Effective Partnering With Medical Interpreters

As a Spanish medical interpreter at Johns Hopkins, I’ve had the privilege to serve in many encounters between medical providers and their patients with limited English proficiency (LEP). Recently, I was reflecting on some of these experiences, and one of them stood out in particular for the clinical excellence practiced by the team of providers as they partnered with the interpreter to deliver outstanding patient care.  

Some time ago, I served as medical interpreter for a meeting between an LEP cancer patient and their medical team. The patient had a large inoperable tumor and was struggling with the diagnosis, declining hospice care, and requesting surgery to remove his tumor. When I arrived to interpret, the team explained the goals of the session to me, as we gathered outside the patient’s room: to help the patient understand that surgery was unfortunately not a real option for him, and to discuss the medical team’s recommendation for hospice care.   

As we walked into the room, the patient appeared angry and avoidant. They would not look at the providers in the eye, gave one-word answers, and sometimes raised the tone of their voice to express their frustration. The tension between the patient and the team was palpable. As the team engaged the patient in the discussion about his plan of care, the interpreter continually reassessed the patient’s body language and tone, while making sure to faithfully render the message the providers were trying to deliver, as well as the patient’s frustration. The patient continually returned to talking about surgery as an option, and the team explained several times that, given the risks of surgery, it wasn’t a real option. With each iteration (and knowing the clinical care goals of the session) the interpreter adjusted the wording slightly, in order to convey the message, by using different words that might help the patient understand his options better.  The conversation reached a peak when the oncologist (the provider with whom the patient was most familiar) spoke to the patient in very direct, clear terms.  The interpreter did the same, making sure to look at the patient in the eye while delivering this clear message. Slowly, the patient began to come around, and eventually agreed to accept hospice care. The team compassionately affirmed the patient’s decision. As the visit ended, the patient joked with the oncologist, and everyone in the room laughed.   

This example of clinical excellence illustrates how, in interpreter-mediated clinical encounters, a couple of practices can facilitate successful communication between LEP patients and their medical teams, helping to build a cross-cultural connection between patient and provider, and enhance patient-centered care.  

Have a pre-session with the interpreter.  

The pre-session is a critical tool to help you attain the goals for the patient encounter. It’s extremely helpful to give some background to the interpreter about what to expect, and how they can partner with you in achieving those goals. Tell the interpreter what you would like to have happen at the end of your encounter with your LEP patient. Are you wondering if your patient is having trouble understanding how to take their medication, or whether they need assistance with how to obtain them? Are there any cultural issues that you think might arise, which will need brokering? Mention any matters like these to the interpreter before the encounter begins.   

Having a pre-session also helps you establish rapport with the medical interpreter and shows that you acknowledge the important role they play as part of the team. You can make sure the interpreter is comfortable, but most importantly that any necessary vocabulary will be at the top of their mind, to help prevent unnecessary interruptions for clarification. Even a simple statement about the purpose of your visit, such as “I’m a primary care provider, speaking to my patient about their diabetes care,” can go a long way.  Please, try at all costs to avoid only saying “Can you introduce yourself to the patient?” the moment the interpreter answers your call, without providing any additional information.   

Connect with your patient, not the interpreter. Be yourself!  

Shared language is a powerful connector.  Sometimes, through the act of interpretation, there is a risk that the provider connects with the interpreter more than they connect with the patient, simply because they share the same language.  A professional medical interpreter will seek to remain as invisible as possible, in order for communication between you and your LEP patient to happen as if there was no language or cultural barrier present. In addition to interpreting the verbal communication between you and your LEP patient, professional medical interpreters are constantly reassessing body language (if in-person) or other cues, to gauge understanding and figure out where they might need to adjust a word or two. This constant reading of the room helps the professional interpreter to ensure they are conveying the underlying tone and meaning of the message being delivered, in addition to the words, in the most truthful, faithful and transparent way possible. So, it’s important for medical teams to practice addressing LEP patients like they would any patient, including addressing the LEP patient directly—and trust that the trained medical interpreter will know how to convey the message. When you display kindness to your patient, when you act with a friendly demeanor, when you need to be brutally honest, or when you need to deliver a difficult message—a professional interpreter is trained to convey what you say, your emotions and tone, and reflect it to the patient.  So, be yourself! When providers change the way they naturally speak to their patients (perhaps because they stress about the words they are using, or over-worry about being culturally appropriate) they miss a golden opportunity to use the trained medical interpreter to help them build a relationship of trust and connection with their LEP patient. During the encounter with your LEP patient, don’t worry so much about the cultural or language barrier, speak naturally, and trust that the interpreter is trained to broker any issues that might arise.  

Avoid jargon and idiomatic expressions—but don’t avoid humor!  

Many materials that address “how to work with an interpreter” usually counsel against the use of jargon or idiomatic expressions, which may not be translatable when speaking through an interpreter. While “knock-knock jokes” may not translate, do remember that humor is a nearly-universal form of communication. Laughter can relieve stress, and help you to develop an intangible connection of trust with your patient. Practice making small talk, or using a good sense of humor to break the ice in ways that translate across languages and cultures.   

Have a post-session with the interpreter.  

Depending on time available and the type of encounter, there might be value in asking the interpreter to hold the line (if on the phone) or stay for a few minutes to debrief outside of the patient’s room. This post-session can give you valuable insight about what the professional medical interpreter might have picked up on during the encounter: potential misunderstandings, cultural issues that might need further clarification, or other important information for you to know as the LEP patient’s provider. Both medical interpreter and medical professional need to be careful about making assumptions about the LEP patient during this post-session. However, any nuances the interpreter might have picked up on (like dialect differences) or delicate questions that might need further follow-up with the patient, might come up during a post-session that could assist you in developing a better plan of communication with and treatment of your LEP patient in the future.  

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.