Interpreter Guidelines

Guidelines for Selecting Interpreters

1. If practitioners do not speak the same language as the patient or the patient has limited English proficiency (LEP), then trained interpreters should be used. In the 2000 census, 38% of Hispanic/Latino elders, and 41% of Asian elders reported that they speak little or no English, and in some populations, this is true for over 80% (See Table 1-1). Four of the fourteen Standards for Culturally and Linguistically Appropriate Services (CLAS Standards) developed by the Office of Minority Health specify language appropriate services. Title VI of the Civil Rights Act mandates interpreter services, and the Joint Commission is increasingly considering language services and CLAS standards in accreditation of health care organizations.
2. Use of family members, especially children, as interpreters is strongly discouraged because of:
   1. Possible lack of appropriate language skills in one or both languages.
   2. Culturally based barriers of modesty or taboos that prevent discussion of certain topics, especially across genders and age hierarchy.
   3. Fear (e.g., elder abuse) that may lead to difficulty in discussing family problems (Jackson, 1998).
   4. Psychological trauma to children when they hear very disturbing news or when they realize the extreme responsibility they have for the family member’s health and they feel unqualified to interpret.
3. Avoid using untrained interpreters.
4. Providers can be advocates for effective on-site interpreter services and access to telephone based interpretation services (Villarruel, Portillo & Kane 1999).
5. Always keep in mind that the interpreter is a member of the team to be treated with respect. Develop a means to establish rapport.
6. See Interpreter Types for advantages and disadvantages in using different types of interpreters.

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Basic guidelines for providers working with interpreters

1. The provider should meet with the health care team members who serve as interpreters on a regular basis to review interpreter roles and procedures, provide in-service training, and develop a collegial relationship.
2. The provider should speak in short segments and ask short questions. Interpreters will have difficulty interpreting long, involved statements without forgetting something important.
3. Avoid technical terminology, abbreviations, and professional jargon (or explain them thoroughly).
4. Avoid colloquialisms, abstractions, idiomatic expressions, slang, similes, and metaphors.
5. Encourage the interpreter to translate the patient’s words as much as possible rather than paraphrasing or polishing with professional jargon. This approach will give a better sense of the patient’s understanding and emotional state. Be aware, however, that there are no exact equivalents for some words or phrases in other languages.
6. During the interaction, look at and speak directly to the patient, not the interpreter. It is helpful to position the interpreter beside the provider.
7. Listen, even though you do not understand the language and look for nonverbal cues.
8. Be patient. Interpretation takes time when done right.
9. Have the interpreter ask the patient to repeat as accurately as possible the information the provider has communicated, to see if there are gaps in understanding (the teach back method).

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Basic principles for using interpreters during health care situations

1. Professional interpreters are trained to create conceptual transfer rather than verbatim translations.
2. They make sure that concepts get across correctly in both directions of the clinical interaction.
3. Technical clinical concepts in one language are translated into acceptable social terminology that conveys the clinical meaning in the second language.
4. The interpreter knows the technical concepts, preferably in both languages, and how to express them in terms that the patient will understand.

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