Wearing Too Many Hats
(Sight Translation by Certified Deaf Interpreter Mistie Owens)
When a Deaf and hard of hearing (HOH), (LEP) patient has a medical appointment, providers are legally obligated to make arrangements for a qualified interpreter. Some providers may believe because a patient is accompanied by their family and friends to a medical visit, they can also serve as an interpreter. At first it might seem like a reasonable accommodation because the friend and/or family member knows the patient well, is familiar with their medical condition and can communicate with the patient. However, as you can imagine, relying on family and/or a friend as an interpreter poses several conflicts, not only for the provider, but also for the patient and the family member.
Interpreting in any language takes several years of study, practice and experience, particularly in medical environments. Additionally, conversational fluency, while valuable in personal relationships is not sufficient to interpret in clinical settings. Further, giving the professional interpreter the time and space to do their job, reduces opportunities for miscommunication between the provider and patient.
Often times, a provider may interpret the facial expressions or body language of a Deaf/HOH patient rather than waiting for the interpreter to do their job. In ASL, a nod is not just a nod of approval, confirmation, or agreeance but can also be a nod of comprehension or that the Deaf/HOH person is following the conversation but not necessarily agreeing or answering in the affirmative. Additionally, since ASL is its own language with its own structure and grammar, an interpreter will often restructure a question. This restructure may prompt the Deaf patient to answer in the affirmative or denial but not in the way the provider is anticipating.
The provider asks: “Is this the first time you’ve broken your foot?”
The interpretation: “Have you broken your foot before?”
The patient responds: “No.”
If the doctor tried to work around the interpreter, they may have suspected that the “no” or shaking of the head meant the patient had broken their foot before when in fact, they hadn’t.
The precarious nature of the above scenario is often compounded by medical providers who know some ASL. Often times, medical providers who’ve completed a few courses in ASL while in college feel that they will remember enough to provide medical care without an interpreter. However, this can be very damaging to the patient’s ability to communicate and fully engage in their healthcare. Fingerspelling and gestures may communicate basic and rudimentary information, but it is far from suitable for a medical encounter.
When a patient or support person offers to interpret rather than use a professional interpreter, medical providers and professional interpreters should say, “Why not let the family member be of support to the patient and leave the interpreting to the professional interpreter.”
When anyone including providers, interpreters, family/support people and patients try to wear too many hats at once, something will surely suffer. A support person may not be able to fully engage in his or her role, patients may not have total confidence that they are able to fully participate in their healthcare because of the interpreting, and providers who try to act as an interpreter may misunderstand or entirely miss critical information.
Additionally, a patient may not feel comfortable telling family or friends not to interpret for them, which is why it’s even more imperative that medical providers advocate and insist that patients use professional interpreters. There may be relationship dynamics between the patient and the accompanying family/friend that will prevent the patient from being completely honest. This invariably causes a liability issue for the hospital and an ethical dilemma for all parties involved. Finally, minor children who are asked to interpret may not be able to adequately interpret because of their own language exposure, therefore, they may omit information or misinterpret entirely.
We can’t forget that the Americans with Disabilities Act and the Affordable Care Act mandate that providers make the appropriate interpreting accommodations for patients and their families/support persons.
For the sake of efficiency and ease, it may seem like using family and/or friends or even a medical provider who speaks the patient’s language is the best use of resources and time, but it isn’t. It is always beneficial to regularly review language access plans and to ensure that all medical providers know how to request interpreting services.