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Managing the Flow of Communication: The Importance of the Pre-Session and Clarification in Over the Phone Medical InterpretationElizabeth Gonzlez Soto

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Introduction: A brief history of phone interpretingTelephone interpreting is a relatively new field. With advances in communication technology, we have witnessed how the humble telephone made more services available to those that need it the mostTelephone interpreting started in Australia in 1973 as a free service in response to a wave of immigrants, which resulted in an increase for the need to communicate in different languagesOriginally, the service was used mostly for emergencies and was only available in the cities of Sydney and Melbourne. It was later expanded to become a program with a more general scope and national availability (Department of Immigration and Multicultural and Indigenous Affairs, 2005).

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In the United States, telephone interpreting was first offered in 1981, when a police officer noticed the need for language assistance when dealing with immigrants in the state of California. This need helped create a charity-based organization that offered interpreting services. That company transitioned from charity-based to for profit and by the 1990s, there were more for-profit companies in the horizonThe name of that first company is what is now known as Language Line Solutions

Today, there are many companies that offer telephone interpreting to a number of different industries, such as finance, insurance, communications, legal and healthcare. In the case of healthcare, hospitals sometimes have their own phone interpreting department.The focus of my research is on healthcare interpreting. I have investigated the tools of the pre-session and clarification and how they are vital to provide excellent service to both healthcare providers and patients when interpreting over the phone.

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What is the Pre-Session?When we talk about the pre-session, we refer to the time before the interpreter formally starts an encounter. It can be referred to as pre-interview or pre-encounter. The interpreter has the responsibility to inform both the provider and the patient of certain parameters that will guide the encounter.The pre-session should start with interpreters identifying themselves, their language and organization if its different than the clinic or hospital

The interpreter will also explain to both patient and provider that the confidentiality of the encounter will be maintained. If needed, the interpreter will explain the concept of confidentiality as it applies on a healthcare setting.Interpreters will indicate that everything spoken by both parties will be interpreted, something that it is required by the standards of practice of the healthcare interpreting profession. (National Standards for Interpreters in Healthcare*)

National Standards for Interpreters in Healthcare, 1st Standard, Accuracy, 3rd tenet: The interpreter advises parties that everything said will beinterpreted. For example, an interpreter may explain the interpreting process to aprovider by saying "everything you say will be repeated to the patient."6

The last two steps in the pre-session are the following: To make sure that both parties know that the interpreter shall intervene if theres a need for clarification and, that the interpreter will ask the provider if theres something that she/he needs to brief the interpreter on. Interpreters will emphasize how important it is for each party to address each other directly. They will also make sure that both parties know that they need to pause frequently to allow for interpretation.As you have seen, the pre-session is a multi-step process. So how can we adapt it to the immediacy and urgency that sometimes precludes phone interpreting? Before we do that, lets talk about our other tool: Clarification

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What does Clarification means in an interpreting context?The medical encounter is a highly interactive process in which the provider uses language (the providers and the patients) as a powerful tool to understand, evaluate and diagnose symptoms (Woloshin et al., 1995)It is no surprise then that when we are interpreting, we need to make sure that the message being transmitted is understood.Clarification means that when theres a risk of miscommunication, the interpreter must step out of her main role as a conduit

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The National Standards of Practice for Interpreters in Healthcare say the following about clarification*: The interpreter maintains transparency. For example, when asking for clarification, an interpreter says to all parties, "I, the interpreter, did not understand, so I am going to ask for an explanation

When the interpreter assumes this role or uses this tool, he/she is either verifying for comprehension or requesting an explanation when necessary. An example of this would be if theres a word that the patient has used in a way the interpreter not used to hearing or when a doctor uses an acronym that the interpreter is not familiar with.

*National Standards of Practice for Interpreters in Healthcare 1st Standard, Accuracy,6th Tenet9

When the interpreter verifies for comprehension is usually because there has been a nonverbal cue from the patient that denotes that he/she might have issues understanding what is being said.

So how does clarifying and the pre-session aid the interpreting telephonic encounter? Why are they so vital?

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Why is the pre-session so important in over the phone interpreting?It helps maintain situational control for the interpreter. If all parties are aware of what is needed to achieve a successful encounter, it is likely that everyone will cooperate Situational control is very important in healthcare phone interpreting as the interpreter depends completely on what she can hear; whether pauses, hesitations, inflexion or tone. For example, if the doctor or patient is not informed that they need to pause frequently or speak in first person, the interpreter can miss auditory cues that are vital to understanding what is happening in the medical encounter.

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A Successful Phone Pre-SessionBecause of the time constraints in phone interpreting, the interpreter can not be as thorough as a face-to-face counterpart when doing a pre-sessionHowever, the interpreter can summarize a phone pre-session as follows: The interpreter will repeat everything you say, everything you say will remain confidential, please speak in the first person and pause frequently to allow for interpretation Even if the interpreter ends up dealing with a long-winded doctor or patient, a polite reminder to pause for interpretation usually brings the monologue to a halt

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Why Do We Ask Them To Speak in 1st person? Healthcare interpreters are aware of patient-centered care , enabling the primary parties to communicate and build rapport. Therefore, they encourage speakers to address each other directly (AUSIT,2012)*The constant Please tell the doctor/patient proves to be distracting to the interpreter and its best avoidedWhen both parties do NOT address each other directly, it makes for a longer and more cumbersome encounter, especially over the phone when we cannot direct our gaze to the other party to help direct the conversation.

*NSW Health Care Interpreter Services (NSW HCIS)Interpreting in healthcareGuidelines for interpreters13

Why is it so important to use the clarification tool in phone interpreting?

Phone interpreting comes with unique challenges. There are no visual cues, so interpreters depend solely on what they can hear.Because phone interpreters depends only on auditory cues, it is imperative they use the clarification tool and if possible, in a continuous manner to check for comprehension.A good rule of thumb : When there are instructions to be given, such as directions on how to take a medicine, post-op or discharge instructions, the phone interpreter should check for comprehension to make sure the patient understands this vital information.

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Healthcare phone interpreters like their counter-parts on-site, deal with information that is incredibly important tot he patient. It is vital they use whatever tools available to make sure the patient has all the information that was conveyed by the health care provider. That is the main reason why the clarification tool is so necessary. It empowers phone interpreters to do the best job that they can

Phone Versus On-Site Interpreting: The Importance of Providing Great Service Something that distinguishes telephone interpreting from many other types of interpreting is the focus on customer serviceBecause telephone interpreting is, at the end of the day, provided by companies that are all competing for business, customer service skills are required for employment with most telephone interpreting companies (Kelly, 2007 p.38) Although the opportunity to actually provide customer service is very limited, it is still important that the health care phone interpreter has some knowledge or training in this area.

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Whereas in on-site interpreting the hospital or clinic may simply choose not to work with a certain interpreter, in phone interpreting, sometimes the doctor or nurse may be directly connected with the interpreter and have no other interaction with another representative of the interpreting company. This is the main reason why the phone interpreter needs to use every single tool available to provide excellent service. From a polite, professional tone of voice to taking advantage of the pre-session and clarification tools, the health care phone interpreter not only provides a valuable service, but it is also representing a for-profit business. Therefore, every effort must be made to provide excellent service.

Phone Versus On-Site Interpreting: Focus on Customer Service

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ConclusionPhone interpreting comes with unique challenges (dependency on auditory cues, technical difficulties)The Pre-session and clarification tools aid the interpreter when navigating these challengesThe phone interpreter has an obligation to provide excellent service, as it is representing a for profit business.Situational control is vital to the phone interpreter and the pre-session and clarification tools directly contribute to create a better session/encounter.The pre-session and clarification tools directly impact in a positive manner the quality of service that phone interpreters provide.

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Reference ListNational Standards of Practice for Interpreters in Healthcare (September,2005) National Council of Interpreting in Healthcare www.ncihc.orgTelephone Interpreting: A Comprehensive Guide to the Profession by Nataly Kelly (2007) Trafford PublishingLanguage Service Associates Training Department www.lsaweb.com New South Wales Healthcare Interpreter Service, Professional Development Committee (2014) Interpreting in Healthcare: Guidelines for Interpreters Retrieved from: www.wslhd.health.nsw.gov.au/ArticleDocuments/518/HCISBrochure.pdf.aspx

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