Good practice guidelines for community interpreters in healthcare settings

The primary aim of the healthcare interpreter should be to facilitate communication between two persons who do not speak the same language.

Therefore a healthcare interpreter:

• Should never act on behalf of the user and should never speak on behalf of either party.
• Should not act as an advocate.

While a healthcare interpreter is expected to have a general understanding of the cultural background of both parties, they are not a cultural expert and should be wary when offering cultural advice.

If asked to provide a written translation of a document, a healthcare interpreter should refuse this task, as this is the role of a translator, and not an interpreter.

Before a session – Where possible, the interpreter should avoid situations where s/he is left waiting with the non-English speaker for an appointment. If this is not possible, the interpreter should avoid discussing any medical history or concerns.

At the start of a session – The interpreter should explain to all parties that s/he is there to interpret, s/he will respect confidentiality, and will interpret everything that is said.

During the session – The interpreter sits to the side, out of the eyeline of the healthcare worker and the patient. The interpreter should respect the physical privacy of the patient during any examination.

At the end of the session – the healthcare worker should, if the conversation has been a difficult or stressful one, check that the interpreter is not too distressed by what has been discussed.

The healthcare worker should ensure that paperwork/invoices are signed to support the payment of the interpreter

The key ethical tenets for healthcare interpreters are confidentiality, impartiality, accuracy and professionalism.

Confidentiality – The mutual trust and uninhibited transfer of information essential for effective healthcare interpreting is dependent on confidentiality.

 Therefore;

• Nothing said in the session will be communicated outside the session.
• A healthcare interpreter will not reveal personal information gained from work that may lead to the identification of the parties involved.
• A healthcare interpreter will not reveal information about either party learned from any prior meeting.

The only exception being when either party is in immediate danger. If, for example, a person confides to an interpreter in private that he or she has suicidal thoughts, the interpreter must pass on this information to a medical practitioner.

Impartiality – Impartiality is essential to ensure the transfer of an undistorted message.

Therefore a healthcare interpreter will:

• Disclose any prior acquaintance with either party.
• Decline to interpret where a family or close personal or professional relationship may affect impartiality.
• Inform all parties prior to the communication process that everything said during the exchange will be interpreted, even if they say something not meant for interpretation.
• Not impose his/her philosophical, religious or political views on any interpretation.
• Not offer advice or personal opinions either on own initiative or when asked.
• Never correct erroneous facts or statements that may occur, even though the error is obviously unintentional. Neither should s/he infer a response, that is, if the beneficiary is asked to clarify a prior response, the interpreter should pose the question as asked and not volunteer what he or she thought the person meant.
• Bear in mind that lengthy conversations with a speaker can lead to suspicion and distrust of the interpreter by the other party in the communication process, thus leading to incorrect perceptions as to his or her objectivity. If the interpreter needs to clarify a point with a speaker, then s/he should explain what has just happened to the other speaker.

Accuracy – Accuracy is essential to ensure the transfer of an undistorted message.

Therefore, a healthcare interpreter should always use direct speech, using the first person as if the interpreter does not exist. All parties involved in the communication process should be informed of this, so as to avoid confusion.

An exception may be made in mental health interpreting, including counselling, psychological or psychiatric sessions and assessments, where the interpreter may choose to use either the first or third person singular, as considered appropriate by the healthcare interpreter and the clinician involved in the communication process. If a healthcare interpreter needs to refer to him or herself, s/he should do so in the third person as “the interpreter”. This distinction is made so as to eliminate any confusion.

A healthcare interpreter should:

• Interpret in a clear voice accurately, completely and objectively everything that is said, without adding, omitting or changing anything.
• Not emulate the gestures made by the speakers; they have already been seen.
• Emulate the inflections and intonations of the speaker, in order to reinforce the meaning and stresses of the speaker’s words.
• Reflect the person’s way of speaking as accurately as possible. The interpreter will therefore interpret obscenities and colloquial language and will not simplify language used.
• Request clarification if a medical practitioner uses specialised terms.
• Acknowledge and correct promptly any interpreting errors made.

If one of the parties speaks too fast or for too long, a healthcare interpreter should stop them as appropriate in order to interpret as accurately as possible. If a message is unclear, the interpreter will ask for repetition or rephrasing where necessary with the knowledge of all parties.

Should a serious communication problem arise between the interpreter and one party, the interpreter should bring this to the attention of the other party.

Professional Conduct – A healthcare interpreter is a professional and should act accordingly at all times.

Therefore, a healthcare interpreter will

• Always interpret to the best of their ability.
• Have a good command of both languages including specialist terminology, current idioms and dialects.
• Maintain and develop their command of both languages.

• Keep up to date with the relevant procedures of the particular area in which they are interpreting.
• Participate in continued professional development.
• Behave in a courteous, polite and dignified manner at all times.
• Aim to establish a compassionate but professional relationship with beneficiaries.
• Be on time and prepared for all assignments.
• Dress appropriately for the particular assignment.
• Not accept any gift in return for interpreting services from either party.
• Charge an appropriate fee for their services dependent on experience, certification and the nature of the assignment. Services should only be provided free of charge in exceptional circumstances.
• Not make any personal gain from any information learned on an assignment.
• Follow the code of ethics and conduct at all times.

Where possible, a healthcare interpreter should receive accurate and sufficient information from the user or agency regarding the assignment, place, time as well as an indication of the duration of the assignment at least 48 hours before the assignment is due to take place in order for the interpreter to prepare for the assignment.

A healthcare interpreter may refuse an assignment but must advise the agency in advance.

A healthcare interpreter may withdraw from an assignment if it becomes apparent that expertise beyond their technical or language competence is required, or if an interpreter has been given incorrect information or insufficient time to prepare for an assignment.

The session should not last longer than previously established without the interpreter’s consent.

If asked to provide a sight translation (where the interpreter reads out a translation rather than writing it) of complex medical documents, a healthcare interpreter should make it clear that unless given adequate time and without proper preparation any translation can, at best,  be provisional.

Interpreters should be treated with dignity and respect with adequate provision for their comfort and safety—interpreters have a right to a toilet break when needed and should not be left alone with a dangerous person or someone who is very ill.
If a healthcare interpreter feels exploited or discriminated against during the assignment s/he has the right to withdraw his or her services.

Ideally, any change or cancellation should be made known to the interpreter company and/or the interpreter the day before the assignment and failure to do so will result in the client being billed for the service.

Where an interpreter has been booked for an appointment and the session is cancelled at the last minute, a minimum payment should be made to the interpreter who otherwise is out of pocket.

Interpreters’ travel expenses should be reimbursed. This includes a proper mileage rate for those travelling by car and the reimbursement of all train, bus, Luas and Dart tickets. Payment should also be made for time spent travelling to assignments.
These arrangements may differ amongst individual service providers and interpreters should clarify these details with the service provider.