22 Mar Wild Wild West Conditions Persist in Medical Interpreting

Co-author: Kaitlin Heximer, Candidate for the Masters in Conference Interpreting, Glendon School of Translation, York University

“When I think back to the first time I ever interpreted in a formal setting, I would have done things differently if I knew then what I know now about interpreter ethics and best practices. A “simple” medical appointment turned into an epic 11-hour saga at the hospital emergency room with a patient whose sinus problems were quickly overshadowed by his mentally unstable condition.” **

So begins the story that Kaitlin Heximer, my co-author for this week’s blog, has to share. Kaitlin is currently a student in the newly-minted and highly-innovative Masters in Conference Interpretingprogram, offered through the Glendon College School of Translation at York University. She already has a Masters in translation, and is no stranger to the healthcare system herself. She started interpreting just a year ago, as a volunteer interpreter for a refugee resettlement agency.

Her story is worth hearing. It is a stark reminder that despite so much rapid change transforming the healthcare interpreting profession, the “bad ‘ol days” of pressing untrained bilingual staff or volunteers into service are not yet a thing of the past. Hospitals may be jumping on the technology bandwagon in droves, doctors now access video medical interpreters through their smart phones and there are not one but two validated national medical interpreter certifications in the US[1]. However, patients and bilingual individuals trying to help them are still put in high-risk situations with depressing frequency.

Multiple studies show the relationship between poor healthcare outcomes, costly medical errors and increased litigation when professional interpreters are not used.[2] We know the critical difference formal training makes. But outside awareness of this reality has yet to reach a tipping point where it becomes an automatic practice to call in the professional interpreter. Until we reach that point, many entering our field will be subjected to the Wild Wild West conditions Kaitlin describes below.

My first official interpreting assignment was to accompany a male client to a medical appointment. I was volunteering for a social service agency. The client had a sinus condition and was prescribed medication to treat it. When I thought we were wrapping up, the client turned to me and asked me to tell the doctor his throat was closing. I said, “Mr. X says his throat is closing.” The doctor said to me, “Tell him he should go to the emergency room,” so I said, “the doctor says you should go to the emergency room.”

Leaving the doctor’s office, I phoned the social worker who had assigned me to the case to see if another interpreter could cover. I was trying to show awareness of my own limitations as an interpreter, but at the same time make sure that the patient had access to the language services he needed. Though my intentions were good and my instincts on the right track, this was the point where my many mistakes began!

The social worker informed me that there were no other interpreters available, and could I please accompany the patient to the emergency room? Despite misgivings, I said yes. I got the patient through triage pretty quickly, but then a long wait ensued. During this time, the patient became increasingly attached to me. I attempted to get some distance from him but he followed me to where I was or begged me not to leave. After about four hours, the client was becoming increasingly delusional about the hospital staff, screaming and saying they were going to hurt him. I did not know what to do.

I felt it was heartless not to be near him, that he obviously needed help and that I was the only one he could communicate with. I realize now that I am not a mental health professional equipped to deal with people in his state. At the time, I had no guidance as to how to handle the situation. My first instinct was to get the hospital staff to put him ahead in the order of patients to be seen. I went up to the desk, said, “I am an interpreter, I have to get home, and my client is very agitated. Could you please do something to get him seen faster?”

No one was available to tend to my client, so I sat with him for several more hours as he told me the sad story of his life, past and present. He said, “You’re the only person who has ever listened to me.” I did not know what to say, so I said nothing, which was pretty easy because his talking could be called ranting at this point. I knew his throat was not really closing because he could still talk, however it was clear to me that he needed some help. I felt obligated to stay with him. When we finally got in to see the doctors, one of them ordered an EKG.  The patient asked me to go with him to the change room to help him take his clothes off. I told him I was not comfortable with that.

No one had told me that I must not accept requests to physically aid patients.

I said I would try to get him a male nurse to assist. He agreed but 20 minutes later when I found one, I went back to where I had left him and he was not there. The doctors asked me to search for him and bring him back, which I did. They did the test and left us alone again. By this time I had been with the patient, mostly alone, for about seven hours. Now I was alone with him in a hospital waiting room with a bed.

No one had told me I shouldn’t stay alone with the patient.

He asked me for ice chips, so I went in search of a nurse who could bring him some. Instead, a nurse gave me some ice chips in a cup, and said “bring these back to him.

No one had told me it was not my job to fill in for nurses or medical assistants.

When it was time for the next step, the client grabbed my hand firmly. Even though I was just his interpreter, he was now seeing me in more of a maternal, comforting sort of role. 

In the next hours, I worked very hard to get us seen. I told the hospital staff that the patient was agitated and I the interpreter was tired and that a doctor needed to attend. I inquired (as I already had twice) whether there were any interpreters on call in the hospital. They said no. Eventually, the possibility of a phone interpreter was brought up, but the client said that frightened him, and that after many previous visits to the emergency room, he deserved a real live interpreter.

After an 11-hour shift “on the job”, the client was finally served. I felt good about providing him this service, but I was VERY TIRED.

Despite my best intentions, I failed at establishing myself as a professional with this client. I did not yet have formal training in medical interpreter ethics and standards of conduct. That initial failure led to a relationship with him where he not only wanted, but expected, me to be a confidante and to advocate for him with his counselors, his housing workers and other service providers.

Since that first assignment, I have learned about proper role boundaries for a medical interpreter. I’ve adopted the use of first-person interpreting, conduct pre-sessions for new clients, and never stay in the room with the client when the provider leaves. I know now that clients who are showing mental stress or imbalance need an additional level of care that requires specialized training. I greatly appreciate the new knowledge about interpreter roles that I am gaining in my current educational program, but realize that it represents the exception and not the norm. Knowing what I do now, it is my goal to raise awareness in and outside the field about the limitations and complexities of healthcare interpreting work.

As Kaitlin’s moving story illustrates, public awareness of the critical role interpreters play and of what constitutes a professional medical interpreter lags far behind the level of professionalization our field is reaching. Even those who hire, oversee and use interpreter services are often woefully ignorant of the complex skill set required to competently bridge language barriers. Until those who are outside our profession know this as well as those of us inside our profession, the “bad ol’ days” will remain, in actuality, “now.”

Let Kaitlin’s story be a reminder to all of us about the need for continual client education, and the importance of supporting – in any way we can – the generation of interpreters now entering the field. I look forward to the day when stories like Kaitlin’s truly are a thing of the past.

Raising the profile of the interpreting profession is a major focus for InterpretAmerica. The theme for this year’s 4th InterpretAmerica Summit is On The Cutting Edge: Bringing Interpreting To The Forefront. To be held June 14-15 in Reston, Virginia, the Summit is great opportunity to help make our profession more visible everywhere.

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**  The patient’s medical details have been changed for the purposes of confidentiality.

[1] Certification Commission of Healthcare Interpreters: www.healthcareinterpretercertification.org and National Board of Certification for Medical Interpreters: www.certifiedmedicalinterpreters.org

[2] “Do Professional Interpreters Improve Clinical Care for Patients with Limited English Proficiency? A Systematic Review of the Literature” by Leah S Karliner, Elizabeth A Jacobs, Alice Hm Chen, and Sunita Mutha for Health Services Research (2007)

by Katharine Allen