This post has been a work in progress for the past couple of weeks. Obviously, I learned a lot and had a lot to share.
"Introduction for Medical Interpreting" was followed by a full weekend of learning:
Saturday, May 21
Medical Terminology for Interpreters
Presented by Dr. Rachel St. John
I've been to several "let's learn the sign for that" workshops. Despite best intentions, I find these workshops rather impractical. Let's face it...you sit in a room for hours on end, then leave remembering a fraction of what you learned. Eventually, if you don't use what you've learned, you forget what little you initially retained.
What I loved about Rachel's workshop was that she took a different approach than typical terminology workshops. Instead of memorization, she provided a foundation and resources for medical terminology. Rachel provided a handout with root terms by system as well as common abbreviations. We went through several examples where we had to decipher the meaning of a term, using our "cheat sheet" as a guide.
Examples: hyperglycemia -- macrocephaly --
hyper = elevated macro = enlarged
glycol = sugar cephalic = head
emia = in the blood
Rachel addressed several common issues in medical settings, both from her "doctor hat" and "interpreter hat," including:
-Asking the doctor to speak your language ("Can you explain what that means so I can interpret it accurately?")
-Additional information need to interpret vs. additional information/ explanation that the patient needs (what is too much or too little? does it change the dynamic?)
-When/ how to use expansion or ask for clarification
-Is the physician explaining appropriately? Who s the audience?
-Is knowing too much information a role conflict?
-What cultures come into play? (hearing, Deaf, medical, layperson...)
Rachel also directed us to NAD's "
Questions and Answers for Health Care Providers." She observed that by referring doctors and patients to resources, it becomes practice, rather than individual. For our own benefit, she also recommended
Stedman's Medical Dictionary as a resource.
Ethics and Law in the Medical Setting
Presented by Jay Moradi-Penuel
The content of this workshop was similar to Jay's"Medical & Legal: The One & the Same" workshop that I attended in December. However, a new set of participants brought a new set of questions as well as different perspectives. Jay addressed sticky situations & potential legal impact in addition to pertinent laws, our Code of Professional Conduct, contracts & limitations, boundaries, conflict & perceived conflict, mandatory reporting & duty to warn, what is legally permissible on an invoice, and qualification versus certification.
Critical take-home points:
-"Non-deference...The Deaf person is not the only person in the room" (Jay) We must evaluate the needs of all of our consumers- hearing and Deaf!
-"Legal necessity of boundaries" (Jay)
-It 's okay to say this situation is "outside my scope of practice" (Jay)
-When in doubt, get a qualified D.I. (Deaf Interpreter).
-"Every medical situation is a legal situation" (Jay)
-Who is responsible for following the law? Everyone!
-Related to neutrality and impartiality- "You are a person & have feelings. It's what you do with those feelings" (Rachel).
-Freelance interpreters should have a business associate agreement (BAA) with health care providers. The less specific it is, the less protection there is for you [the interpreter] as well as patient privacy. BAA is different than Terms & Conditions.
-If you breach HIPAA, you can be fined. Liability insurance does not protect you if you break the law.
-The law can compel you to answer. A subpoena can require you to testify unless it is a privileged interaction. An interaction is privileged if no one else is present (i.e. doctor & patient or lawyer &; client in a private situation), however interpreters are exempted.
*Law beats the CPC.
*You are your own best advocate.
Debriefing and Social Construction of Knowledge
Facilitated by Jay Moradi-Penuel & Rachel St. John
This was a unique
"workshop." Instead of a workshop with a formal presentation, we all went to a local Mexican restaurant to take advantage of a more relaxed atmosphere while engaging in dialogue with our peers. It was a fantastic opportunity to process and share what we had learned the last two days, as well as discuss our own experiences. Since I lack medical interpreting experience, I was rather curious how hospitals and medical institutions screen their interpreters, assessing their skills, qualifications, and credentials. While I did pose this question during Jay's "Ethics and Law," workshop, I was not satisfied with the response. During his workshop, one participant, who is on staff with a hospital system and has a nursing and interpreting background, shared her procedures, however during the de-briefing, I posed the question to my colleagues once more. While her experience and expertise is valuable, from my perspective, her policies and procedures seem atypical; arguably, she is more savvy than the average medical institution, if only for the fact she was participating in the Medical Interpreting Institute. Presenting this question to my colleagues provided me with a broader view of medical interpreting.
One of the big learning points that I shared was that I was surprised to learn (in Jay's workshop) that IEP (Individualized Education Plan) meetings are indeed legal situations and that the interpreter is required to sign the IEP document. I shared that I was actually relieved to learn this. Not too long before this, I interpreted an IEP meeting and was taken aback when asked to sign the IEP as well. Originally, I was asked to sign my name and "participant;" I was not prepared for this request and was there as an agency interpreter, making it an uncomfortable situation. I agreed to sign the IEP as "interpreter," but was struggling with my decision. Having worked as an educational interpreter, I honestly did not think that interpreting for an IEP meeting was a big deal when I accepted the assignment, even though I had not interpreted an IEP meeting previously. This was certainly an interesting tidbit that I never would have expected to pick up at a medical workshop- but is immediately applicable to my work.
Sunday, May 22
Teaming in the Medical Setting
Presented by Jay Moradi-Penuel &Rachel St. John
This was my favorite workshop of the weekend. First and foremost, Jay and Rachel's approach to interpreting as a practice profession, rather than a technical profession, really resonates with me. Secondly, approaching an assignment with a holistic team approach makes a lot of sense to me. Essentially, by approaching the assignment as a team, an interpreter can do his or her job better. Unfortunately, a holistic team approach cannot happen overnight and requires mutual respect and willingness to invest the time and energy- both the interpreter and medical professional have to "buy in" and be partners in the endeavor.
With the holistic team model,
- The interpreter is a professional- not a paraprofessional.
-Language match and position can be achieved.
-Interpreters can optimize his/her boundaries by receiving the necessary information to interpret effectively and accurately (this is not carte blanche access to patient records).
-There is pre- and post-conferencing with the medical team as well as environmental pre-assessment.
-There is "inclusivity modeling"- all participants are included in all aspects of the interaction.
Jay and Rachel also addressed concerns about a holistic approach violating the Code of Professional Conduct (CPC) and the perceived requirement of interpreters being invisible or neutral. They highlighted the following points:
Confidentiality (CPC Tenent 1.0)
1.1- "Share assignemt related information only on a confidential and 'as needed basis'..."
Professionalism (CPC Tenent 2.0)
2.2- "Assess consumer needs and the interpreting situation before and during the assignment and make adjustments as needed."
2.3- "Render the message faithfully by conveying the content and spirit of what is being communicated, using language most readily understood by consumers, and correcting errors discreetly and expeditiously."
2.5- "Refrain from providing counsel, advise, or personal opinions."
Towards the end of the workshop, Jay and Rachel also touched upon the Demand-Control Schema and Critical Friends Model as tools to process ethical decision making.
As with every workshop, participants are required to complete an evaluation form and answer the following question: What is one thing you will remember from today?
My response? "People first! Interpreters are people too!"
Sometimes as interpreters, we lose ourselves and identity in the interpreting process. The interpreting process can become so seamless that those around us forget we're there. This approach to interpreting in the teaching of interpreting has further compounded the problem. The holistic teaming approach can help us re-claim our identity and place on the team. Jay repeated emphasized to always put people first and remove the labels; as Rachel aptly stated "You are people who are interpreters."
In closing, two stellar life lessons from my dear friend, Jay:
"Progress, not perfection."
"If you give yourself permission to be a rock star, you're a rock star."
