Dimensions of Culture

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Consistently, one of the biggest challenges faced by health care professionals is communicating with patients and families who have limited English proficiency. In this issue of the cross-cultural communications newsletter, we focus on some basic guidelines to follow when working with interpreters. Though the context of each patient encounter is unique, there are some fundamentals of working with interpreters that can make a significant difference in patient understanding and compliance. These guidelines may take a little more time and planning up front, but can actually save time in the long run by decreasing miscommunication.

Hold a brief pre-interview meeting with the interpreter.
Plan to meet with the interpreter for a couple of minutes before the interview to explain the situation and any background needed for understanding what you plan to talk about. Agree with the interpreter in advance on such things as how the interview will start and where the interpreter should sit.

Plan to allow enough time for the interpreted sessions.
Schedule enough time for the interview, remembering that an interpreted conversation requires every statement or question to be uttered twice. If family members are part of the conversation, it will further extend the time needed. Remember that what can be said in a few words in one language may require a lengthy paraphrase in another.

Don’t ask or say anything that you don’t want the patient to hear.

Expect everything you say to be interpreted as well as everything the patient and his family says.

Use carefully chosen words to convey your meaning, and limit the use of gestures.
When speaking English, you may be used to supplementing your words with gestures to help convey your meaning. Competent interpreters will convey the meanings of your words and not take the liberty of interpreting your gestures.
The patient may be confused by gestures that are not linked to words they understand, and may misinterpret your meaning.

Speak in a normal voice, clearly, and not too fast or too loudly.
You don’t need to speak more loudly or slowly (unless the interpreter asks you to slow down). It is usually easier for the interpreter to interpret speech produced at normal speed, with normal rhythms, than artificially slow speech.

Avoid jargon and technical terms.
Avoid idioms, technical words, or cultural references that the interpreter might have difficulty translating. (Some concepts may be easy for the interpreter to understand but extremely difficult to translate

Keep your utterances short, pausing to permit the interpretation.
For consecutive interpreting, you should speak for a short time—one longer sentence or three or four short ones—and then stop in a natural place to let the interpreter pass your message along. Be aware of the length and complexity of your speech so as not to unduly tax the interpreter. She may need to hear the whole sentence before she can even start to interrupt it.

Ask only one question at a time.
If you string questions together, you may not be able to match questions with answers, and you may confuse the patient.

Expect the interpreter to interrupt when necessary for clarification.
Let the interpreter know that you are prepared for him to interrupt when necessary, to ask you to slow down, to repeat something he didn’t quite get, to explain a word or concept he might not be familiar with, or to add background information for the patient’s increased understanding.

Expect the interpreter to take notes if things get complicated.
Don’t be surprised if the interpreter takes notes to facilitate recall. This is an aid to memory, not an interruption.

Be prepared to repeat yourself in different words if your message is not understood.
If mistranslation is suspected (for example, the response doesn’t seem to fit with what you said), go back and repeat what you said in different words.

Have a brief post-interview meeting with the interpreter.
Meet with the interpreter again after the interview to assess how things went, to see if the interpreter is satisfied or has questions or comments about the process of communication.

Remember that the interpreter is not there (just) to interpret for the patient or to interpret the patient’s language.
The interpreter is there to interpret for two clients who don’t know each other’s languages, you and the patient. The interpreter is there to facilitate communication between the two of you.

Use a seating arrangement in which you, the patient, and the interpreter form the points of a triangle.
This arrangement makes it easy for the provider and patient to address each other directly, both verbally and visually, and for the interpreter to support both parties in the exchange of information.

Read related newsletters on this topic listed under newsletters at www.dimensionsofculture.com

• Some Basics for Conversing Across Cultures
• 8 Tips for Conversing With Limited English Proficiency Patients and Families

Resources: The information provided in this newsletter is borrowed with permission from The Provider's Guide to Quality and Culture, a joint project of: U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, and Management Sciences for Health (MSH) at erc@msh.org.

For more information on this and related topics visit www.dimensionsofculture.com

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