Interpreter location relative to the patient and provider can impact the information being shared in the appointment. Being bilingual and trained in healthcare interpretation are the cornerstone requirements to perform as a medical interpreter. However, it’s also necessary to possess certain other skills, which are pivotal in each encounter, such as: having an attitude of service to patients and providers while maintaining the interpreting profession’s boundaries; being culturally aware; understanding the ethics and standards of practice that rule this profession; knowing how the US healthcare system and insurance/billing process work; and knowing idioms and regionalisms or how to recognize them.
Since we understand the impact of our services, we follow a model in which interpreters are based in the US. Over the years, we have identified crucial implications regarding the interpreter location of their video or audio:
A. Customs and Cultural Aspects
Remote interpreting raises the issue of how flexible interpreters can be when it comes to knowing location-specific customs, terminology and idioms, and cultural differences of where the physician or provider of care resides when delivering their services.
Coming from a Latin American country that has a healthcare system very different from the US, I have had to learn about the US system as a patient, provider, and interpreter. Having that familiarity with the US healthcare system has helped me tremendously in my interpretations. Many examples on this topic come to mind. It is common to interpret for a patient or a parent asking the doctor “how much do I owe you, doctor?” because in many other countries the healthcare provider may be more involved in the financial aspects of the practice. It is shocking for patients to receive care without having to pay cash up front or before they leave the hospital. It is also surprising for US healthcare providers, based on my experience, to receive financial questions from patients. As expected, all these questions are interpreted but, if the interpreter does not identify these differences as reasons for lack of conversation flow, the interpreter may not act appropriately, thus s/he may not intervene and empower patient and provider to talk about it for the well-being of the patient.
B. Interpreting Regulations
Interpreter location also affects what rules they abide by. Auditing interpreters and ensuring compliance with the US Code of Ethics/Professional Conduct and Standards of Practice as well as with privacy and security of data are simply not possible if they don’t reside within US territories.
C. Ability to Monitor, Mentor, and Maintain Oversight for Quality
Another factor that may be related to location is whether interpreters can be employees or simply contractors for an interpreting company. This affects the ability to perform quality controls, obtain and provide feedback, perform research, train, and work on enhancing processes and performance. Having interpreters on US soil who are employees allows for ways to ensure quality and invest in cultural awareness and professional development.
Our company has been able to develop quality assurance processes and identify how location may affect cultural awareness and thus accuracy in interpretations. Furthermore, having a network of interpreters from multiple countries in our language centers and a support system with quality assurance and training allow interpreters to grow and learn. Not only do they expand their vocabulary for multiple regions, but their awareness of cultural differences enhances their interpretation work and improves the patient and provider experience.
An example – shared by one of my colleagues who is an interpreter and Quality Assurance expert – explains that: “Even a native Spanish speaker may not realize the importance of the words ‘agua fresca’ (literally fresh water) if they’re not trained to look for their contextual meaning. In certain regions, agua fresca is a beverage made with fruit, flowers, or herbs mixed with sugar and water. A diabetic patient who reports drinking this vs. its literal interpretation will be provided with much different instructions that may affect treatment and outcome.”
D. Security of Data
Just as we use remote interpreting to help care for patients and save lives every day, expanding our communication possibilities brings questions about the privacy of the information being shared or how the data are being handled and stored. At a macro-level, data recorded and stored in other countries may not be subject to the same data protection and privacy rules that apply to US-based operations. Interpreters processing calls are considered to have access to non-public health information and the transmission, transportation, and storage of such non-public information is generally prohibited.
In summary, knowing the language is not enough and interpreter location does affect interpretation encounters. The benefits of staffing interpreters who are based in the US are numerous and impactful. Here is a partial list to keep in mind:
- Ability to monitor, mentor, and conduct oversight for quality
- Professional development in a diverse learning environment for interpreters
- Multi-cultural, multi-nationality environment to learn from
- Familiarity with the healthcare system that both the patient and provider at the other end of the encounter are experiencing
- Security of data, and the vendor’s control thereof
- Enterprise-level internet connection, which directly relates to quality of service