Interpreters shouldn’t always take ‘no’ for an answer, argues Renata Towlson
A community interpreter is a facilitator of free verbal expression, in my case for clients with limited English proficiency (LEP). Yet I have been called to hospital assignments many times only to be informed by the patient that they do not require an interpreter. Sometimes, I have been booked simply because the patient is not a British national. The client has a right to refuse an interpreter, and this should normally be honoured, but we can also find ourselves in an ethical maze when there are doubts as to whether the client understands spoken English well enough to benefit fully from a clinical encounter.
On one occasion, a young woman expressed her surprise that I had been booked for her prenatal appointment as she “could speak English”. The midwife looked at me with hesitation; she had a duty of care, and clinical excellence depends on clear communication and understanding. Reading the midwife’s signs, I suggested that, since I was already booked, it made sense for me to stay in case of any difficulties with the medical vocabulary. It wasn’t long before the client had answered a medical question incorrectly and we finally agreed that I would do my job.
A community interpreter must act in the best interest of the LEP client and the public service professional. Communicative autonomy is paramount in linguistic assistance. Defined as “the capacity of each party in an encounter to be responsible for, and in control of, his or her own communication”,1 this concerns the right to make one’s own decisions. But what if a client exhibits false confidence in their understanding? Should the interpreter respect the client’s freedom to choose how they express themselves, or make an intervention? Should the interpreter stay to assess whether their services are required, or leave the patient and clinician to find out?
In a medical context, freedom of expression involves the ability to tell a medical professional what the problem is and to be a full participant in any treatment or action. My patient may have acted with communicative autonomy, but if I had left as requested, she would not have had freedom of expression, and any communication would have been difficult and inaccurate.
As long as an interpreter’s objective is to support a client’s access to a health service, they should not worry about overstepping the boundaries or being perceived as patronising. The focus should be on remaining pleasant, warm and unassuming, gently suggesting a back-up support presence. Introducing three elements at the start of the encounter helps: everything said or signed will be interpreted; it will also be kept confidential; parties should speak to each other, not to the interpreter. This gives an assurance that the interpreter’s presence is discreet and will do no harm.
False confidence can come from different places: a client may be ashamed to admit their need for linguistic assistance; be convinced of their capabilities in English; or feel guilty that they require paid assistance. It is usually exposed when LEP clients express themselves in English, but interpreters are not always able to listen as the communication unfolds and in some cases may not be called at all.
Medical practitioners do understand the prevalence of false confidence and err on the side of caution when booking interpreters. However, in the public sector, interpreting services are under continuous scrutiny due to funding pressures. The extent to which false confidence leads to communication errors is unknown and requires further research.
Once a patient, clinician and interpreter meet, the encounter becomes a collaborative endeavour. False confidence among clients is a common phenomenon which can be discreetly counteracted by a confident community interpreter who is sensitive to the context of the encounter.
1 Bancroft, M A et al (2015) The Community Interpreter: An international textbook, Columbia, Maryland: Culture & Language Press, 36