1.7: An Introduction to Medical Interpreting

Medical Interpreting is challenging, educational, and intimate. It may be necessary in nearly any situation – a child gets hurt in school or an older adult faints in the grocery store. The focus of this chapter is on Deaf people needing access to clinical or hospital care. Effective communication access between patients and health care providers is a large part of a patient’s healing process. Much of the information in this chapter is true for most medical settings.

Clinic Visits

If you are working with a referral agency or directly with a health care provider, there is key information that you will need to ask for. First, is the date, time, and location of the assignment. Next, you will want to know the nature of the visit: Is it a well-baby check? An annual check-up? A medicine (med) check? Physical therapy appointment? A catastrophic test result? Or any other of the myriads of clinical possibilities? Knowing this, you will need to consider whether you are physically, mentally, and emotionally able to accept that assignment. If you are, next, you will need to know the patient’s name, and to be sure there’s no conflict of interest for you or for the patient.

Once you have accepted the assignment, you will need to prepare. Knowing what the appointment is about, you should search the internet for relevant information about common symptoms, procedures, treatments, and vocabulary. Calling to confirm the appointment gives you an opportunity to double-check the address, time of the appointment, and ask about parking, is parking free or, “Do you validate parking?”

Interpreters always strive to dress professionally, but that can mean different things in different settings. For medical interpreting, choosing clothing that is comfortable for standing, sitting or kneeling on the floor is important. For the patient to see you, you may need to interpret at times in any, or all, of these positions. Be prepared for the potential of blood, and/or other bodily fluids getting on your clothes.

A Best Practices Tool Kit of items you may want to bring with you to the assignment:

• A white-board and black marker (especially useful for patients with low vision);
• Reading glasses – if needed- (helpful when interpreting medical forms);
• A snack (such as a granola bar or an apple);
• A book that is related to your work – medical field or interpreting
• Breath mints (some interpreters keep a toothbrush and toothpaste with them); and
• A change of clothes in your car

Be sure you arrive 15-20 minutes early. Plan for traffic, parking, and the time it will take to walk across the clinic/hospital to where you will be interpreting. Approach the front desk and introduce yourself.

“Good morning, my name is Jane Deer, and I am scheduled to interpret with Dr. Smith and his patient Joe Jones at 9:00.”

NOT, “I’m here to interpret for Joe Jones….”

Verify whether Mr. Jones has arrived yet and if so, “Could you point him out?” Approach the patient and introduce yourself. It is appropriate to chat with the patient, just avoid talking about their medical issues. If they start to discuss their medical issues, you can redirect the conversation, for example. “Let’s save that information for Dr. Smith. I know he will want to know what you have to say. So, what do you think about this weather we’re having?”

If Mr. Jones has not yet arrived, sit where you can see patients arriving, and when Mr. Jones has arrived, meet him at the front desk for check-in. The patient may have already checked in online, but the receptionist may ask to verify name, address, phone number, and to see picture identification and insurance cards. Staff may also ask if Mr. Jones has any respiratory illnesses or symptoms and whether he has traveled outside the country within the past three weeks. There may also be a co-pay for the appointment. Often the patient is asked if they want to pay now or be billed later. And the patient may be given paperwork or a tablet to fill out additional information. If the patient does not understand the written questions, as the interpreter you should sight translate them to the patient.

When the patient’s name is called, inform the patient and accompany them to the nurse. Introduce yourself, “Hi, I’m Cindy and I’ll be interpreting for Dr. Smith with his patient Mr. Jones.” Including both the provider’s and the client’s names presents more professionally and encourages mutual respect. From there the staff person often confirms the patient’s name and birthdate and often the patient’s weight is taken while walking in. It works well to stand in such a way that you are not privy to the weight information et cetera but can still be seen to interpret.

This moment is often a good time to ask the staff person if they have worked with an interpreter before. If the answer is, ‘No,” this becomes an opportunity to offer a few brief pointers as you would in any other interpreting setting. As the appointment progresses, you can add additional information as needed. Naturally, an interpreter will want to repeat this process with the doctor when they arrive.

If you are working with a Certified Deaf Interpreter (CDI), defer to the CDI to explain their place in the interpreting process. If necessary, in consultation with the CDI, you may ask for a larger room if you believe it is appropriate.

Be aware of things like lighting; are the blinds open and bringing in too much light? Check with the patient and make adjustments as needed. And, keep the staff informed of the reason why you may be making or requesting adjustments.

Where you sit or stand will be dictated by what is going on during the appointment. Often, the nurse will sit at a computer desk collecting or verifying information. It is good for the interpreter to sit near to, but slightly behind, the nurse so the patient can see both the nurse and the interpreter. Do not look at the computer screen as that may contain sensitive information. Nurses will often start by confirming medications which can be challenging with generic and brand name medications. Not all patients have their current medications committed to memory and may only know the color and size of pills. Next, the nurse will take the patient’s blood pressure, oxygen level and temperature. If the nurse is asking questions while checking blood pressure, you may want to mention that if the patient is signing, it may impact the blood pressure results. And of course, be sure let the patient know what you said to the nurse.

If the patient needs to change into a gown, be very clear in your interpretation about what clothes need to come off and what can stay on. For example, “Remove your shirt (and bra if the patient is female, or transgender), but you can leave your pants and underpants on.” Be clear about whether the gown needs to open or tie in front or in back. A misunderstanding here can prove embarrassing for the patient. Obviously, you will leave the room while the patient is changing.

When there are no health care providers present in the examining room, the general protocol is to leave the room with the provider. Inform the patient that you will be right outside the door. However, there can be exceptions such as if the patient:

• asks you to stay (you can decide if you want to or not). As always, be aware of your own safety.
• is elderly or vulnerable in some way, it may seem most appropriate to stay in the room. Always check for patient consent and notify the clinician.

Additional activities that may happen while the patient is in the room. For example, being asked to leave a urine sample. In which case, be sure the instructions are clear, including identification of the sample shelf, or drawer. Or, a phlebotomist may come to draw blood samples, or the patient may be asked to stop at the lab before they leave.

If x-rays are going to be taken, the interpreter will accompany the patient to the radiology room. Establish a system to let the patient know when to inhale and hold their breath, and when to breathe again. Options for this can include flicking the lights once to hold their breath, twice when they can breathe again. Or tapping the patient’s shoulder to inhale and hold and tap again to breathe. Some interpreters even carry a small flashlight and set up a flash signaling system. Remember that you will need to be behind the protective window with the x-ray technologist while the actual x-rays are taken. And be sure to verify the availability of, or need for, a protective vest or apron.

Other imaging could include a Positron Emission Tomography (PET) scan, a Computed Tomography (CT) scan, or a Magnetic Resonance Imaging (MRI). These may be done with or without contrast (dye). Any of these scans can cause anxiety for patients, Deaf or hearing. Note that, for an MRI, the patient may be given a sedative to be sure they are calm enough to remain still for imaging.

Generally, the last activity in the room will be the doctor checking back to explain any results, to write any needed prescriptions. At check out, the patient should be given a printed After Visit copy of information from the appointment. If the patient needs to schedule another appointment, interpret for them at the scheduling desk.

Finally, if you are working for a referral agency, they may require the clinic staff sign a form confirming that you were at the interpreting assignment. This typically includes the start time and end time of the appointment. Such forms may be signed by the doctor, nurse, or front desk staff.

Hospital In-Patient Interpreting

Medical interpreting often includes interpreting for patients who are hospitalized or Deaf family members visiting people in the hospital. Most often, such interpreting services are provided during the day. The most common time for various providers to see patients are between 8:00 am – 4:00 pm. Yet, depending on the seriousness of the hospitalization, and the communication needs of the patient, interpreters can be hired for 12 or even 24 hours a day. These longer assignments will usually need for a switch of interpreters at some point. And, the hospital may have the ability to provide Video Remote Interpreting (VRI) some of the time.

Similar to a clinic visit, when a patient is first admitted, they will go through a standard hospital admission process. The patient will be asked the usual questions and be given various forms, such as Medicare Know Your Rights, Health Insurance Portability and Accountability Act (HIPAA) information, et cetera.

Patients will also be asked if they have a Medical Healthcare Directive form. Be sure you are familiar with these forms prior to interpreting in medical situations, as these are legal documents. The Medical Healthcare Directive form includes a yes or no question regarding a Do Not Resuscitate (DNR) and Do Not Intubate (DNI) directive, and under what circumstances. These can be challenging concepts to interpret, as well as the concept of quality of life. It is a good idea to practice these terms before you need to interpret them. And of course, it might be helpful to ask a healthcare CDI for their suggestions.

If an Intravenous (IV) line is inserted, it is okay to inform staff that long-term IV placement in the bend of the arm can be uncomfortable for Deaf people who sign. And be sure to let the patient know you shared this information.

When there is a nursing staff shift change, the patient’s current nurse will give report meaning they meet for about a half-hour with the in-coming nurse to update them on the patients’ information. Interpreters can, and should, do the same with in-coming interpreter. Giving report needs to be objective and necessary for the interpreter to do their job. For example:

You have interpreted for Mr. Brown who has been hospitalized for end-stage leukemia. You have been with him for the morning and a replacement interpreter is taking over at noon. During the morning, Mr. Brown’s young children came to the hospital to see their father for the last time, and it was an emotional morning. After the children left, Mr. Brown began acting out – yelling at the staff and you, throwing things – and you understand that this is a natural reaction given the circumstances. When the replacement interpreter arrives, you take 5-10 minutes to give report.

“Mr. Brown’s children came this morning for a final visit with their father. It was very emotional. After the children left, Mr. Brown began exhibiting negative behaviors – angry with staff and me and threw his breakfast dishes to the floor.

Now the replacement interpreter will not be surprised if this behavior continues and will know that it is not the interpreter themself that is the cause of the patient’s distress.

Another example includes:

Another situation might involve childbirth. You are the first interpreter on the scene for a woman and her partner, both Deaf, who are in labor with their first child. After ten hours of labor, you call for a replacement interpreter and give report.

“The couple arrived last night at 10pm. This is their first baby, and things are progressing slowly. They are working with a midwife named Susan. They would like the interpreter to wait in the hall and come in with the midwife or nurse.”

Generally, in-patient interpreters station themselves outside the patient’s hospital room, ready to accompany any staff (including clinical, dietary, pharmacy, ombudsman) that needs to talk with the patient. It is okay to ask for a chair if you are remaining in the hallway.

Doctors generally make their rounds in the early morning, while nurses and nursing assistants (CNA) will go in and out of the room all day. And Laboratory Technologists (Lab Techs) may come to take blood, and so on. Times for these visits are unpredictable. You can ask nursing staff for approximate times for things like Occupational Therapy (OT) or Physical Therapy (PT). If you need to leave to use the bathroom or grab some lunch, let the nursing staff know. And provide them your cell phone number so they can message you if you are needed. Remember, providers often come in and out throughout the day unannounced. Other in-patient interpreting may include interpreting for:

• Staff to put the captioning on the television
• A non-signing family member, friend, or visitor
• A hospital chaplain
• Doctors, Physician Assistants (PAs), Residents, CNAs, OT/PT, Speech Therapists, Hand Massage Therapist, Palliative or Hospice Care staff, Social Worker, and even Therapy Pets

In terms of daily ordering of patient meals, this may be done by a nurse, a CNA, or a family member who will call in the meal requests. Sometimes the patient may need you to interpret if they call in their meal order themselves.

With regards to patient hygiene, whether that includes a sponge bath or cleaning after a bowel movement follow the desire of the patient if they want you in the room since communication happens during this time. If you are asked to stay in the room, position yourself so that you are looking at the patient’s face or the wall to maintain a sense of privacy for the patient. This may be uncomfortable at times, but this is a part of the job.

If family members or visitors are present, and they do not know sign language, you should interpret for all those involved but should not be an hours-long responsibility for the interpreter. If the patient has a family member with them who can sign directly with the patient, you can share with them the hospital is obligated to hire an interpreter for the patient and health care staff, with a goal of clear communication and that you are open to receiving clarifying information, especially home signs or names.

Discharge

There is a saying in the hospital setting which says, “hurry up and wait.” One area where this is true is patient discharge. Hospital staff will say they are preparing discharge papers, and they will be ready soon, but “soon” could be several hours.

It is vital for an interpreter to be present when discharge instructions are given. Information will be shared regarding what the patient can or should not do when they arrive home. Any wound care and medication instructions will be explained. Take the time needed to be sure the interpreted information is clear and understood. The same is true for any patient questions or concerns.

Ethical Considerations

Medical interpreting involves a lot of ethical considerations and decision-making. Remember, the interpreter is a part of the medical team. Our role on that team is to make communication clearly accessible. If there is not a family member or friend who can advocate for the patient, and the patient cannot advocate for themselves, interpreters often have an obligation to advocate on behalf of the patient. For example,

• If you believe the patient has not understood something and you want to repeat it, you can say something like, “I’m not sure I interpreted that as clearly as I would like. Could you please repeat that information, and I’ll interpret it again.”
• Do not inform family members of medical updates. Encourage family members to check in with the patient directly, and/or nurse or doctor about any new information.
• If the nurse has left the room, and the patient tells you they have not understood the information and wants you explain it to them, you can say, “Yes, that is important information. Let’s get the nurse back in here to go through it again.”

These are a few possibilities, but every situation will be different. Most medical interpreters will tell you that many times they face difficult decisions, but they always err on the side of patient safety and understanding.

Insights from Deaf Consumers – Medical Settings

Out-Patient Surgical Procedures

Sometimes surgeries are done in a doctor’s office, and sometimes they are done as an outpatient at a hospital. It is a good idea to contact the hospital surgery center the day before the assignment to confirm the date, time, and what the surgery is for, et cetera. Most often, either the referral agency or the surgery center will be happy to share that information. Occasionally, this information may not be made available until you arrive at the hospital on the day of the surgery.

Interpreters need to check in 15-20 minutes early at the registration desk. Just as the in clinic process, when the patient arrives, they will check-in with the usual information. However, with surgery, the patient will be asked who is with them and who will be driving them home. That person must check in and give their contact information to hospital staff. Staff will explain about parking, the cafeteria, and how the driver will be notified when the surgery is over. Sometimes the interpreter and driver will be given a pager. If the driver is Deaf, you can let them know that the staff in the waiting room can page you if needed. If you leave the waiting room area, inform the staff or volunteer.

Surgery waiting rooms will often have a monitor that will indicate when the patient’s surgery is underway and when it is complete. Staff at the waiting room desk can answer questions about where the patient is in the surgery process.

When the patient is called back to the pre-operating (pre-op) room to prepare for the surgery. You will accompany them, and the patient will change into a hospital gown (often a disposable paper gown). Again, be sure to specify if the gown is to tie in the front or the back. If the interpreter needs to be in the operating room during the procedure, you will be given a paper jumpsuit to put over your clothes, slip covers to wear over their shoes, a cap, and a mask. You can ask the nurse to put your belongings (bag, purse, knapsack) behind the desk or there may be a locker in the changing room where you can store these items.

Once the patient is gowned, they will wait in the pre-op area. While there, the nurse will verify the patient’s name and birthdate, and place an IV in the patient’s arm (this may be placed elsewhere, but most commonly in the arm). The anesthetist or anesthesiologist (or both) will come to talk with the patient in the pre-op area, ask for their name and birthdate again, and discuss whether the patient has had anesthesia previously and if they have ever had a reaction to anesthesia.

The surgeon will make an appearance in pre-op, to check in and ask a few questions. For example, “Can you tell me what kind of surgery we are doing today?” Or “Which leg are we operating on today?” These are times to be highly observant, and to note which limb, or body part is marker-identified. The patient and doctor, and sometimes the interpreter, will sign the consent form. When everything is ready, the patient will be wheeled into the Operating Room (OR), and if, needed, you will accompany them.

An interpreter might need to be in the surgery room when the patient will either be awake or will be lightly sedated or will be having a local anesthetic (nerve block). For example, during a hernia repair the sedation may need to allow for the patient to be alert enough so the surgeon can ask them to cough several times. Or during eye surgeries such as cataract removal, the patient is awake and needs to let the surgeon know if they feel any pain.

After the surgery is over, and the patient is in the Recovery Room, the surgeon will come to the waiting room (or smaller room inside the waiting area to ensure privacy) to speak with the person waiting for them. After the surgeon is finished reporting information about how the surgery went, the interpreter will go back to the recovery room for the first phase of the patient’s waking up process. Here, the patient will have their blood pressure taken several times and, as they begin to wake up, the nurse will ask how they are feeling. If the nurse needs their attention, you can tap the patient on the shoulder or leg. Better yet, you can remind the nurse that the patient is Deaf and explain to them that they can tap the patient on the shoulder or leg to get their attention.

From the recovery room the patient will be wheeled into the post-op area. At this time, the person waiting for them may join them. The patient needs to stay until they can eat and drink something – usually a cracker or cookie and some apple juice. Then discharge instructions are given. At that point, the patient will be free for discharge.

Video Remote Interpreting (VRI)

VRI is becoming more common in medical settings. Our recommendation is novice interpreters gain experience medical interpreting on site before trying to interpret medical settings using VRI. There is great value in experiencing the dynamics of the medical setting in person. On-site jobs will guide the questions you will want to ask in a VRI situation. For example, who are the parties in the room? Why is the patient in the clinic or hospital? Can the Deaf person(s) see the video screen comfortably?

And of course, the interpreter will need to have expertise in call management.

Closing Thoughts

We hope we have given you a useful overview of medical interpreting. In sum, thoughtful decision-making is required, preparation is necessary, vocabulary and knowledge about medical procedures is vital. We both have focused on medical interpreting for our careers and have found it to be stimulating, ever-changing, and gratifying work. We feel we have played a positive role in providing accessibility for the Deaf community and medical providers.

Tips and Additional Thoughts

• You must be nationally certified.
• Additional education related to medical interpreting is recommended.
• Take an anatomy class and a medical vocabulary class. For the latter, there are books available, and they make for good reading.
• Know your tolerance for blood, guts, broken bones, odors, sounds and pain (the patient’s, not yours).
• Know when to wear a gown and gloves. This may not be posted outside the door but follow your instincts and follow what other medical providers are doing.
• Know the pecking order of “who’s in charge?” Generally, the doctor or surgeon is at the top.
• Know who the other “players are in the surgery room. The circulating nurse is your best friend.
• Be familiar with legal issues. You can find settlement cases for doctors’ offices and hospitals on the web.
• If you are going to do a home visit with a provider, be sure you wear socks as you may need to take off your shoes.
• If you are allergic to pets, you may want to exercise caution and take your allergy medication
• Do not schedule assignments too close together. Medical appointments can often start late or run late. It is good to have buffer time in your schedule in case the appointment time runs over.
• Establish your own practice of calling the contact person at the clinic on the morning of the appointment to ensure it has not been cancelled, or to confirm that it is an in-person appointment. It is not uncommon to arrive for the appointment only to learn, “Oh, the patient called yesterday and cancelled.” This often does not get communicated to the interpreter.
• Do not use your personal phone, tablet, or other device to interpret any calls for the patient.
• Often the patient (and/or the person waiting for them) may be nervous about the surgery. Seeing a friendly, experienced medical interpreter, who is familiar with the hospital, can help assuage their concerns.
• Operating rooms are always cold! You may want to wear layers so you will have enough clothing under your paper suit to stay warm.
• Often surgery will involve cauterizing when incisions are made. This helps to control bleeding. There is an odor with cauterization, so be prepared. One trick is to have a flavorful piece of gum in your pocket so that you can feel it with your hand and rub it under your nose. Carmex under your nose works too.
• Some agencies require you to get your referral form signed while onsite at the appointment.
• BE FLEXIBLE!
• And remember – You are a part of the medical team!

Activities

• Search the internet to find two settlement cases between Deaf complainants and hospitals. Study the settlement agreement and identify which parts of the Americans with Disabilities Act (ADA) are applied in the settlement.
• Contact a teaching hospital to see if you can do a surgery observation. Sometimes it is easier if you have an interpreter program instructor contact the hospital and explain that you are going to be interpreting in medical settings, and you would like to observe a surgery as part of your training. This experience will let you know what sights, sounds, and smells may affect you when actually interpreting in a medical setting. If you can do this with a partner, you will be able to debrief with each other.
• Using Google Images search for Hospital Admission Form or Hospital Release Form or DNR/DNI Form. Read the form for understanding, then alone, or with a partner, record yourself interpreting the form. Analyze your work for meaning and understanding. Repeat and practice until you are satisfied.
• Nigel Howard is a Deaf Medical Interpreter. Search for him on the internet and/or attend any medical interpreting workshops you can find. He is an extraordinary interpreter and teacher.

Discussion Questions

• If the patient wants you to stay in the room, what things do you need to consider?
• We suggested that you not discuss the patient’s medical issues while in the waiting room. Why do you think this is so?
• When is it appropriate to share information? What information can you share?
• Suppose the hospital insists they use VRI services for childbirth (the patient has requested an on-site interpreter). What options does the interpreter have in this situation?

Resources

American with Disabilities Act. (n.d.). Americans with Disabilities Act. https://www.ada.gov

Association of medical professionals with hearing loss. (2021). Resources. https://www.amphl.org/resources

Bancroft, M. A. (2010). Medical terminology for interpreters (3rd ed.). Culture and Language Press. www.cultureandlanguage.net

CATIE Center at St. Catherine University. (2024). Medical. https://healthcareinterpreting.org/medical/

CATIE Center at St. Catherine University. (2008, October 9). Medical interpreter: ASL/English domains and competencies. https://healthcareinterpreting.org/domains-competencies/

Chicago Hearing Society. (2022). CHS. https://chicagohearingsociety.org/asl=health=resources/

Dean, R., & Pollard, R. (2013). The demand control schema: Interpreting as a practice profession. CreateSpace Independent Publishing Platform.

DigiterpVideo. (n.d.). Digiterp Communications. https://www.youtube.com/@DigiterpVideo/featured

Morisod, K., Malebranche, M., Marti, J., Spycher, J., Grazioli, V. S., & Bodenmann, P. (2022, May 28). Interventions aimed at improving healthcare and health education equity for adult d/Deaf patients: a systematic review. The European Journal of Public Health, 32(4): 548–556. Ncbi.nlm.nih.gov/pmc/articles/PMC9341675

National Association of the Deaf. (n.d.). Position statement on health care success for Deaf patients. https://www.nad.org/about-us/position-statements/position-statement-on-health-care-access-for-deaf-patients/

Swabey, L. & Dutton, L. (2014, October). (2014). Interpreting in Healthcare Settings: Annotated Bibliography. CATIE Center at St. Catherine University. https://healthcareinterpreting.org/annotated-bibliography-interpreting-healthcare/