Medical Interpreting by Bilingual Staff Whose Primary Role is not Interpreting: Contingencies Influencing Communication for Dual-Role Interpreters

Abstract

In an effort to address health care disparities, U.S. laws mandate that health care organizations provide free language interpreting and translation anytime a patient and health care provider cannot communicate in the same language. The heretofore absence of legislative and professional oversight in health care interpreting allows for anyone to interpret. A qualitative study was conducted to understand the conditions and practices of bilingual staff who interpret as a secondary part of their job in community health clinics.

Four focus groups were conducted as part of a study on shared decision-making during interpreted medical visits in a busy, urban clinic serving a large number of limited English proficient (LEP) patients. The focus groups were designed to understand the process of interpreting and how interpreters influence medical decisions between LEP patients and their health care providers. To understand the interpreting process from multiple perspectives, one focus group was conducted with users of interpreters – monolingual health care providers (N=6), two with Spanish speaking men (N=10) who were experienced with interpreted health visits, and one with bilingual staff (N=5) who interpret as an ad hoc feature of their job, also known as dual-role medical interpreters.

Dual-role interpreters use different styles while interpreting what is communicated between health care providers and patients. In some cases, they provide near word-for-word interpretation of what is said. In other cases, they summarize and or paraphrase multiple sentences, seek clarity through questions, and deconstruct culturally laden and technical terms. In still other cases, dual-role interpreters combine interpretation styles within a single interactional exchange. Each of the three major styles of interpreting has advantages in medical settings. Specific style is influenced by health care provider preference, interpreter–health care provider trust and familiarity, and interpreter medical knowledge. Interpreters are challenged by the patients’ dialects, educational level, provider personalities, gender issues, and out of clinic relationships with the patients. Contextual conditions and contingencies of reinforcement contributed to varying methods of interpretation. These conditions included organizational policies, language and bilingual communication, and social relations with both the health care providers and the patients.

These findings demonstrate the complexity of medical interpretation and the critical involvement of health care providers and bilingual staff in facilitating interpreted encounters. Findings suggest the need for training both health care providers and interpreters and possible change in reimbursement for services.

Citation

Mueller, M.-R., Roussos, S., Hill, L., Salas, N., Villarreal, V., Baird, N. and Hovell, M. (2011), "Medical Interpreting by Bilingual Staff Whose Primary Role is not Interpreting: Contingencies Influencing Communication for Dual-Role Interpreters", Jacobs Kronenfeld, J. (Ed.) Access to Care and Factors that Impact Access, Patients as Partners in Care and Changing Roles of Health Providers (Research in the Sociology of Health Care, Vol. 29), Emerald Group Publishing Limited, Leeds, pp. 77-91. https://doi.org/10.1108/S0275-4959(2011)0000029006