Critical incidents and why you need an interpreter in healthcare
Maybe it’s no extreme sport, but there are many ethical and professional dilemmas that arise each day. It’s not easy to carry out. The job can get personal. It’s a stressful environment at times. Very sensitive day today. It sometimes even strikes a personal note. And these critical moments and incidents reveal how necessary having a qualified interpreter is.
Let’s get that first definition out of the way. It can be simplified as “any event during the interpreting encounter in a healthcare setting that causes the interpreter to self-reflect about their decisions”.
If the event makes the interpreter feel doubt, frustration, or anxiety. If a new optimal solution is found (not all is bad). Or if the interpreter feels the need to change the existing protocol, then it’s a critical incident.
There is a repertoire of reports on this field. The CCHI (Certification Commission for Healthcare Interpreters) counts with a Repository of Critical Incident Reports (CIRs) to offer aid in a systemic and public manner.
Still, let’s go over a few situations. There is an already studied example in the AMA Journal of Ethics that can illustrate perfectly. They present Shiv, a medical student who attends a demonstration on some skin findings on a patient. The patient is a Haitian woman with limited English proficiency. The physician in charge briefly explains, in English, what they will be looking for and requests she nods in approval. Which she does, hesitantly. The doctor abruptly pulls down her hospital gown and starts the exposition. The woman is acutely uncomfortable. Our friend Shiv speaks Haitian Creole and asks her if she is OK and explains the teaching session situation and this soothes her. But Shiv is reprimanded for carrying on a conversation that the rest of the group can’t understand and detracting attention from teaching time.
This can happen all the time. What should Shiv have done? First, there is a clear need for an interpreter. Medical educators have a responsibility to create a healthy learning environment. But then, let’s give this a plot twist. Imagine Shiv is an interpreter, and the Doctor decides to proceed in an unprofessional way. Not explaining in detail or handling the situation in a way the interpreter and/or the patient are not comfortable with. Should the interpreter intervene? Give an opinion? Keep quiet? What is the professional thing to do?
There are already defined steps as to what to do when a critical incident takes place. The person in question should:
This means context, being very specific about the event but only as to what is necessary to understand.
HIPAA rules apply. This means no names of patients, providers, or facilities. You may change (“blur”) the info to some extent only to preserve confidentiality.
3. Be relevant
Assess the relevance of the needed demographic info of all parties. The cultural, medical, and appointment information (such as type of facility, urban/rural, face-to-face, video) and the existence of special protocols.
There are risks in poor-quality translation and interpreting services. Which could lead, and have led to lawsuits, inefficient resource utilization, misdiagnosis, misunderstandings. While making sure there is always someone available to speak the patient’s language increases safety, follows a professional code of ethics, improves service performance, and creates a better working environment.
Having a full-time staff of interpreters in each language is not cost-efficient, so that is not what we propose. But there are plenty of certified agencies that save time, money and provide outstanding customer service.
Here are a few answers as to how to deal with situations such as Shiv’s.
A healthcare interpreter is first, and foremost, providing a service. They are not doctors or healthcare experts, so personal judgment must not come in the way. Be it disagreeing with the client’s style or methods. Or feeling close to the personal situation the patient might be going through.
An interpreter is a bridge between two parties, not a qualified advisor. So at most, we highly recommend the interpreter and healthcare expert meet first to set any necessary baseline they both feel comfortable with.
Asides from that, the healthcare interpreter should be accurate, and must always keep sessions private with anyone outside of the meeting. They should be impartial throughout their sessions. And if possible, be aware of the cultural nuances that could be misinterpreted.
Although an interpreter should not personally intervene in normal sessions, this shouldn’t be taken to the limit. If there is an immediate risk or a pattern of disrespect, they can report it to the appropriate authority.
Access to healthcare services is a human right. As the United Nations Committee on Economic, Social and Cultural Rights states: “Every human being is entitled to the enjoyment of the highest attainable standard of health”. And the only way to meaningfully access health services is by clearly communicating with healthcare professionals using their preferred language of care.
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