What is the role of the interpreter? Should they offer emotional support to the patient?
Interpreter-as-conduit reflects a neutral, more literal information exchange and is preferred by certain medical providers who prioritize a more exact interpretation of the medical conversation. In this role, the interpreter assumes a more passive role and the emphasis is on the interpreter’s linguistic ability [21]. Providers need to be aware that word-for-word interpretation may not align with what is regarded as culturally sensitive care—such as when the term “cancer” is to be used. Also, word-for-word interpretation does not necessarily mean the patient will understand what is being interpreted if the terminology does not reflect the literacy level or dialect of the person with LEP [22].
Interpreters may also assume an active role, sometimes referred to as clarifier and cultural broker. Clarifying may be utilized, for example, when a medical provider is discussing complicated treatment options. This requires an interpreter to step out of a conduit role (if that is the preferred role) and confirm or clarify information to ensure accurate information exchange [21,23]. As a cultural broker, communication between provider and patient is exchanged in a manner that reflects consideration of the patient’s cultural background. Interpreters may explain, to the provider, the cultural reason for the patient’s perspective of what is causing or contributing to the illness. Cultural brokering may as well include communicating the medical terminology and disease explanation, given by the medical provider, in a way that the patient would understand. This role, additionally, can involve educating the provider about aspects of the culture that may influence the patient’s communication with him or her [22].
Furthermore, interpreters may fulfill an advocate role for patients by helping them understand the health care system and increasing patient empowerment by seeking information and services that the patient may not know to ask about [23].
The interpreter may offer emotional support during a medical visit, for example, where the diagnosis of cancer is conveyed. In such a case, an interpreter’s emotional support may be considered by providers to be appropriate. In contrast, with visits related to mental health evaluations, having the interpreter remain neutral, rather than being a more active participant by offering emotional support, may be preferred [24]. In addition to interpreters remaining more neutral during mental health visits, providers may prefer that interpreters not speak with the patient prior to the visit, depending on the mental health condition, as negative therapeutic consequences may occur [21]. Trust is an important element of the provider-patient relationship and, as such, there is concern on the part of some providers that if the trust of patients falls to the interpreter rather than to the provider, then therapeutic progress may be compromised [24]. In general, clarifying with interpreters the goals of the visit and expectations regarding speaking to the patient outside of the visit may ensure the provider-patient relationship is not diminished [21].
What are the disadvantages and caveats of using family members or bilingual staff as interpreters?
Although family members and other ad hoc interpreters may be present and willing to interpret, the risk of miscommunication is greater than with professional medical interpreters [5,6]. This risk of miscommunication extends to partially bilingual medical providers who do not utilize appropriate interpreter services [10,25]. Ad hoc interpreters may try to answer on behalf the patient [6,26] and may not have the appropriate medical terminology to correctly interpret what the provider is trying to communicate to the patient [6].