By Matt Ginsberg-Jaeckle, MA, CHI, Associate Director of Global Patient Services
Shirley Ryan AbilityLab (formerly Rehabilitation Institute of Chicago)
Only one type of healthcare professional is part of every conversation patients have while receiving care. It’s not a nurse, not a case manager, certainly not a doctor … Need a hint? It’s someone who acts as the voice for all of the above, as well as for the patient — the interpreter. For patients with Limited English Proficiency (LEP), the entirety of their care is mediated through the voices of interpreters. In the world of Workers’ Compensation, we call this essential function support, i.e., providing critical, two-way communication that takes place from the time of the injury through recovery.
Traditional understanding of the role of the interpreter emphasizes an ideal of interpreter invisibility (PDF) in these encounters, and this framework of invisibility is part of the reason the work of interpreters often goes unnoticed. Despite this ideal of invisibility, however, all of us in the healthcare and Workers’ Compensation world would do well to take a closer look at what interpreters do and what that can teach us about establishing therapeutic relationships across linguistic and cultural differences.
At the large, urban rehabilitation hospital where I work, in 2020 alone, interpreters were needed for more than 22,000 appointments. A number of those patients were injured in the workplace and came to us on their path to recovery. While Title VI of the 1964 Civil Rights Act requires that we, like all hospitals who receive federal funding, provide language assistance services, the reasons for providing professional interpreters and quality language access are not just regulatory in nature. Lack of interpreters can lead to inaccurate diagnoses, unnecessary repetition of diagnostic testing, poor treatment compliance, missed appointments, distrust and worse health outcomes.
What exactly do interpreters do? As distinguished from translators, who are solely concerned with written texts, interpreters facilitate communication in real time between two people who lack a thorough understanding of the other’s language. However, they are far more than just a conduit through which one language goes in and another comes out. As someone who has trained interpreters for more than a decade, I teach new interpreters about four different roles they may have to assume:
- The conduit between languages,
- The clarifier seeking to better understand what someone is saying,
- The cultural broker helping identify when cultural difference may be playing a role in misunderstandings, and
- The advocate when a patient’s health or dignity may be at stake.
A substantial body of literature emphasizes the importance of patient-provider relationship, rapport and trust for achieving good treatment outcomes. Establishing these trusting relationships between people who come from different cultural backgrounds and speak different languages involves much more than just transferring meaning back and forth between the world of a provider and that of a patient.
A colleague shared an example in which a patient originally from Mexico asked the nurse for some alcohol to cure her headache. An “invisible” interpreter may have just interpreted those words and the nurse’s quick rejection of the request. Not knowing that soaking a washcloth in rubbing alcohol and placing it on the forehead is a common home remedy in the patient’s culture, the nurse may have unintentionally assumed that the patient meant she wanted a drink and then verbally or non-verbally may have conveyed an attitude of judgement, confusion, pity or humor at the patient’s expense. The patient, meanwhile, perhaps not realizing the nurse’s misunderstanding, may feel not listened to and disrespected.
These types of seemingly minor misunderstandings can erode not only the trust between nurse and patient, but can also affect the patient’s overall receptiveness to care and undermine the ability of other providers to ascertain important information or assure follow-through on treatment recommendations.
Luckily, my colleague is a skilled interpreter who understands the need to go beyond the “invisible interpreter” archetype. She stepped in using her role as clarifier and cultural broker to give the patient and nurse a chance to explain themselves, and the nurse a chance to learn about her patient’s culture. In this way, the interpreter helped turn the situation into an opportunity for their relationship and trust to actually deepen. Clearly, open and trusting communication is essential for achieving better outcomes.
About Matt Ginsberg-Jaeckle
Matt Ginsberg-Jaeckle, MA, CHI is the Associate Director of Global Patient Services at the Shirley Ryan AbilityLab, where he has worked for over a decade first as a Spanish interpreter and now as an administrator and leader. The Global Patient Services department helps facilitate access to rehabilitation for hundreds of patients from dozens of countries around the world every year and also coordinates care for patients coming from other states, for injured workers, and for active duty service members. Matt received his MA in Translation & Interpreting Studies from the University of Illinois’s Center for Translation Studies in 2015 and his BA from the University of Chicago in Latin American History in 2005. Matt has also trained hundreds of Chicago healthcare interpreters for both local language access agencies and community colleges over the last decade. He recently completed a project he designed and obtained funding for via a Shirley Ryan AbilityLab collaboration with the Coleman Foundation to better understand and improve the services received by patients with communication disorders who have Limited English Proficiency and access speech therapy through an interpreter. That project, “Measuring and Enhancing the Reliability of Interpreter-Mediated Aphasia Assessments” was the first study of its kind to not just understand the impact of interpreting on the assessment of patients with aphasia but implement and measure the effect of an intervention to shift the role of the interpreter and improve the reliability of those assessments.
About Shirley Ryan AbilityLab
Shirley Ryan AbilityLab, formerly the Rehabilitation Institute of Chicago (RIC), is the global leader in physical medicine and rehabilitation for adults and children with the most severe, complex conditions — from traumatic brain and spinal cord injury to stroke, amputation and cancer-related impairment. The organization expands and accelerates leadership in the field that began at RIC in 1953. The quality of its care and research has led to the designation of “No. 1 Rehabilitation Hospital in America” by U.S. News & World Report every year since 1991. Upon opening in March 2017, the $550 million, 1.2-million-square-foot Shirley Ryan AbilityLab became the first-ever “translational” research hospital in which clinicians, scientists, innovators and technologists work together in the same space, surrounding patients, discovering new approaches and applying (or “translating”) research real time. This unique model enables patients to have 24/7 access to the brightest minds, the latest research and the best opportunity for recovery. Shirley Ryan AbilityLab is a 501 (c)(3) nonprofit organization. For more information, go to www.sralab.org.