Health Care Interpreting

Health care interpreters facilitate communication between patients with limited English proficiency (LEP) and their physicians, nurses, lab technicians and other healthcare providers. Because of the growing number of LEP patients, the need for healthcare interpreters has grown swiftly in the last decade, so there is good career potential in this profession.

When a patient has limited ability to speak English, it is nearly impossible for even the most skilled clinician to provide high-quality healthcare services without accurate interpreting performed by a trained, qualified interpreter who is familiar with medical terminology. If family members, friends or staff who are not trained as healthcare interpreters try to interpret in healthcare settings, errors in understanding and/or communication can occur, posing grave risks to the patient and immense liability to the healthcare provider or institution.

Most full-time healthcare interpreters are responsible for providing face-to-face interpreting between patients and providers. However, interpreters may also be asked to work with other individuals, such as family members or a patient representative, and they may provide cultural information to facilitate support for a treatment plan.

Healthcare interpreters often render sight translation of basic health care documents by orally translating the document into the patient's language. Healthcare interpreters may also interpret over the phone or through video. Healthcare interpreters often have to educate other members of the healthcare team regarding the duties, requirements and ethical standards involved in healthcare interpreting.

Throughout the United States, interpreters are becoming key and highly valued members of the healthcare team. Their responsibilities have evolved greatly in the last decade and are continuing to change to meet needs.

For compelling and moving depictions of the importance of this new and growing career, see:

• "Worlds Apart" - A powerful video documentary by the Stanford University Center for Biomedical Ethics 
• "Doctoring Across the Language Divide" - An article that appeared in Health Affairs, a health policy journal

Health care interpreters work in a variety of health care settings, including hospitals, clinics, private offices, rehabilitation centers and nursing homes. The unique rewards and challenges vary with each situation -- for example, some interpreters work in the ER, which can be very challenging. Some interpreters work in only one department while others may work in a number of departments as needed.

In addition to the stress of working in primary care and medical specialty fields, interpreters also confront unique issues related to working in mental health facilities, substance abuse clinics, forensic services, domestic violence programs or similar types of health care settings. Since this is a relatively small field in proportion to the growing population of limited English proficiency (LEP) patients, the volume and pace of work in a larger, urban hospital may also be challenging.

Despite the career's unique challenges, most health care interpreters speak of the intense emotional rewards they derive from their work. Like health care providers, they see on a daily basis that their work saves lives and protects health and well-being.

In the past, health care interpreters worked primarily on day shifts. However, today, they may be called upon to work any shift schedule and may also work on call, especially in acute care settings. Since interpreting requires immense concentration and focus, some protocols specify that interpreters be given breaks every two hours; however, it is common for interpreters to work much longer as needed.

Many health care interpreters perform their work over the telephone or using video technology. Due to limited resources, particularly in rural areas and/or when specific language needs arise, telephonic interpreting is an industry which has seen considerable growth in the past few years. Health care interpreters may provide this service either full-time or in addition to on-site interpreting.

Until recently, the primary job prospects for health care interpreters were in urban settings. However, particularly for certain languages such as Spanish, the need is growing in all parts of the country, including many rural settings.

The average salary varies widely, depending on the language, job location, years of experience and employment status. The job prospects for qualified interpreters are excellent for the foreseeable future.

Salary Information

According to the U.S. Bureau of Labor Statistics, in May 2010, the median annual salary for a health care interpreter was $43,000.  The median hourly rate for health care interpreter was $20.82 per hour.  It should be noted that these figures will vary considerably based on numerous factors such as such location, type of institution/organization and employee status (a full or part-time employee versus a contracted interpreter).  Additionally, even the specific language in which an interpreter interprets may also be a factor. 

Academic Requirements

To become a health care interpreter, you need to be far more than simply bilingual, although that's a good start. Certainly, interpreters must have advanced to superior fluency in at least two languages, as well as an in-depth knowledge of the cultures of the languages they are interpreting.

However, you also need to be sensitive to the subtle nuances of meaning in a given language and be able to communicate them in two directions. You must have the skills and knowledge to quickly grasp the intention of a message in its original language, then you must be able to re-express it swiftly and accurately in the target language.

In addition to this kind of language fluency, you need a thorough knowledge of medical terminology in both the target and source languages. You also should be familiar with specific medical procedures, as well as the different clinicians' roles at the health care facility in which you work.

To accomplish all this, you must have excellent oral communication skills, knowledge of specialized health care terms and concepts, and a commitment to adhere to the national code of ethics and national standards of practice for interpreters in health care. One of the standards of practice, for instance, is that a health care interpreter must never add or subtract from what is communicated by anyone.

As of 2010, there are two national certifications for health care interpreters:

• Certification Commission for Healthcare Interpreters (CCHI)
• National Board of Certification for Medical Interpreters (NBCMI)

Certification and other credentialing requirements vary by state.

Minimum requirements for the profession vary greatly from state to state.  Nonetheless, most health care institutions prefer to see:

• A certificate of successful completion from a recognized educational institution or training program (whether through a private institution, a two-year college or a four-year college)
• A certificate attesting to language proficiency in all of the interpreter's working languages
• Skills testing in health care interpreting
• Proof of mastery of medical terminology in all working languages

General education and experience, rather than specific academic requirements, are the only other typical prerequisites. National standards for training of health care interpreters were developed in 2010.

Professional Associations

 

• California Healthcare Interpreting Association
• Certification Commission for Healthcare Interpreters (CCHI)
• Hablamos Juntos
• Interpreters Division of the American Translators Association
• Limited English Proficiency - A federal interagency website
• National Council on Interpreting in Health Care (NCIHC)

What it is like to be an interpreter

The importance of understanding what interpreters do is incredibly important; not only for those who are interpreters, but also for those who use interpreter services.  Knowing the different styles of interpreting and the skills associated can help businesses or organizations use their interpreters in the best way possible.  However, as they say as well, it is very important to get a qualified "well seasoned" interpreter, not just an individual that claims to be bilingual.

To do a good job interpreting, and individual needs to be properly trained. This TED Talk does an excellent job discussing and showing the different kinds of interpreting and what we do on a daily basis.

 As a medical interpreter, which is not discussed at lengths during this video, a combination of interpreting styles is necessary, a long with a wide vocabulary used by many different dialects of the secondary language.  Without the necessary knowledge and skills a case can get away from the interpreter very quickly without much hope of accurately interpreting the conversation.

The need for health care interpreters

February 5, 2014, Audrey Singer and Camille Galdes. A new U.S. citizen waves
a U.S. national flag in front of a display of flags.

According to the 2010 Census, roughly 574,560 people in Minnesota speak a language other than English at home; or 10.6% of the population in Minnesota, compared to the 20.5% of the total US population. Over half of these individuals report that they speak English less than “very well.” These individuals are considered to have limited English proficiency (LEP). That is, they are not able to speak, read, write, or understand the English language at a level that permits them to interact effectively. 

Due to this deficit in communication between patients and providers in a medical setting there are many issues that arise; they are at risk due to their ability to access care and communicate with their providers, to name the two most important.

It is well established that language barriers contribute to health disparities for LEP patients. These patients have less access to a usual source of care, and lower rates of physician visits and preventive services. Even when they do have access to care, LEP patients often have poorer adherence to treatment and follow-up for chronic illnesses, decreased comprehension of their diagnoses and treatment after emergency department (ED) visits, decreased satisfaction with care, and increased medication complications. In contrast, language concordance between patients and physicians increases patient satisfaction, patient-reported health status, and adherence with medication and follow-up visits.

Given that over 100 languages are commonly spoken in the United States (US Census), it is often not possible to provide language concordant health care. In some clinics around Minnesota, providers my experience 20+ different languages in one day alone; and many interpreter services agencies offer 40-50 of the most common languages, where hospitals and clinic are forced to fill in the gaps with  "web or telephone" communication with up to 104 languages in any given day.  

Although some LEP patients are fortunate enough to be seen in settings where physician and office staff speak their primary language, this language concordance can readily disappear once these patients present for laboratory testing, emergency care, or are admitted to the hospital. Therefore, the majority of providers must use other means to communicate with their LEP patients and, if they receive federal financial assistance, they are required to do so by Title VI of the Civil Rights Act of 1964. Most often this means is a third person, an interpreter, who can range from a highly trained professional medical interpreter to any available bilingual person (NCIHC 2001).

The National Interpreter Organizations such as, the National Council on Interpreting in Health Care (NCIHC), and many professional interpreters agree and recommend the use of professional interpreters to augment the use of bilingual clinicians and staff, in order to improve the quality of care delivered and to decrease health disparities. A recent general review of literature concludes that the quality of medical care is improved by either use of professional interpreters or via direct provision of care by bilingual health care providers. 

Through careful evaluation of this literature it is clear that professionally trained interpreters decrease communication errors, increase patient comprehension, equalize health care utilization, improve clinical outcomes, and increase satisfaction with communication and clinical services for limited English proficient patients. Health care providers need to recognize that language barriers place LEP patients at a disadvantage that can be overcome by providing better linguistic access. Without access to professional interpreters, this large and growing population will continue to suffer differentials in both health and access to quality health care.