Phone, video, or in-person interpreting? One size may not fit all

By Anna Martorell Fuste and Daniela Elizabeth Obregon

Andrea* and her mother begin their journey in Fullerton, CA. Slowly, they make their way through the greater Los Angeles area, braving the unusual rainy Southern California weather. They arrive safely and on time for Andrea’s cardiology appointment on Sunset Boulevard in Los Angeles, home of Children’s Hospital Los Angeles. It is their first visit back at the hospital since Andrea’s heart transplant surgery last July.

The interpreter as part of the health-care team

Sandra, Andrea’s mother, is one of the more than 12 million foreign-born residents living in the United States with limited English proficiency (LEP), who speak English less than “very well”.¹ During Andrea’s long hospital stay, Sandra could have not made it without the in-person interpreter at the Cardiovascular Acute Unit. The interpreter helped her communicate with the medical team and also helped her make the hospital their home. Data suggest that from a patient’s or parent’s perspective, professional interpretation is what is crucial for optimal communication, regardless of whether interpretation is in-person, over the phone or by video from a remote location.² In Sandra’s case, the interpreter assisted in person at family conferences during which the medical team would gather to explain her daughter’s complex diagnosis and upcoming treatment plans. The in-person interpreter played a crucial role in the process of keeping Andrea’s mother informed in all direct patient care communications, throughout the pre- and post-surgery phases, and during sensitive, lengthy and highly complex conversations.

Having an in-person interpreter who was familiar with Andrea’s case and spoke Sandra’s native language of Spanish not only benefitted Sandra, in helping her feel safe and comfortable since she could understand and communicate in her native language. The in-person interpreter was also vital for the medical team. The interpreter was able to render verbally what was being said as well as pick up on Sandra’s more subtle, non-verbal cues. Certain body movements and gestures can be culture-specific, and non-verbal cues don’t necessarily share the same pragmatic meaning for both the provider and the patient or their family. Interpreters understand the importance of recognizing these differences. Having the ability to distinguish and understand the differences is essential. For instance, when Sandra nodded her head, the interpreter might have known that it was a sign of politeness and respect for the physician, and not assent as the physician initially thought.² Flexibility and adaptability are two of the main characteristics that the medical team of providers and interpreters need to demonstrate for a successful encounter with an LEP family. Providers at this medical facility consider the in-person interpreter, who is routinely included during complex encounters, to be one of their care team members.

Three delivery methods, one patient

A few months after the surgery, Andrea and her mom are living at home, their own home. They can come to the hospital as needed for routine appointments and follow-ups. In these instances, an in-person interpreter isn’t always available and providers have access to either an over-the-phone interpreter (OPI), or a video-remote interpreter (VRI). Although a recent study has suggested that current evidence does not support the notion that there is one particular type of interpreting that is superior to others³, it depends on the circumstances. An in-person interpreter might be more beneficial for complex cases, while over-the-phone or video can be more suitable for follow-ups or short encounters. If it’s a simple follow-up with routine questions and answers, Sandra doesn’t usually mind using OPI or VRI. However, lately Andrea has been experiencing acute episodes of tantrums when in a new situation where she doesn’t feel comfortable. Today was no exception. From the moment Andrea and her mother checked in at the clinic, the child was fidgety. Right after they were taken to a room and the provider came in, Andrea started displaying her usual intense behavior.

Indeed, one size does not fit all when it comes to interpreting, and this holds especially true in medical settings, pediatric ones in particular. Although the provider came in alone, with a telephone he was planning to use for the simple, quick update session, he soon realized it was inadequate for this specific session. The use of an interpreter is not only a matter of quality but also a patient safety imperative². Fortunately, the family did not have to wait long, as the provider was able to secure an in-person interpreter to help with the session and meet the communication needs of both the family and the provider.

*The personal information of the characters in this story has been changed to preserve their privacy.

 

References

1) United States Census Bureau. Detailed Languages Spoken at Home and Ability to Speak English for the Population 5 Years and over for United States: 2009-2013. [Table] October 2015.

2) Crawley LM, Marshall PA, Lo B, Koenig BA. Strategies for Culturally Effective End-of-Life Care. Annals of Internal Medicine. 2002;136(9):673. doi:10.7326/0003-4819-136-9-200205070-00010.

3) Goenka, Pratichi K. Lost in Translation: Impact of Language Barriers on Children’s Healthcare. Current Opinion in Pediatrics. 2016; pp. 659-666.

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Anna Martorell Fuste, a native of Barcelona, Spain, is a Spanish translator and interpreter based in Los Angeles, California. Ms. Martorell holds an MA in Translation and Interpretation from the Middlebury Institute of International Studies at Monterey and a BA in Journalism and Mass Communication from Saint Bonaventure University. Ms. Martorell is an ATA certified translator (English >Spanish) and a CCHI certified medical interpreter. She currently works as a Language and Cultural Specialist at Children’s Hospital Los Angeles, as a translator, interpreter and coordinator of its Translation Program. Previous to CHLA, she worked as a Localization Project Manager and Spanish Quality Control Manager at a Los Angeles-based LSP.

 

Daniela Elizabeth Obregon is a born and raised Argentinian who moved to the United States over eight years ago. Ms. Obregon is a Certified Healthcare Interpreter working as a Language and Cultural Specialist III at Children’s Hospital Los Angeles in the Pediatric Intensive Care Unit and the Neonatal Critical Care Unit. She holds a B.A. in English with Concentration in Language Studies from University of Nebraska at Omaha and is currently working on her M.S. in Translation from New York University. Ms. Obregon has over five years of experience interpreting in hospital settings, and is a proud member of the American Translator Association and the California Healthcare Interpreting Association. https://www.linkedin.com/in/danielaeobregon

 

Image by Bruno Glätsch from Pixabay