Wednesday, October 6, 2010

Interpretation Files: The Language Line

Since I began interpreting in New Orleans, I have been very interested in the use of the language line at hospitals and clinics. I had never seen it in action until today. I have always wondered how it compares to the use of on-site interpreters. My experience today is too small a sample size to draw any conclusions about the service, but it is a good example of how badly an interpretation session can go.

When the nurse first walked into the consultation room, I introduced myself as the patient's interpreter. The nurse said I wouldn't be necessary as the clinic uses the language line. I explained this option to the patient, who then said she still wanted me to interpret. When I told the nurse what the patient preferred, I was told that it was the clinic's policy to use only the language line. She specifically said "That is the only we can be sure the patient understands what is being said."

Now, I see how such a policy could be a good thing. It would prevent children, family members and friends who may not actually be fluent in both languages from serving as interpreters. This can potentially ensure accuracy and prevent a conflict of interest. The problem with the nurse's understanding of the policy was that even when a trained interpreter was available in-the-flesh, she chose to use the language line over the patient's request not to use the telephone service.

I explained that I am actually a trained interpreter but the nurse wasn't having it. I asked the patient if she still wanted me to stay in the room and she said yes. So I sat in the corner of the room, deciding to remain quiet and observe just how the language line really works. It didn't go very well. We waited quietly for ten minutes for the nurse to secure an interpreter on the other end of the phone. And I was right there, doing nothing!

The interpreter on the phone did almost every thing right; he spoke in the first person, even speaking in the third person when he had to request repetition. He was accurate most of the time. It was clear that he had received training similar to mine, which was interesting for me to see.

But he did not lay down any ground rules and this actually resulted in some major mistakes. He should have - from the very beginning - told both the nurse and the patient to speak only in short phrases. He let the nurse talk too long, giving him complicated directions, mixing questions with instructions. Clearly, she had no idea how difficult it would be for him to remember and interpret everything she was saying.

At one point she asked the interpreter - directly, as she wasn't even looking at the patient - to ask the patient if she was allergic to any medications, if she had been to the doctor recently and to list all the medications she was currently taking - all without giving the interpreter any time to ask the individual questions or giving the patient time to respond. The nurse wrote down that the patient had no allergies and then announced that the patient must not be taking any medication - as the interpreter hadn't listed any - and began to move on to the next set of questions.

This was the only time I interfered and I only did so because I knew the patient was taking medications and I also knew that the interpreter had never asked her that question - he had forgotten in the midst of all the other questions the nurse was asking. I interrupted to tell the nurse that the patient did take medications.

Here is the absurd part. The nurse looked at me and said "You see? The language line is the only way we know if the patient is understanding or not. If she can't even understand him, and he's a professional..." she shook her head. I took two things from this: One, she did not believe that I was a professional interpreter and two, she thought the patient was so stupid that she could not even understand another Spanish-speaker. The nurse had no idea that not everything she was saying was being interpreted because she herself wasn't giving enough time to the interpreter to do so. She had actually caused more inaccuracies because of the way she was handling the consultation. She was giving too much information at once, she was being confusing and she was treating the patient as if she wasn't in the room at all.

The interpreter is partly to blame as well. If he had simply set up the rules at the beginning, by insisting the nurse speak only in phrases short enough for him to remember, such mistakes could have been avoided.

I was impressed that the clinic has any language policy at all, but clearly it had been implemented without any staff training. The nurse's inflexibility was all a power trip anyway. When the doctor entered the room, I again introduced myself. I asked the doctor what she wanted to do, use the language line or me. She shrugged her shoulders and said, "Well, since you're already here. Why not?"