In-person medical interpreters are needed now more than ever.

The idea that on-site, face-to-face medical interpreters are being replaced or will eventually all be replaced by remote interpreters has not come to fruition even after more than a year and a half into the COVID-19 pandemic.

It has been shown that in-person interpreters are a necessity. And the demand for interpreters to work in person will not be going away. Furthermore, having to choose between remote and on-site interpreting is a false dilemma—medical interpreters are needed in all modalities—phone, video, and in-person, depending on criteria and circumstances.

I have been working with a language services and interpreter training company for almost ten years and will share my viewpoint and experience from the past 18 months. For some perspective, our company has made a name for itself largely on its consistently high-quality pool of on-site interpreters, mostly medical interpreters. We also provide remote interpreting services, both telephonic and video, and were prepared for an increased volume of remote interpreting as hospitals and other medical providers had to adapt to seeing patients via telemedicine visits over the phone or video.

Pandemic Interpreters

Some people have been surprised to hear when I tell them that our on-site work did not completely disappear and that on-site interpreters were still being requested in the first months of the pandemic. The volume of on-site assignments decreased at first and the volume of remote interpreting increased for much of the past year. Many formerly on-site only interpreters accepted being trained and making the switch to video remote interpreting. They had the internet connection, appropriate devices, and physical space that allowed them to do this. This was of great benefit to all: to interpreters, who could continue to work with our company and be provided assignments; to our company so that we could continue to provide requested services; and to the hospitals and medical settings we serve so that they could continue to provide language access services to their limited-English proficient (LEP) patients.

The desire and need for in-person interpreters is not simply wishful thinking or because a company wants to continue to enjoy business from that modality. Often, in-person interpreters offer the best possible solution for quality language interpretation. This modality generally increases patient satisfaction and clear communication—especially communication between a patient and provider that is more complex such as dealing with sensitive or difficult topics, diagnosis, discharge instructions, or complex care and treatment discussions.

The benefits and advantages of having an on-site, in-person interpreter are discussed in a study of interpreter perspectives and indicate that in-person interpretation is better for “establishing rapport and for facilitating clinician understanding of patients’ social and cultural backgrounds.”

The Power of Interpreters

the mere presence of an in-person interpreter is powerful. The interpreter becomes the person in the room who not only ensures communication between parties, but also gives a voice to the LEP, can more readily check for understanding, and meaning, and also manages cultural issues and “bumps” if they arise. Remote interpreters also provide this voice. However, there are important differences due to the limitations of an interpreter appearing on a screen. The interpreter behind the screen has limited ability to view all body language, all participants, and the entire room. Other barriers to effective communication when a remote interpreter is provided include difficulty by all parties being able to use their devices, the app or program, and the “technology” not working for various reasons including poor connection or no connection, not to mention that not all individuals possess a smartphone or internet device.

Even before the COVID-19 pandemic, hospitals had protocols in place regarding when to provide in-person versus remote interpreters. There is specific guidance on what types of medical encounters require an in-person interpreter versus a virtual or remote interpreter. These protocols continue to be in place and for in-person interpreters, now include added personal protective equipment (PPE).

Remote interpreting alone will never be able to provide the quality and health equity that in-person interpreters provides. Remote interpreting should not be considered a complete solution. Unfortunately, remote interpreting technology can have the effect of compounding already existing barriers to healthcare experienced by LEPs.

Growth in Interpreter Demand

The COVID-19 pandemic forced a faster move to use the technology available for language services. This is generally seen as a good advance—the use of technology to bring together a provider, LEP and interpreter so that critical communication takes place. Except for whoever was left behind. How many LEPs were not reached or served in the past 18 months due to this forced change? Who was left behind due to technological requirements and other constraints for a telemedicine visit? Remote interpreting by itself cannot be considered a complete solution as far as equal access is concerned.

There is a continued demand and need for on-site interpreters. Aspiring and already working interpreters can plan on returning to or continuing to work alongside frontline healthcare workers. Working on-site is an experience like no other and many interpreters prefer to work in medical settings in person. Those who train and mentor interpreters should continue to guide and advise new interpreters on how to work properly and effectively on-site with medical teams at hospitals and other medical settings.

By: Silvia Villacampa, Managing Director

This opinion article appeared in the Spring 2021 quarterly newsletter of the ATA Medical Division, Caduceus.

Reference:

Price EL, Pérez-Stable EJ, Nickleach D, López M, Karliner LS. Interpreter perspectives of in-person, telephonic, and videoconferencing medical interpretation in clinical encounters. Patient Educ Couns. 2012;87(2):226-232. doi:10.1016/j.pec.2011.08.006