Using a Medical Interpreter with Persons of Limited English Proficiency

• How might gender-specific issues impact working with an interpreter?

As gender concordance of patient and physician [37] at times is desired, gender concordance of patient and interpreter [16,18] may also be important to optimize communication of gender-specific issues [16,18,37]. For example, an Arabic-speaking man from the Middle East may prefer to discuss sexuality-related concerns in the presence of a male rather than female interpreter [16]. An Arabic-speaking female who has a preference for female providers may prefer a female interpreter when discussing sexuality and undergoing a physical examination [19]. In one study, the majority of Somali females preferred female interpreters as well as female providers for breast, pelvic, and abdominal examinations [38]. If a same-gender interpreter cannot be present, an option is to have the interpreter either leave the room or step behind a curtain or turn away from the patient during a sensitive part of the physical examination [39].

• What are recommended strategies for using a medical interpreter?

It is often helpful to have a brief discussion with the interpreter prior to the medical visit with the patient to speak about the general topics that will be discussed (especially if the topics involve sensitive issues or news that could be upsetting to the patient) and the goal of the visit [2, 11]. Certain topics may be viewed dissimilarly in different cultures, thus approaching the interpreter from the view point of cultural broker or liaison [10] may bring to light cultural factors that may influence the medical visit [40,41]. the name of the interpreter should be noted for documentation purposes [10].

To start the visit, introductions of everyone involved should take place with a brief disclosure about the role of the interpreter and assurance of confidentiality on the part of the interpreter [2,11]. Also, the provider should set the expectation that all statements said in the room will be interpreted so that all persons can understand what it being spoken [10].

There are several options for where each person should be positioned. In some medical visits, a triangle is pursued where the interpreter sits lateral to the provider, but this may lead to challenges in maintaining eye contact between the patient and provider. Another option is have the interpreter sit next to [10] and slightly behind the patient to improve eye contact between provider-patient and to maintain the patient-provider relationship [2,41]. When seated, the medical provider should try to sit at the same level as the patient [16]. Seating is different with persons requiring the use of sign language interpreters as the interpreter needs to be visible to the patient for communications purposes. One possibility is having the interpreter sit beside and slightly behind the provider; this positioning allows the patient to understand what is being communicated and also allows the patient to understand what is being communicated and allows him or her to see the provider during the conversation [40].

There are 2 main communication styles used by interpreters: consecutive interpreting, where the interpreter exchanges what has been said by the clinician or patient after each one has finished speaking, and simultaneous interpreting, where the interpreter translates as the person is speaking. Interpreters and medical providers may have a preference and it is important to clarify, if needed, which method is preferred [21].