FAQ for Healthcare Professionals

FAQ – Healthcare Professionals

What is healthcare interpreting?

It is interpreting that takes place in healthcare settings of any sort, including doctors’ offices, clinics, hospitals, home health visits, mental health clinics, and public health presentations. Typically, the setting is an interview between a healthcare provider (doctor, nurse, lab technician) and a patient (or the patient and one or more family members).

What is the difference between translating and interpreting?

In popular usage, the terms “translator” and “translation” are frequently used for conversion of either oral OR written communications. However, within the language professions, translation is distinguished from interpreting according to whether the message is produced orally (interpreting) or in writing (translation).

What is the definition of a qualified interpreter?

An individual, who has been assessed for professional skills, demonstrates a high level of proficiency in at least two languages and has the appropriate training and experience to interpret with skill and accuracy while adhering to the National Code of Ethics and Standards of Practice published by the National Council on Interpreting in Health Care. MAMI interpreters are all required to take the MAMI training and pass the final exam before they can begin to interpret.

What is the difference between a qualified healthcare interpreter and a bilingual speaker?

While a trained interpreter is bilingual, a bilingual person is not a competent interpreter in the healthcare environment. A medical interpreter interprets everything accurately and completely. He/she is trained in professional conduct, is knowledgeable about medical terminology and procedures, follows ethical procedures required in hospitals and other healthcare facilities, allows both parties to communicate as directly as possible, and identifies cultural barriers and communicates them to both parties. A MAMI medical interpreter is also covered by liability insurance.

When should I use telephonic and when should I use the on-site interpreter?

Using MAMI’s telephonic language service can be beneficial in a number of situations, such as an emergency or when a trained medical interpreter is not readily available, but the presence of a trained on-site medical interpreter improves the clarity of communication: telephonic interpreters can’t see the encounter so they miss the visuals.

A trained on-site interpreter contributes to the health care goal of good patient outcomes, as he or she is there from start to finish, contributes to a relationship of trust between provider and patient, ensures that patient’s questions are answered, enhances patient education, helps overcome cultural barriers and misunderstanding, and maintains patient confidentiality.

What should healthcare interpreters know before they start interpreting?

The following six components together comprise a reasonably comprehensive process for initial assessment of qualifications for health care interpreting.

  • Basic language skills. General proficiency in speaking and understanding each of the languages in which the applicant would be expected to work. (If multiple languages are involved, it is essential that the applicant’s ability in each language be assessed, especially those in which the applicant may have more limited proficiency.)
  • Code of Ethics. Recognition of ethical issues, knowledge of ethical standards (a code of ethics) and ethical decision-making.
  • Cultural issues. Ability to anticipate and recognize misunderstandings that arise from the differing cultural assumptions and expectations of providers and patients and to respond to such issues appropriately.
  • Health care terminology. Knowledge of commonly used terms and concepts related to the human body; symptoms, illnesses, and medications; and health care specialties and treatments in each language, including the ability to interpret or explain technical expressions..
  • Integrated interpreting skills. Ability to follow specific procedures and to manage the process to ensure that interpretation is accurate and complete to ensure accurate communication and understanding.
  • Translation of simple instructions. Ability to produce oral translations, or, where appropriate, brief written translations, of written texts such as signage, or medicinal labels.

What should the healthcare provider offer under the law?

The US Department of Health and Human Services Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons describes various options available for providing oral language assistance including the use of bilingual staff, staff interpreters, or contract interpreters…The guidance stresses that interpreters need to be trained and competent, though not necessarily formally certified, and discourages the use of friends and family members, particularly minors, as interpreters…

How does my facility determine if we are required to provide qualified interpreters?

Use the Four-Factor Analysis Process below:

The extent of responsibility can be determined using an individualized assessment that balances the following four factors:

  • Number or proportion of LEP persons eligible to be served or likely to be encountered by the program or grantee
  • Frequency with which LEP individuals come in contact with the program
  • Nature and importance of the program, activity, or service provided by the program to people’s lives; and
  • Resources available to the grantee/recipient and costs.

How does my facility demonstrate compliance to translation obligations?

Actions considered strong evidence of compliance with written-translation obligations:

  • Written translations of vital documents for each eligible LEP language group that constitutes 5% or 1000, whichever is less, of population served.
  • If 5% includes less than 50 persons, providing oral/sight interpretation of written materials and notice of such right.

What can I do if there is a problem with interpreting services?

Many hospitals and health care organizations have an Interpreter Services Manager who is responsible for seeing that qualified interpreters are being provided by their organization. If there is a complication, the Compliance Office should be contacted.

What is the difference between a certified and a qualified interpreter?

A certified interpreter is an interpreter who is certified as competent by a professional organization or government entity through rigorous testing based on appropriate and consistent criteria. Interpreters who have had limited training or have taken a screening test administered by an employing health, interpreter or referral agency are not considered certified.

A qualified interpreter is an individual who has been assessed for professional skills, demonstrates a high level of proficiency in at least two languages and has the appropriate training and experience to interpret with skill and accuracy while adhering to the National Code of Ethics and Standards of Practice published by the National Council on Interpreting in Health Care.

Many agencies say that their interpreters are “certified.” In most cases, they are referring to in-house certification and not national certification. When interviewing an agency, make certain you get clarification. In the case of MAMI, for example, some of our interpreters have national certification and all have received and passed extensive in-house training – the equivalent of an in-house certificate.

Who pays for interpreter services?

Patients themselves are under no obligation to pay for these services. Thirteen states currently provide reimbursement for language services provided to Medicaid enrollees. For more information, see the National Health Law Program’s publication, Medicaid/SCHIP Reimbursement Models for Language Services: 2007 Update.

Some health care providers pay for interpreter services themselves. For more information, see the NHeLP’s publication, Providing Language Interpretation Services in Small Health Care Settings: Examples from the Field (April 2005). This report focuses specifically on promising practices for providing language services in small health care provider settings, including solo and small group practices and community clinics.

Is there a law that requires a facility to provide an interpreter?

Yes. The following are key laws and policy guidance concerning provision of services to people with limited English proficiency (LEP):

  • Title VI of the Civil Rights Act of 1964
  • HHS Policy Guidance on the Prohibition Against National Origin Discrimination as it Affects Persons With Limited English Proficiency
  • DOJ Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons
  • Culturally and Linguistically Appropriate Services Standards for Health Care
  • Executive Order 13166
  • Strategic Plan to Improve Access to HHS Programs and Activities by Limited English Proficiency Persons
  • Governor Cuomo’s Executive Order on Language Access (2011) and NYS Language Access Policy

For an explanation of these federal laws and policies, see NHeLP’s publication, Language Services Action Kit (2004).

For an explanation of federal laws concerning language access and examples from the field in video format, see the LEP Video, Breaking Down the Language Barrier: Translating Limited English Proficiency Policy into Practice, which can be ordered through www.lep.gov

For a more comprehensive explanation of language access responsibilities under federal and state law, as well as in the private sector, and recommendations for addressing identified problems, see NHeLP’s Ensuring Linguistic Access in Health Care Settings: Legal Rights & Responsibilities (2nd edition, August 2003). $100.00 ($65.00 for nonprofit advocacy organizations). To order, go towww.healthlaw.org

Do healthcare professionals make good interpreters?

Bilingual staff are often used to interpret, without any assessment of their skills. In a recent study, a total of 840 dual-role staff interpreters were tested for Spanish (75%), Chinese (12%), and Russian (5%) language competence. Two percent did not pass, 21% passed at basic level, 77% passed at medical interpreter level. Staff that passed at the basic level was prone to interpretation errors, including omissions and word confusion. Thus, about 1 in 5 dual-role staff interpreters at a large health care organization had insufficient bilingual skills to serve as interpreters in a medical encounter. Health care organizations that depend on dual-role staff interpreters should consider assessing staff English and second language skills.

In another recent survey, Dr. Glenn Flores determined that untrained interpreters make 22% medically significant errors.