Getting doctors to speak to patient directly
Thread poster: Sara Senft

Sara Senft  Identity Verified
United States
Local time: 04:15
Spanish to English
+ ...
Dec 12, 2008

I've seen from reading the posts that doctors often speak indirectly to the patient. When I interpret at medical appointments, the doctor often says "tell him/her...." and what ever the message is. I feel strange using the first person when I give the response (if this happens) because I wonder if the doctor will think I am referring to my situation. (Even though I know I am supposed to use the first person.)

Should I take the direct route and ask the doctor to speak directly to the patient?

Fortunately, lawyers and other legal professionals tend to know better!

[Subject edited by staff or moderator 2008-12-15 09:04 GMT]


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Juan Jacob  Identity Verified
Mexico
Local time: 03:15
French to Spanish
+ ...
More context... Dec 12, 2008

...first of all, into wich language are you translating to?
Doctors, where?


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Alexandra Goldburt
Local time: 01:15
English to Russian
+ ...
I can only simpathize... Dec 12, 2008

I tried to ask the doctors to speak to the patient directly. In only a handful of cases, they've agreed to do it and actually done it.

Typical doctors reactions are:

- they agree, say "you" a couple of times, and then go right back to "he/she";

- become completely bewildered - what the heck does this interpreter want from them! - and even angry.

If somebody knows the magic formula how to make doctors to use second person, I'd like to know it, too.


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Mario Gonzalez  Identity Verified
Mexico
Local time: 01:15
Member (2008)
English to Spanish
+ ...
I guess Dec 12, 2008

If the communication works, use whatever is good.
insisting on ignoring you are in the same room is kind of silly.


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Tina Vonhof  Identity Verified
Canada
Local time: 02:15
Member (2006)
Dutch to English
+ ...
A suggestion Dec 12, 2008

I'm not an interpreter, so I have not been in this situation but I am familiar with doctor-patient communication. I wonder if it would help if you position yourself somewhere where the doctor would have to turn around to see you, either to the side or even slightly behind him/her, so that you are both facing the patient.

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Lidia Saragaço  Identity Verified
Portugal
Local time: 09:15
English to Portuguese
+ ...
It's not easy but I believe it is the best way. Dec 12, 2008

I worked as an cultural interpreter at a large Toronto hospital with Portuguese, Italian and Spanish speaking patients, for four years. It was part of our training to make doctors and other health care providers understand that we are not the "patient" and to make the patient understand that we are not the "health professional", this is important because otherwise the interpreter assumes a role that is not hers or his to take. We are there to be that person's voice and as such we always used the first person (it also helps with the flow since you are not repeating constantly "he says"). I guess it really depends on the experience that health professionals have with using interpreters.

Ours was a hospital that a had lot of experience in providing care for non-english speaking persons so it was fairly easy for us interpreters. When a new health care professional arrived we would take some time to explain how the system worked and likewise when seeing a patient for the first time we would explain what our role was. (Of course in emergency cases we cared more about getting the information flowing, but in other situations we followed that procedure.)

Whenever possible we would arrange the seating in such a manner that the doctor would face the patient directly and the interpreter would be in the middle but seating back from both, much like a triangle; that way the interpreter is "part" of the picture and accessible by both people but is not in the way.

Just another note, we were cultural interpreters because culture has a great influence in language as you know and specially so in the area of health, an area where people's beliefs, food habits, hygiene, etc. play a very important role and have to be understood and respected, so it was important to know the language but also to know the culture of the patient in question.

It was a job that I absolutely loved!


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PAS  Identity Verified
Local time: 10:15
English to Polish
+ ...
Happens, difficult to control Dec 12, 2008

Since you're the person speaking "directly" to the doctor (the patient is speaking to you), the doctor automatically responds to you, not to the patient. It's part of us, difficult to overcome.

This happens on occasion when I interpret at meetings, negotiations etc.
Usually it is not an annoyance, so I ignore it.
If it hampers the discussion somehow, I will try to direct the speaker to talk to the person, not to me, by looking at the person that the speaker should be speaking to etc.
Sometimes I make a small motion of the hand and point to the recipient.

Once or twice I made a direct comment. I was never reprimanded for this. There was never a problem because of my comment or gestures.

I mostly interpret at meetings between consultants and the government (somewhat below ministerial level), mostly with 10-20 people in the room.

I suppose in an intimate and at once "unofficial" situation of a doctor's appointment, this should not really be a problem.
I would only ask the doctor not to use phrases like "Please ask the patient if it hurts him when....".

So, there's my long-winded response, for whatever it's worth

Best
Pawel Skalinski


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juvera  Identity Verified
Local time: 09:15
English to Hungarian
+ ...
Bad guess Dec 14, 2008

Mario Gonzalez wrote:
I guess
If the communication works, use whatever is good.
insisting on ignoring you are in the same room is kind of silly.


There are tried and proven methods of effective communication through an interpreter, like talking in first person. The communication works less well without this method. Sooner the doctor learns it, better it is for his/her patients.

Ignoring this is kind of silly.

Usually it only takes a couple of reminders to the doctor to start using first person; after all, he would use it naturally if the interpreter were not present.

The same applies to the patient.

Both can be informed about best practice, particularly when they are new to using an interpreter, and can be reminded of it when necessary.

I interpret almost daily in all sort of situation, and it is rare that somebody cannot adapt to using first person. Just the opposite, the interpreter using first person usually makes them understand how it works and they quickly follow the pattern. Even those who are a bit confused in the first few minutes settle into the natural way of addressing the person they want to talk to, instead of telling the interpreter: tell him/her!

Effective professional interpreting requires a lot of specific discipline, (not only using first person, but many other things besides) and these have to be learnt and adhered to. Otherwise you and your clients are open to all sorts of problems, too numerous to list.

So no guesses, please.


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Alexandra Goldburt
Local time: 01:15
English to Russian
+ ...
In an ideal world, yes Dec 14, 2008

juvera wrote:

Mario Gonzalez wrote:
I guess
If the communication works, use whatever is good.
insisting on ignoring you are in the same room is kind of silly.


There are tried and proven methods of effective communication through an interpreter, like talking in first person. The communication works less well without this method. Sooner the doctor learns it, better it is for his/her patients.

Ignoring this is kind of silly.

Usually it only takes a couple of reminders to the doctor to start using first person; after all, he would use it naturally if the interpreter were not present.

The same applies to the patient.

Both can be informed about best practice, particularly when they are new to using an interpreter, and can be reminded of it when necessary.

I interpret almost daily in all sort of situation, and it is rare that somebody cannot adapt to using first person. Just the opposite, the interpreter using first person usually makes them understand how it works and they quickly follow the pattern. Even those who are a bit confused in the first few minutes settle into the natural way of addressing the person they want to talk to, instead of telling the interpreter: tell him/her!

Effective professional interpreting requires a lot of specific discipline, (not only using first person, but many other things besides) and these have to be learnt and adhered to. Otherwise you and your clients are open to all sorts of problems, too numerous to list.

So no guesses, please.


In an ideal world, doctors would receive training about working with interpreters. Sadly, this is not the case in California (and probably in the rest of the U.S. as well).

Everything you say, Juvera, is absolutely right, but here is my problem: a typical doctor has worked with dozens interpreters before, and practically all of them have no problem with using the third person. I frequently hear other interpreters at the medical appointments saying "He says... he asks...".

Here comes a new interpreter (me) and asks him to do things differently, and even insists that using the second person (what a doctor is not used to doing) is the right way. Now, no matter how politely you put it, the doctor perceives it as criticism. The interpreter basically informs the doctor that what he has done so far is wrong, and asks him to change. Well, you have to know human nature a bit - it's unlikely he'll respond with "Oh, now I realize I've been ignorant all along! Thank you for enlightening me!"

Chances are, he might even ask the agency not to send this interpreter again!

And this why we continue to have problems.


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juvera  Identity Verified
Local time: 09:15
English to Hungarian
+ ...
I see... Dec 15, 2008

It may be that here in the UK we have an easier job.

Those who have not used interpreters before, usually say so, and we can tell them how it is supposed to work. They don't get offended when we tell them in a diplomatic way that it is easier to speak directly to the patient. Generally, in the UK doctors are well mannered, and not too difficult to work with.

The direct, first person reply from the interpreter relaying the patient's speech also helps.
Tina's suggestion to stay somewhat behind the doctor for a while is also a good tactic.

Alexandra Goldburt wrote:

In an ideal world, doctors would receive training about working with interpreters. Sadly, this is not the case in California (and probably in the rest of the U.S. as well).

...here is my problem: a typical doctor has worked with dozens interpreters before, and practically all of them have no problem with using the third person. I frequently hear other interpreters at the medical appointments saying "He says... he asks...".


It seems to me, it is not necessarily the doctors' fault. Hopefully they know their own job. Interpreters cause the damage by not knowing how to interact and conduct the technical side of interpreting, or unable to convey it for whatever reason to the relevant parties. I fully understand how difficult it is to rectify bad habits, once they take root.

The primary culprits are these interpreters, and I also know that there are a lot of them who never had any training.
I suppose in the US it varies from state to state, but it would be beneficial to hold at least some sort of induction course/day for would be interpreters from time-to-time, to enable them to pick up the basics.

Any agency working in the health service would do a good turn to all concerned - including themselves - to hold such a session once a year or so.

That's how I started many years ago, and it made me realise that the job I embarked is not only a question of being able to convey the meaning of what somebody said in a different language.
I am very grateful for that because the initial course gave me the impetus to learn more about it, and helped me to be aware of the pitfalls, and on the long run made my job much easier.

I think these discussions are useful to help inexperienced interpreters to look for some guidance. I have not had a chance to search for relevant literature, but if anybody knows some, that would be great to share it with this community.

I wish you all the best.

[Edited at 2008-12-15 11:09 GMT]


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Hengky Chiok  Identity Verified
United States
Local time: 01:15
Member (2008)
English to Indonesian
+ ...
Keep on using the first person voice. Dec 15, 2008

Sara Senft wrote:

I've seen from reading the posts that doctors often speak indirectly to the patient. When I interpret at medical appointments, the doctor often says "tell him/her...." and what ever the message is. I feel strange using the first person when I give the response (if this happens) because I wonder if the doctor will think I am referring to my situation. (Even though I know I am supposed to use the first person.)

Should I take the direct route and ask the doctor to speak directly to the patient?

Fortunately, lawyers and other legal professionals tend to know better!

[Subject edited by staff or moderator 2008-12-15 09:04 GMT]


I interpret medical interviews almost on daily basis, and regardless the third person voice the providers use, I always interpret it in 1st person voice. If I have a chance to do a pre-session with the providers and the LEP, I will explain to them that they should talk directly to one another; but whether they do so or not, I continue in 1st person voice.

Managing the flow of the conversation and to help both parties understanding each other is much more important to me than whether they do it correctly or not. If the patients understand the providers instructions and take that medicines in the mornings after a meal instead of in the evenings after a bottle of beer, or the providers understand that the patients are complaining that the headache feels like the head is about to explode and it is not that the patient is trying to blow the head off, then I am fine with the "tell her/him" part.

I only use third person when referring to myself and pretend not to notice the baffled look.


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Sara Senft  Identity Verified
United States
Local time: 04:15
Spanish to English
+ ...
TOPIC STARTER
Some doctors are better than others Jan 26, 2009

In my experience, some doctors DO speak directly to the patient. Two specific ones come to mind.

One of these doctors was working with a patient whose basic English was fine; I stepped in when there were more advanced questions. Another doctor was working with a paitent who understood far less English.


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