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Working with case managers-Is it the interpreter's responsibility to check on patients?
Thread poster: Adriana Johnston
Adriana Johnston  Identity Verified
United States
Local time: 17:30
English to Spanish
+ ...
Feb 15, 2015

Hi, I'd like to ask those of you who do medical interpreting and who have encountered the following: I usually work with interpretation agencies who normally do all the communications between their client, case manager, patients, etc.
I recently signed a contract with a direct client whose employee got injured on the job. I have been interpreting at all of the injured worker's medical appointments including surgery, and his case manager has attended some of the appointments.
I realize now, that I spend quite a lot of time exchanging emails, calls and texts updating the parties involved on what went on during the Doctors appointments, and am wondering if I'm still working within the scope of my duties.
What I mean specifically is for example, after the surgery, the case manager asks me to call the patient's home to see how he has been doing after his surgery, and then contact her back telling her what the patient says.
Of course I don't mind interpreting, it's what I was contracted for, but from your experience are those calls and emails back and forth a standard procedure? or should parties like the case worker be on the line while I call his patient or be present at all of the patient's appointments so I can interpret directly??


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Michael Grant
Japan
Local time: 08:30
Japanese to English
Blurred lines... Feb 15, 2015

Hi Adriana,

Wow! That sounds like a full-time job!
On the one hand, I can understand the caseworker's thinking: it's faster just have you call the patient, than for him/her to call and conference you in or record the conversation, translate, and send it to him/her...but on the other hand, making house "calls"...? I highly doubt they are paying you enough for the level of responsibility they are placing on your shoulders...that's really blurring the lines between case worker and interpreter!

If it gets to be too much, you may want to review your contract and/or re-negotiate it...I am sure other "Proz" have more experience and will give you more useful/pertinent advice, but at the very least I can say you are right to be concerned.

Michael

[Edited at 2015-02-15 23:54 GMT]


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Joseph Tein  Identity Verified
United States
Local time: 15:30
Member (2009)
Spanish to English
+ ...
It's best to just interpret Feb 16, 2015

I think you need to be careful with this, because there's always a possibility that somebody will misunderstand something, or even at least potentially the patient can claim you said something you didn't ... that's certainly what court interpreters are taught: you never want to be alone with the person you're interpreting for. Certainly you should never be put in a position to "explain" something to the patient or answer questions based on your own knowledge and understanding ... you need to just relay communication between the parties.

Are you getting paid for the emails and phone calls? That should certainly be part of the agreement ... all of your professional time should be reimbursed. I think it's best to just interpret for the parties, but if you're going to do more it should be spelled out in your agreement. You're also free to refuse to do the work outside the interpreting sessions ... but it might cost you a client. You have to decide.





[Edited at 2015-02-16 01:41 GMT]


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liviu roth
United States
Local time: 18:30
Romanian to English
+ ...
here we go again Feb 16, 2015

There is absolutely nothing wrong with it. Just keep in mind that we are human beings and that we need to put a human touch to our robotic job. I did that many, many times, I drove indigent patients to their appointments, helped them to get their medication from the pharmacy, even help them buy groceries if they lack transportation or are unable to drive. I don't see anything out of the ordinary to spend 1/2 hour to get all the information and relay it to the case worker. Life is not only about $$$$$$$.

Best,
Lee


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jyuan_us  Identity Verified
United States
Local time: 18:30
Member (2005)
English to Chinese
+ ...
I think most direct clients don't understand the difference between freelancer and employee Feb 16, 2015

That is why they would ask you to do everything. They think you are paid so you must do everything they ask you to do.

Last year I was assigned to work on a large multilingual project and after everything had been approved by the client, the client started to send in additional requests. It is all about updates of the target language versions because of the change of the English version. In the beginning, I just did them a favor and had my linguists make these minor changes without an additional charge. But soon I found this will be an endless process so I told the client that additional payment is needed, otherwise I will not do as they requested.

The client was shocked and their thinking was that now that we have paid you, you have to do whatever we requested you to do.

Of course, after negotiation I got extra pay for these extra tasks. It turned out that there were more than 50 followup requests, which, timed by 6 (6 languages), equals to 300 additional requests!



[Edited at 2015-02-16 03:04 GMT]


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Phil Hand  Identity Verified
China
Local time: 07:30
Chinese to English
I once did a similar thing Feb 16, 2015

A direct client wanted some chivvying, follow-up phone calls put in to their contact, and asked me to make them on my own. I asked for and received explicit instruction on what to say, and gave the client a written report on the conversation afterwards. I charged for the telephone and writing time.

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Eva Ba
United Kingdom
Local time: 23:30
English to Slovak
Don' do that Feb 16, 2015

You crossed the boundary. You do more then professional interpreters should do. They have to remain independent and not to be involved in to the procedures.... The role of the interpreter is to facilitate communication and to interpret what is being said between two parties who do not speak the same language. Interpreters must act confidentially and impartially, and in any circumstances to keep a professional distance. The interpreter has to remain as neutral as is possible and cannot be involved personally or emotionally in the discussion.
Your job is to interpret at presence all parties and nothing else - this can also be on the phone, but still both parties have to be connected...and they should make a call, but you... You may only intervene, in the course of the discussion to clarify accuracy of the meaning, and also may explain the cultural misunderstandings when it is necessary and/or is appropriate during the session.
If you do translation and other work it means you crossed professional interpreting duties.
Translations job is paid differently... and other job you are involved in is not the part of interpreting....

You are not their employee!
Eva


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Vanda Nissen  Identity Verified
Australia
Local time: 09:30
Member (2008)
English to Russian
+ ...
I agree with Eva Feb 16, 2015

The principle of impartiality seems to be misinterpreted there. You have definitely lost neutrality here.

Refer to your contract. What does it say? Does it cover medical appointments only or does it also include translation of emails and follow-up calls? I suggest to get everything in written from your client before making any calls on their behalf.

@Lee, with all respect, interpreters are neither taxi drivers neither home help. It has nothing to do with being human.


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Joseph Tein  Identity Verified
United States
Local time: 15:30
Member (2009)
Spanish to English
+ ...
here we go again (revisited) Feb 16, 2015

I totally agree with Lee that we're human and that we need to bring a human touch to our work. The question is where to draw the line. I get requests from PMs I work with regularly for help with a word or acronym or little phrase in a document, and I don't mind doing them a favor when I have the time, to make their work a little easier. (I should add here: I also push hard to get paid what I think my time and services are worth when we're dealing with real "work".) Likewise I once gave money to a very poor person that I had interpreted for, and bought food for somebody who was going through a diabetic hypoglycemic crisis. I don't do these things frequently or regularly, but it just felt like the necessary thing to do at the time.

The other side of this is that we need to be respected for what we do, and sometimes we have to educate clients about our professional worth and boundaries. Adriana's client needs to be clear about what's expected and part of the contract. Adriana hasn't replied to say whether she gets paid for the extra work or not; I definitely think that we need to be paid for our professional time and services ... it's disrespectful to an interpreter when certain "favors" are taken for granted and expected.

And I'll say again that I think there's potential risk in dealing with the non-English speaking person alone; it's best to keep it to interpreting as much as possible. I like Phil Hand's approach.

[Edited at 2015-02-16 22:45 GMT]


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liviu roth
United States
Local time: 18:30
Romanian to English
+ ...
different point of view Feb 17, 2015

Vanda Nissen wrote:

The principle of impartiality seems to be misinterpreted there. You have definitely lost neutrality here.

Refer to your contract. What does it say? Does it cover medical appointments only or does it also include translation of emails and follow-up calls? I suggest to get everything in written from your client before making any calls on their behalf.

@Lee, with all respect, interpreters are neither taxi drivers neither home help. It has nothing to do with being human.


For God's sake! It is medical interpreting, not courtroom interpreting! What neutrality? Acting normal, as a normal human being gets lost in interpreting the rules. People who act and work as programmed robots are the easiest to replace.
If you know that you are interpreting for a 75 old lady with cancer and she is scheduled for chemo the following day and she tells the doctor that she does not have transportation, is it absurd for the interpreter to offer to drive an extra 1(one) mile to pick her up from home? When you get paid $50/hr and spend with the patient 4-6 hours/day, is it too much of an effort to be nice and act humanly?
Thank God that I don't think like that! This must also be the reason why I have been asked to interpret in hospitals all over the state for almost 20 years, although I am a court interpreter.

Good luck!

[Edited at 2015-02-17 03:13 GMT]

[Edited at 2015-02-17 07:52 GMT]


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Vanda Nissen  Identity Verified
Australia
Local time: 09:30
Member (2008)
English to Russian
+ ...
A different approach Feb 17, 2015

Well, I prefer being called for interpreting assignments because I am a good interpreter, not a driver:). But it is of course, a matter of preference.

As for the patients, I am proud to live in a country with a free medical care for everybody, so there is no need for me to patronise people. Luckily, my country can afford a taxi service for a terminally ill person. On the other hand, we do not get 50 dollars per hour for each and every hour we spend at hospital as interpreters, so we can say that here, in Australia, our taxes are used for taxi drivers, home help, free hospitals and other things. And yes, tax significantly higher than in the US.

Actually, quite a lot of agencies in Australia directly prohibit further contacts with patients, i.e. going to the pharmacy, giving a lift etc.

Finally, in Australia we follow the principle of impartiality in all settings: legal, medical, or business. I am surpised to hear that it is different in the US.


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Ewa Olszowa  Identity Verified
Canada
Local time: 18:30
Polish to English
+ ...
Guide? Feb 17, 2015

Hi,
Is there any standard guide that you should obey and which clarify your scope of duties/role? Rules and regulations what you are allowed to do as an interpreter and what you should avoid? Do you have insurance and what does it cover?
I would say that if the job you are hired for is interpreting, you should stick with that; anything you do beyond that is at your own responsibility and risk. The point is, if something happens (for example, you give a patient a ride and there is an accident), it is your responsibility and probably every other party (hospital, company who sent you for interpreting, etc.) will stay away from taking any responsibility for that.
So, any task other than interpreting should be assigned separately as a specific work order - I do sometimes message relay, when I call a person at home and deliver message and get the answer back to service provider (or to agency and they deliver that further), but it is a separate work order specified in writing.




[Edited at 2015-02-17 14:38 GMT]

[Edited at 2015-02-17 14:39 GMT]

[Edited at 2015-02-17 14:43 GMT]


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liviu roth
United States
Local time: 18:30
Romanian to English
+ ...
I fully agree with you, Vanda Feb 17, 2015

Vanda Nissen wrote:

Well, I prefer being called for interpreting assignments because I am a good interpreter, not a driver:). But it is of course, a matter of preference.

As for the patients, I am proud to live in a country with a free medical care for everybody, so there is no need for me to patronise people. Luckily, my country can afford a taxi service for a terminally ill person. On the other hand, we do not get 50 dollars per hour for each and every hour we spend at hospital as interpreters, so we can say that here, in Australia, our taxes are used for taxi drivers, home help, free hospitals and other things. And yes, tax significantly higher than in the US.

Actually, quite a lot of agencies in Australia directly prohibit further contacts with patients, i.e. going to the pharmacy, giving a lift etc.

Finally, in Australia we follow the principle of impartiality in all settings: legal, medical, or business. I am surpised to hear that it is different in the US.


Don't get me wrong. In the US apply the same rules . Unfortunately, these rules apply more or less to textbook scenarios; the rules, guide, code of ethics do not teach or explain what to do in certain out of the ordinary situations. These situations show how prepared is an interpreter. The guide, rules or code don't tell an interpreter what to do if he needs to spend 3 (three months), 8 hrs/day in a psychiatric ward of a detention center interpreting every other hour for the patient/inmate and there is no way out, just stuck with the LEP in a room/cell.
This post should have been posted under "Interpreting", not "Medical" where many colleagues may think that it pertains to medical translation. Under Interpreting I posted or commented on out of the ordinary situations and ethical problems encountered during my 20 years as an interpreter.

Best to everybody,
Lee


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Christine Andersen  Identity Verified
Denmark
Local time: 00:30
Member (2003)
Danish to English
+ ...
A very interesting discussion for everyone IMHO Feb 17, 2015

lee roth wrote:
...

This post should have been posted under "Interpreting", not "Medical" where many colleagues may think that it pertains to medical translation. Under Interpreting I posted or commented on out of the ordinary situations and ethical problems encountered during my 20 years as an interpreter.

Best to everybody,
Lee


It is good for us translators to see what a very different job interpreting is!
Thanks to everyone for your points of view - I enjoyed them from my safe 'den'! You certainly face some issues that the rest of us don't, when we rarely have to meet clients face to face.

If you want to, however, you can ask one of the moderators to move the thread to the Interpreting Forum.


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liviu roth
United States
Local time: 18:30
Romanian to English
+ ...
a re-post from another forum Feb 17, 2015

Real life situation:

ethical dilemma in a medical setting Aug 31, 2014

I remember a case where a large hospital, for liability reasons, hired me as an interpreter to spend 8-10 hrs/day with a patient who had already five surgeries. Initially, the patient was supposed to have a same-day laparoscopic surgery. Unfortunately, the doctor operating the patient punctured her hernial sac and the patient went into septic shock. After about four months of being every day with the patient, the hospital decided, for financial reasons, to move her to another unit with less qualified medical staff. After two days I noticed a profound worsening of the patient’s health. I told the nurse to call the doctor and let him know that the patient is dehydrated (she wasn't able to drink any fluids and the medical staff refused to put an IV without the doctor’s order). At the end of the day I requested to talk to the head-nurse of that unit. I told her that I have been with the patient for more than four months and therefore I knew her very well. Her reaction? “You are here as interpreter, it is none of your business”.
Next day, when I showed up at her room, she was gone to another unit, even less qualified to handle her situation. I went directly to her supervising doctor and told her that the patient is in coma because of dehydration. Within ten minutes they moved the patient to the Emergency room. Three nurses and a doctor worked on her and were able to bring her back. I asked the doctor what was the cause of her coma and his response “deep dehydration” !!!!!
Unfortunately, the Code of ethics does not teach new interpreters how to handle these kind of situations. From an “ethical” (by the book) standpoint I should have done nothing. It is not in our job description to do that and we are not paid to do that. Correct, but what about some common sense and behaving like a human being?

lee


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