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APHA Scientific Session and Event Listing

Recorded presentation

M. Barton Laws, PhD, MA, Latin American Health Institute, 95 Berkeley St., Boston, MA 02116, 617-350-6900 x142, bart@lhi.org and Kari White, MA, MPH, Department of Sociology, Population Research Center, University of Texas-Austin, 1 University Station, G1800, Austin, TX 78712.

Studies of medical interpretation have generally focused on specific kinds of errors in translation and their potential clinical consequences. However, there has been little sociological investigation of the role behavior of interpreters and the impact of interpretation on the medical encounter. Javier and Vasquez defined “role exchange” as the interpreter taking over the provider's role in interviewing, but many other behaviors outside of interpreting are possible. We analyzed audiotapes of 13 pediatric outpatient visits, featuring interpretation by professional interpreters, bilingual nurses, a social worker, and a family member. Using an exhaustive coding system, we identified every interpreted segment in these visits in which the interpreter engaged in some behavior other than interpreting, and assigned these to empirical categories. We found that interpreters engaged in speech other than interpretation in 29.8% of all segments. In most of these, the interpreter did not make his or her behavior transparent to both parties (provider and child's caregiver). Specific categories of role exchange included nurse and social worker misrepresenting the physician's advice or the caregiver's requests, apparently substituting their own judgment; interpreters socializing with caregivers and giving their own advice, or complaining about hospital procedures; and interpreters consulting with the provider about the case or teaching the provider Spanish. We discuss the consequences of these behaviors for medical outcomes and the therapeutic relationships, and ethical considerations.

Learning Objectives: participants will be able to

• Identify 4 major categories of role exchange in interpretation;
• Distinguish role exchange from widely recognized categories of error in interpretation, and from patient advocacy or cross-cultural facilitation;
• Recognize the potential harm to clinical outcomes and patient rights of inappropriate role exchange, and the implications for interpreter training, certification and supervision.

Keywords: Cultural Competency, Interpreters

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation