Working with Interpreters

Genetic counseling through an interpreter is not the same session conducted more slowly. Concepts like carrier, penetrance, and probability often have no ready equivalent in the target language, the interpreter is making judgment calls in real time, and the counselor cannot hear whether the meaning survived. Working well through interpretation is a specific skill, and using an untrained interpreter is a patient safety problem rather than a shortcut.

• Professional interpretation is a legal obligation. Title VI of the Civil Rights Act requires meaningful access for people with limited English proficiency in federally funded programs. This is a requirement, not a courtesy, and it is not satisfied by a bilingual relative.
• Never use family members as interpreters, and never children. The reasons are accuracy, because an untrained interpreter summarizes and softens; confidentiality, because the patient may not want that relative to know; role conflict, because a relative has views about the decision; and, for a child, an unacceptable burden.
• Bilingual staff are not interpreters unless they have been assessed and trained. Conversational fluency does not confer medical terminology or the discipline of interpreting rather than explaining.
• Brief the interpreter before the session. Two minutes covering the purpose, the difficult concepts likely to arise, and the possibility of emotional content substantially improves accuracy. Ask them to tell you when a concept has no equivalent rather than approximating silently.
• Speak to the patient, not the interpreter. Use first person and address the patient directly. "Ask her whether she understands" is worse than "Do you have any questions about this?"
• Speak in short segments and pause. Long passages force the interpreter to summarize, and summarizing is where content is lost.
• Modes differ. Consecutive interpretation is standard in counseling because it preserves accuracy. Simultaneous is rare in this setting. Telephone and video remote interpretation expand language access, particularly for less common languages, at the cost of losing nonverbal information, which matters in an emotionally loaded session.
• Sign language interpretation has its own requirements. American Sign Language is a distinct language with its own grammar, not signed English, and a Deaf patient may prefer a certified Deaf interpreter working alongside a hearing interpreter for complex material.
• Concepts without equivalents are the substantive problem. Probability, carrier status, and the distinction between a screen and a diagnostic test frequently need to be built with analogy rather than translated. Plan for this rather than discovering it mid-session.
• Teach-back matters more, not less. Asking the patient to explain the plan back in their own words is the only way to confirm the meaning survived two translations.
• Allow more time. An interpreted session takes roughly twice as long, and scheduling it as a standard slot guarantees it will be rushed at the point where it matters.
• Document the language, that a professional interpreter was used, and the interpreter's identifier.

• A family arrives with their 14-year-old daughter prepared to interpret her mother's prenatal results. The counselor arranges a professional interpreter, explaining it is standard practice, which both protects accuracy and spares the child from delivering news about her mother's pregnancy.
• Mid-session, the interpreter says there is no direct word for carrier in the patient's language. The counselor and interpreter build an explanation together using a two-copies analogy, and the counselor then uses teach-back to confirm it landed.
• A counselor notices her three-sentence explanation is being rendered in four words. She shortens her segments and checks understanding, and the interpretation lengthens accordingly.
• A Deaf patient is offered a video remote interpreter for a complex results session and requests an in-person certified Deaf interpreter instead. The request is accommodated, because the material is dense and the loss of nuance over video would be substantial.

• Do not use a relative, and never a child. This is the central rule.
• Do not address the interpreter in the third person. Speak to the patient.
• Do not deliver long passages. Segment length determines how much survives.
• Do not assume a bilingual colleague can interpret. Fluency and interpretation are different skills.
• Do not schedule an interpreted session in a standard slot. It takes about twice as long, and the compression falls on the most important part.