the medical interpreter (MI) effectively is crucial to ensure clear communication and understanding between the healthcare provider, patient, and their family.

Introducing the MI:a. Clinician’s Responsibility: The clinician should initiate the introduction and highlight the role of the MI as a team member. The clinician can say something like, “Hello, I’m [clinician’s name], and I am your [ describe expertise and subspeciality and your role in the patient’s care]. To ensure clear communication between us, we have a skilled medical interpreter with us today.”
b. Clarifying the MI’s Role: The clinician should then clarify the MI’s role. For example, “The interpreter is here to help both of us. They will interpret your questions and concerns to me accurately, and they’ll interpret my explanations and instructions to you.”

c. Respecting Patient’s Choice: It’s important to acknowledge that some patients may have family members who want to interpret for them. In such cases, the clinician can say, “While your family members can certainly be here to support you, the medical interpreter is an important member of our healthcare team and is here to help and support us and ensure that we have meticulous communication about your health condition.”
Interaction Before Meeting:a. Pre-Meeting Huddle: If the MI arrives before the clinician, it’s a good practice for the MI and the clinician to have a brief, private huddle. During this huddle, they can discuss the patient’s background, specific language preferences, and any potential cultural considerations. They should also outline the goals for the upcoming encounter.
b. Entering Together: Both the clinician and the MI should enter the patient’s room together. This signals a unified approach to care and helps set the stage for effective communication.
Pitch to the Patient and Family:a. Sample Pitch: During the introduction, the clinician might say something like, “I understand that clear communication is essential for your care. To ensure that we understand each other accurately, we have a highly trained medical interpreter with us today. They will assist in translating our conversation, making sure that your concerns are heard and my explanations are clear.”

By following these steps, healthcare providers can establish a collaborative and respectful environment that promotes effective communication between all parties involved in the medical encounter.

VJ Periyakoil, MD, Stanford University School of Medicine.

Tweet to us: @palliator

September 15, 2023

Microlecture 011: How To Recruit Multi-Ethnic Patients Into Clinical Research

When you look at most research studies, you will often find a common trend– most of the study participants are mainstream patients. Few patients from minority communities enroll in research studies. The reasons for this are many and complex.

All stakeholders have implicit biases. The researchers may feel that patients from communities of color are unlikely to enroll in their study and so do not want to spend a lot of time recruiting them. Persons from communities of color may feel that researchers are not to be trusted. They may worry that they are being experimented upon.

In thinking about this issue, I feel that most large studies are publicly funded i.e. funded by NIH from our tax dollars. If we do not participate in the studies, then the results may be less relevant in the future for our specific ethnic group or population– or we may be in the dark about specific effects and side effects of common medications and important interventions in certain groups.

There is just one way for all cultural groups to shape research and to reap the full benefits of research findings and that is if we participate in the research protocols to the extent we can.

In examining most research studies, a common trend emerges—mainly mainstream patients participate, while ethnic patients are underrepresented. The reasons for this phenomenon are multifaceted. All stakeholders involved hold implicit biases. Researchers may presume that patients from communities of color are unlikely to enroll, leading to limited recruitment efforts. Conversely, individuals from these communities may distrust researchers and fear they are being subjected to experimentation.

When contemplating this issue, it becomes apparent that most large studies are publicly funded, primarily through sources like the NIH, supported by tax dollars. If these diverse groups do not actively participate, research results may become less relevant for their specific ethnic populations. Additionally, there may be limited knowledge regarding the specific effects and side effects of common medications and vital interventions within certain ethnic groups.

A consensus emerges that active participation in research protocols is the most effective way for all cultural groups to influence research and fully benefit from research findings. By actively engaging in research, communities of color can help ensure that future medical advancements remain pertinent and effective for their populations

Watch the video to learn more about this topic.
VJ Periyakoil, MD, Stanford University School of Medicine.

Tweet to us: @palliator

September 15, 2023

Microlecture 010: Teams vs Teaming Instance

I believe that healthcare is a team sport. In order for patients to get the best care possible, we need a multi-disciplinary team of experts to work together to provide patient-centered, family-oriented care.

We all know about teams. A team is a group of people who work together on an ongoing basis to accomplish a common goal. However, truth be told, modern healthcare is so complex with too many moving parts and so most care is provided within the framework of teaming.

So what is “teaming”?

Teaming is “teamwork on the fly”. It involves coordinating and collaborating without the benefit of stable team structures. A perfect example of teaming is when a clinician calls for a medical interpreter to help with a clinical encounter. In all likelihood, the clinician has never met the medical interpreter before. They both walk into the patient’s room together and proceed to provide care to the patient and family, often across the language barrier and overcoming health literacy issues. It is vital that both the clinician and the medical interpreter align effectively and work cohesively through the teaming instance. Watch the video to find out more.
VJ Periyakoil, MD, Stanford University School of Medicine.

Tweet to us: @palliator