Before the Appointment

Set up the room so that you are looking directly at the patient. The interpreter should sit to the side, just behind the patient, to avoid being the centre of attention. When working with patients who are deaf, the interpreter will sit next to the health professional facing the patient, so that the patient can clearly see the interpreter signing.  

The interpreter will be in a better position to accurately interpret if they have a clear understanding of the purpose of the appointment and the role of all parties involved.   

Before the appointment give your interpreter the following information:   

• Your position and role  
• The purpose of the appointment  
• Any complex concepts that will be discussed  
• Specific terminology that will be used  
• Any sensitive issues that may come up  
• Any materials or forms that may be used or may need to be sight translated by the interpreter  

Please note that if you are visiting a patient’s home with an interpreter, make sure you wait for the interpreter outside the home. Interpreters do not enter a patient’s home without the company of a health care provider.  

Introduction at the Appointment

Interpreters are professionals and part of your team. All information they interpret is confidential. The health care provider alone holds clinical responsibility for the appointment and is responsible for outlining what will happen. The same principles apply when working with an interpreter via telehealth.   

• Introduce yourself, your role, and the purpose of the appointment  
• Introduce the interpreter and their role  
• Reassure the patient that everything will remain confidential  
• Remind those present that everything they say will be interpreted, even side conversations  
• Inform the patient that if they have any questions or do not understand something, they should ask you, not the interpreter  
• Remind the patient that they should pause frequently to allow the interpreter enough time to interpret  
• Check that the patient can understand the interpreter and is ready to proceed (there may be differences in dialect)

During the Appointment

Speak to the person, not the interpreter, and maintain culturally appropriate eye contact with the patient, even when the interpreter is interpreting. The interpreter will interpret using first-person speech (not he or she said). When speaking or listening, watch the patient rather than the interpreter so non-verbal messages can be observed. Staying focused on your patient will help to build rapport. This will enable a more natural exchange of communication to occur.  

• Speak in your natural voice at your normal pace
• Pause at the end of every two to three sentences (but never mid-sentence)
• Avoid breaking up a thought—your interpreter is listening for meaning and context  
• Give the interpreter enough time to process your information and to convey it to the client  
• Let the interpreter control the pace of information flow—stop speaking if they signal with their hand  
• Allow the interpreter to complete an interpretation before jumping in with more information or questions  
• Avoid compound questions  
• Avoid ambiguous and complex grammar  
• Avoid slang, jargon and acronyms

Remember to check for understanding:  

• Check at regular intervals to make sure that you and the patient have fully understood each other
• Use teach-back to check for understanding
• Look for non-verbal signs of comprehension, confusion, agreement, or disagreement

Debrief After the Appointment

It may be useful to have a short, follow-up discussion, especially if the conversation has been difficult and/or emotional. You can discuss the quality of the communication and any difficulties that arose during the consultation with the interpreter.

Virtual Consultations and Appointments

An interpreter can be used to provide virtual consultations, either by video or telephone.

Video interpreting is preferred when the client is under emotional, physical or mental stress, the appointment is expected to be lengthy or complex, there is a need for visual aids or documents, or important decisions need to be made. 

 

Telephone interpreting is most useful when:

• An emergency exists and there is no on-site interpreter
• An immediate service is needed
• Brief consultations (e.g., confirming an appointment or identifying a language) are needed; or
• Anonymity is essential

It may not be appropriate for complex consultations.

 When providing virtual care either by telephone or video:

• Always select a quiet and private place with no background noise.
• When using videoconferencing, the camera should be positioned to capture a clear view of all participants in the room.

• Try and wait a moment after someone has finished speaking before responding - sometimes, there is a lag when working through video, and sometimes, the person might not finish.
• Always make a test call to check the camera, microphone and sound and know how to troubleshoot.
• For telephone interpreting you might need a dual handset, a phone with two receivers or a speakerphone if the patient is in the room with you.
• be mindful of the patient holding the phone for a long time after they have finished speaking - they may simply forget to pass it back to you.

If Interpreting is Refused

If a patient or family member refuses the offer of an interpreter, it is important to try and clarify and address the reasons. As the treating health professional, you also have a right to an interpreter and a duty of care to ensure that all information given and gathered is accurate.  

It may be helpful to point out that:

• Interpreters are part of the health team.
• The service is free.
• The role of the interpreter and their Code of Ethics means that they maintain confidentiality and impartiality. 
• If the patient continues to refuse the service of the interpreter and you decide to continue, you need to document that an interpreter was offered and refused in the patient’s medical record.

See the Interpreters – Standard Procedures for Working with Health Care Interpreters for details.