Guidelines for "working with remote interpreters" for health practitioners

The following provides some insights, guidance, and training to support our health practitioners to work more effectively with remote interpreters (click the headings for more information):

Here are some remote interpreting scenarios and what to consider when using a phone or video conference system.

When connecting to multiple remote parties (eg the health practitioner on his own connecting the phone/video conference system to a remote patient, a remote social worker, and a remote interpreter).

  • For telephone interpreting:
    • use a good quality speakerphone (preferably a Polycom conference phone system) to connect to multiple remote parties.
  • For video conference interpreting:
    • use a tablet, laptop, or PC to connect to multiple remote parties.
  • For both telephone and video conference interpreting:
    • check if the interpreter can hear everyone clearly
    • NB: this type of scenario will be commonly used during a pandemic (eg COVID-19) to reduce close contacts.  

When 1-1 connects to a remote interpreter (eg a health practitioner with an in-person patient in a clinic space or a hospital bed, connecting to a remote interpreter by phone/video conferencing system):

  • For telephone interpreting:
    • use a good quality speakerphone, avoid using a handheld phone to pass around.
  • For video conference interpreting: 
    • use a tablet, laptop, or PC, avoid using a handheld smartphone to pass around.
  • For both telephone and video conference modalities:
    • check if the interpreter can hear everyone clearly
    • this type of scenario is NOT the best approach during a pandemic such as COVID-19 to reduce close contacts and to be considered only for special cases.

When a group is connecting to multiple in-person parties (eg the health practitioner with a patient and family in a meeting room, connecting the phone/video conference system to a remote interpreter):

  • For telephone interpreting:
    • use a good quality speakerphone, avoid using a handheld phone to pass around
    • position the phone in the middle of a room or table.
  • For video conference interpreting:
    • use a tablet, laptop, or PC, avoid using a handheld smartphone to pass around
    • Position the device in the middle of the room or table.
  • For both telephone and video conference interpreting:
    • check if the interpreter can hear everyone clearly
    • NB: this type of scenario is NOT the best approach during a pandemic such as COVID-19 to reduce close contacts, and to be considered only for crucial cases.

Be aware that, in face-to-face communication, the majority of the information we convey to others is through non-verbal communication and tone of voice (ie intonation, accent, stress, pitch, speed, and volume). For telephone interpreting, there are no visual cues, it depends on the quality of voice, and it can be quite stressful for the interpreter when multiple parties are involved.

Telephone interpreting may not be as effective when the:

  • health practitioner requires non-verbal cues for the assessment or screening process
  • session involves emotional or distress conversation
  • session involves more than 4 parties joining remotely
  • health practitioner is not familiar with how to manage the interpreting process when connecting to multiple remote parties
  • session involves more than 45 minutes
  • session involves confidential conversation
  • telephone connection is not clear. 

 

It may not be as effective when:

  • one or more parties are not familiar with how to connect to the video session
  • one or more parties are not familiar with the use of the video conference facility eg Zoom
  • the health practitioner is not familiar with how to manage the interpreting when connecting to multiple remote parties
  • the internet is not stable throughout the session for one or more parties involved.
Note: The first two points need to be resolved by providing adequate information to patients or interpreters how to connect via the zoom/video conferencing system. For the third point, there is a course on "how to work with remote interpreters" for those who are not familiar with managing the interpreting process.

The guidelines provide essential principles and tips for health practitioners to utilise remote interpreters effectively. It includes:

  • pre-briefing interpreter (before the session)
  • structuring the session with all parties (including the patient) at the start of the session
  • structuring the session with all parties during the session
  • de-briefing the interpreter, if necessary, after the session.

These guidelines will enable health practitioners:

  • to establish an alliance with the interpreter and to agree on the interpreting process
  • to ensure all parties involved in the session, including the patient, understand the interpreting process and the rules
  • not feel lost in translation but have better control of the interpreting process and know how to manage any interpreting process issues
  • to achieve a better outcome and experience for all parties and ultimately improve patient outcomes.

Before the session (pre-brief the interpreter):

  • introduce yourself and your role
  • explain the purpose and objectives of the session
  • confirm with the remote interpreter that they are in a quiet and confidential space
  • identify a leader for the session if multiple parties are involved in the telephone session. NB. The role of the leader is to help to facilitate the interpreting process eg manage conversation pauses to allow the interpreter to interpret
  • agree to use the consecutive interpreting mode
  • explore the cultural issues with the interpreter if necessary, eg if you wish to understand cultural issues when disclosing bad news to the client
  • explain that, if the content is very distressing or the interpreter is emotionally overwhelmed, they can pause or slow down by indicating to the health practitioner (agree on a cue, eg “please pause”)
  • offer guidance about how to manage emotions during the session
  • inform the interpreter that a debrief is available at the end of the session, if necessary
  • explain how you want the interpreter to interpret for you if the client has a cognitive or mental illness such as thought disorder), eg do you want the interpreter to summarise the information or interpret literally with meaning or without meaning for your assessment purposes.

At the start of the session (structure the session with the patient and others involved):

  • introduce yourself and explain roles 
  • explain that everything said in the session will be interpreted, ie there are not to be private discussions between parties during the session
  • assure the client that the rule of confidentiality applies to both the practitioner(s) and the interpreter
  • explain the use of consecutive interpreting mode and the interpreting process, eg the need to pause for the interpreter to interpret after two-three sentences. 

During the session (apply this communication protocol):

  • use the first person singular when communicating via the interpreter, eg “Mrs Wong, how are you feeling today” and not “Please ask Mrs Wong how she feels today”
  • direct the questions/statements to the client or family, and not directly to the interpreter
  • avoid entering into direct conversation with the interpreter except for cultural or process clarification and then let the patient knows what you were talking about (ie never exclude the client)
  • pause after 2-3 sentences to allow the interpreter to interpret
  • allow enough time for the interpreter to convey information (it may only take three words to explain but it may take more time for the interpreter to convey the information in their language)
  • use simple and succinct language
  • explain concepts or medical terminologies using simple English
  • avoid using jargon, idiom, colloquial language, metaphors, or double negatives
  • avoid asking more than one question at a time
  • reframe questions if the responses from the patient are not what you expected, eg you could ask specifically "When was the last time this symptom occurred i.e. 1 month, 2 months or more?" instead of an open-ended question
  • watch the speed of conversation to minimise accent and pronunciation issues
  • speak clearly and loudly but do not rush and talk over each other
  • manage the situation if the interpreter is emotionally affected by the discussion
  • for video conferencing, politely signal to the patient/others involved, if you need them to pause for the interpreter to interpret (a hand gesture or ask for a pause)
  • for telephone interpreting, ask the patient/others to pause for the interpreter to interpret.

After the session (debrief the interpreter, if needed):

For telephone and video conference interpreting, you could ask the interpreter to stay behind after the other remote parties are disconnected).

The debrief is useful for:

  • summarising the session and identify any issues meeting the objectives.
  • clarifying any interpreting or cultural issues if:
    • you have concerns or are unsure about contradictory, negative (non-verbal or verbal), unexpected responses, or lack of response, from the patient.
    • you felt that at some point that the translation of information did not correspond with the responses from the patients.
    • if you wish to clarify any cultural meanings of some of the words, concepts or responses.
  • •checking how the interpreter is feeling
    • assess whether the interpreter is affected by the content of the session and address if necessary.
  • checking for transference issues
  • NB: please be aware that it is not uncommon for interpreters to experience distress in response to patients' experiences.
    • If the interpreter felt emotionally affected and distressed by the session:
      • if you have time, allowing the interpreter to talk about how s/he felt before concluding the de-brief
      • if you don’t have time, making sure they know how to access supervision or counselling support or to contact the interpreting service provider for such support.

NB: be aware that interpreters move from one interpreting session to another. They may have come from a very traumatic session or maybe going to another emotional session. It is important to remind them about self-care.

How much extra time do you need to consider when involving an interpreter in a session:

  • sessions that require interpreting yield about half the consulting time that they usually would as every interchange is spoken twice!

  • if your session is for 20 minutes, book the interpreter for 30 minutes for the consultation session, plus 10 minutes extra time to provide a 5-minute pre-brief and allow 5 minutes for a debrief, a total of 30 minutes.

  • It is useful to book the interpreter 5 minutes before the patient joins the session to provide a quick pre-brief.

Many health practitioners experienced ‘lost in translation’ when working with a face-to-face interpreter. It is even more difficult working with a remote interpreter without the essential knowledge and skills.

The following are courses available for health practitioners:

NB: The above courses will provide practical skills training for health practitioners to understand how to effectively utilise remote or in-person interpreting sessions to interact with patients.

  • Module 101 will focus on the essentials working with remote interpreters.
  • Module 4 will provide more explanation and more examples of face-to-face or in-person interpreting sessions.

Go to our login page to register and enrol for courses.

You can download the PDF version of the guidelines here.