In this podcast, Debra Haynes talks with Alejandro Muzio, George Donald, and Mariano Siles about meeting and working with a medical interpreter.
ASCO: You're listening to a podcast from cancer.net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the world's leading professional organization for doctors that care for people with cancer. In today's podcast, Debra Haynes talks with Alejandro Muzio, George Donald, and Mariano Siles about needing and working with a medical interpreter. Ms. Haynes is the Hispanic outreach program coordinator for Life with Cancer, which is a part of Northern Virginia's Inova Health System. Mr. Muzio is the language services manager at Inova Health System, and Mr. Donald and Mr. Siles are both medical interpreters with Inova Health System. ASCO would like to thank all 4 of these guests for discussing this topic.
Debra Haynes: My name is Debra Haynes and I work with Life with Cancer as a program outreach coordinator, and I also do interpreting, and I work with cancer patients. And so, sometimes I'm also interpreting for care providers in their whole system of coming to find out about their cancer diagnosis and their treatment.
George Donald: Good Afternoon. My name is George Donald. I am a staff medical interpreter at Inova Fairfax Hospital. We work as a team there, and we have been there for 5 years with Inova. Also 10 years in [inaudible].
Mariano Siles: Hello, my name is Mariano Siles, and I work as a medical interpreter for Inova Mount Vernon Hospital. I've been working there for around 3 years and I'm dealing with [inaudible] for around 8 years.
Alejandro Muzio: Hi, my name is Alejandro Muzio. I'm the language services manager for Inova, and also the Inova's interpreter trainer.
Debra Haynes: Okay, we have a few questions that patients maybe are wanting to know the answers to. So, George, could you just tell us when should a patient work with a medical interpreter, and is it something they will be asked that they need it? Or will they have to ask for the assistance?
George Donald: My first impression is that patients should work with or ask for a medical interpreter any time they feel like they're not sure of the information they're receiving, or any time they feel like they need to express something they need to express. On admission, the language requirements are asked and stated. But a lot of times it's up to the on-hand staff to reiterate the need or the right for an interpreter, or the availability of an interpreter being an in-person interpreter, or an over the phone interpreter. Sometimes that is for me to keep reminding people there's a right to ask for an interpreter.
Debra Haynes: And do they have to know about costs associated with that? Is that a reason why they might not ask for an interpreter?
George Donald: That hasn't been my experience that they are concerned about the cost if they want to communicate through an interpreter. I'm not saying that cost doesn't exist, but I haven't dealt with that here in Inova.
Debra Haynes: Mariano, could you explain to us a little bit, would a patient expect to work with the same interpreter each time, or how does that work?
Mariano Siles: Well, we have different systems in place. If you go into a big hospital like Fairfax and you say, "Fine, I want this [structure?]" And we have 4 people who are there, sometimes 5. And they rotate so they get different focus. So, you can expect to see a different person or the same person, too. It could happen. The hospital where I work at that it's a small hospital. It's just me, Monday through Friday. So, it’s me, most of the time or medical staff or they can use the phone.
Debra Haynes: Alejandro, what should a patient expect when working with a medical interpreter, such as what is the process of meeting a medical interpreter? What should they expect from the interpreter during a doctor's visit and other times?
Alejandro Muzio: Most of the time our staff will request the interpreter and we have to explain to the patient it might be a different interpreter each time. But without knowing who the interpreter is, the expectations from the patient side should be pretty much the same, that the interpreter is there to assist the patient and the provider to communicate with each other as if they both spoke the same language. So, basically the role of the interpreter is to make the language barrier disappear.
Debra Haynes: Okay, and George, is there anything else that you think patients should know about working with a medical interpreter?
George Donald: Well, this kind of dovetails with what Alex was talking about that they should basically know that's what the interpreter is there for, that the interpreter has certain boundaries and the role is proscribed by practice and ethics. And that puts a certain amount of limitation on the interpreter. They should know, the interpreter is not going to be there to offer advice or to make suggestions. But the interpreter might have to—and the interpreter is here for this only to interpret—to create a bridge in language, and pretty much nothing else, to eliminate the barrier of language. But the patients should probably be reminded, like I was saying before, that they do have a right to ask their interpreter. They shouldn't feel like they are there without communication at all. That's something that I feel strongly about.
Debra Haynes: And what about patient confidentiality?
George Donald: Oh, that is paramount. And when they come in they shouldn't be asking you to remind them that what they say is confidential. But the interpreter is very much part of the deal, that ring, of confidentiality. And whenever that needs to be mentioned, it should be mentioned. And if the interpreter has the sense that it needs to be mentioned, the interpreter can [inaudible] and the interpreter would like to remind you that what you say is confidential, and what you say will be completely interpreted to the best degree possible.
Alejandro Muzio: It is important to say that we are all trained the same. We have a certain way to conduct the whole interpretation, the whole—even though we can see different people working with these patients, it's going to be the same way of interpretation. We use the same technique. We use the same introduction. Everything very much works the same all the time.
Debra Haynes: Is there something else you'd like to add—
Alejandro Muzio: No.
Debra Haynes: —to that?
George Donald: On patient confidentiality, the 3 of us are Spanish-speaking, so the Spanish-speaking community in this area is so vast. Most of the time when we find a patient who speaks Spanish who might want an interpreter, we might never see them again at the hospital, or not in the community.
Mariano Siles: Confidentiality becomes particularly important for the non-Spanish languages, particularly for those who are in those very small communities, where patients might know the person who's interpreting. They might know them from church, or they might know them from whatever other community activities there are. Like George mentioned already, every interpreter at the beginning of every session will tell the patient that everything that is shared will be confidential. And for some of our patients, and I'm sure this is the case for the cancer patients as well, it particularly is important.
Debra Haynes: Right. And is it because they want to not have everybody know necessarily in their community. Like you say, some of the communities are very small in the language groups. Anything else you'd like to add?
Mariano Siles: So it’s part of HIPAA rights, so rights of privacy in the hospital. So, when they go to registration, we formally tell them all the information that they need to get. And that's part of HIPAA so they know that everything needs to be kept confidential.
George Donald: We do know that sometimes that there are different circles of confidentiality even between family groups. They want, "I want my husband to know about my diagnosis, about my course of treatment, while I'm here at the hospital. I don't want to tell my kids, yet." And even though the often adult, grown children are waiting outside and the patient is lucid enough to say, "This is what I want. This is who to know. And I want the autonomy to tell them when I'm ready." And within the general idea of confidentiality, the different circles that sometimes have to be pushed out and respected as well.
Debra Haynes: That's a really good point.
George Donald: Yeah. I don't know if others have had the same thing.
Debra Haynes: I think you're right, though. There are times when a patient wants only certain people to know.
George Donald: Yeah, and you don't know who those are because oftentimes in a cancer diagnosis, you would have lots of family members, and you don't know who they are.
Debra Haynes: I think that's a very good point. Anything else that we could add so that patients understand what the role of interpreter is?
Alejandro Muzio: Well, George talked about boundaries before, and I think what may be important for cancer patients particularly is that the interpreter is there to support their communication with the provider. And a lot of the patients who speak to their provider can look at the provider, and to receive comfort from the provider as well, that's what's needed. And so, sometimes some of us will get complaints in our office that one of our interpreters is being cold or is being distant, and it always makes me smile because that interpreter is actually doing what they're supposed to do, which is be as—not cold—but be as sort of removed from the patient as possible, so that the patient-provider relationship can be strengthened. So, the patient can receive from their provider the same service the English-speakers are. Because as we discussed before, the next time around—the next time this patient comes to see their provider, the interpreter might be different. And so, building a relationship with the interpreter is not what we want. We want a good strong relationship with their provider.
Debra Haynes: That's just paramount, probably for them to have good care and finish their treatment as well, and have the confidence in their provider.
George Donald: A better continuity to—I agree, 100% what Alex had said that many times I've been in the room interpreting for a family member, and the victim is not able to communicate, or only explains a little. And the family member will—I mean, many, many times they have thrown themselves upon me like that. And that's not something I—I don't push the person away, I'd still kind of maintain—it's a difficult line to walk. Maintain your professional bearing but not to push somebody off like that. When you go into a situation, and Alex knows and Mariano knows, a lot of times you have to be ready for almost anything. Of course, Mariano is better looking than me [laughter]. It probably happens more often with him.
Debra Haynes: Well, I think that all of you have a lot of experience doing interpreting, so you have a lot of years between you and bring a lot to the table. So, I think that hopefully patients will be able to look at this and find a lot of guidance and knowing confidence that they can ask for an interpreter. And they are going to get a good quality of service, and that it's going to be with their best interests in mind so that they have the best provider-patient relationship. Anything else you all would like to add that the patient should know, that we want the patients to know? We're there for them.
Mariano Siles: Basically, that's it. It's just to let then know that even though we're supposed to be invisible or an invisible breaker downer of barriers, we're still there, we're part—
Debra Haynes: Part of the same team.
Mariano Siles: Part of that, part of it.
Debra Haynes: You're part of the team. Thank you very much.
Mariano Siles: Thank you.
Debra Haynes: Thank you very much for participating.
ASCO: Thank you. More information on the role of a medical interpreter in cancer care can be found at www.cancer.net.
Cancer.Net is supported by the Conquer Cancer Foundation which is working to create a world which is free from the fear of cancer by funding breakthrough research, sharing knowledge with physicians and patients worldwide, and supporting initiatives to ensure that all people have access to high-quality cancer care. Thank you for listening to this Cancer.Net podcast.