Week 2 – Discussion Board 2

[Art Liebl]

In at least 250 words, outline the four chief roles of a medical interpreter, citing examples of each. Reply to two fellow students by Monday.

[Milleny Arantess]

The four chief roles of a medical interpreter are message conveyer, message clarifier, cultural broker, and patient advocate. Each one of these roles have their unique attributes that make a medical interpreter amazing.

The first role is “message conveyer” this is the transport of the verbal and non-verbal messages from the provider/patient to the provider/patient without adding or subtracting anything. A definition straight from the book, ‘“In the message converter role interpreters listen to both speakers,observe body language, and convert the meaning of all messages from one language to another, without unnecessary additions, deletions, or changes in meaning.”’
An example of this is, the patient saying they’ve got a headache and you interpreting to the provider that the patient has got a headache, you shouldn’t add that the patient has been feeling the headache for 5 minutes or remove the word headache from what the patient said.

The second role is “message clarifier” this is the alertness of words/phrases that can confuse the patient, provider, or interpreter. This means that if the interpreter feels that the communication isn’t coming across clearly for either party or for themself they will have to ask the party that stated the confusing word/phrase to explain what they said or to use a simpler synonym of the word used. An example is the patient using the word “mid” to describe their pain. “Mid” is a word used to say that something is okay, not great but not bad. An interpreter might need to ask the patient to use a different/simplier word so the provider will be able to understand without confusion what is being said.

The third role is “cultural broker” this is the alertness of the misunderstanding/miscommunication that different cultures can bring. For example, the interpreter has to pay very close attention to what the patient/provider says and has to read body language to know how that came across because there are certain things that could come across as an offence to the provider when the patient didn’t mean it like that because in both of their cultures the word/phrase said means something different.

The fourth role is “patient advocate” while it isn’t the interpreter’s role to be responsible for everything that happens between patient and provider, the interpreter should always be aware of situations happening that could screw over the patient. An interpreter is available to help the patient that has limited english understand and communicate with the provider so when they see something that can be damaging they should speak to someone of a higher authority to figure it out for the benefit of the patient.

[Lesly Betancur]

Milleny, you brought up a good point about the interpreter’s role as a patient advocate, while they’re not responsible for everything, they are crucial in making sure the patient’s voice is heard and that their needs are met. By the interpreter staying alert to potential issues, interpreters can help ensure that any misunderstandings or barriers are addressed, ultimately supporting the patient’s well-being and bringing it to a higher authority’s attention before the situation escalates.

[Milleny Arantess]

Thank you Lesly!
Interpreters are hired for the benefit of the patient so we need to make sure they are being treated correctly and receiving everything they can when we realize that the patient doesn’t really understand what is going on.

[Cristina Restrepo]

Hi Milleny, I absolutely agree with you when it comes to making sure patients are being treated fairly and if we as future medical interpreters see something that might compromise the patient’s wellbeing or health we should definitely speak up and advocate for them.

[Yona Souza]

The four chief roles of a medical interpreter are:

1. Message Conveyor or Conduit: As a medical interpreter, you’re supposed to conduct the message from the provider or patient without adding or subtracting any details, by first listening to the speaker observing their body language, and converting that message from one language to the other.

Example: The provider reports the patient is diagnosed with kidney stones disease, and an interpreter interprets that information without adding that the patient was diagnosed with the disease because they didn’t drink enough water or remove the word stones from the sentence. In this example removing the word stones would change the whole meaning of the diagnostic and adding a causation that might not be the right root of the disease is completely wrong and unethical.

2. Message Clarifier: A message clarifier pays close attention to any wording that may cause misunderstanding between both parties when interpreting. They may interrupt the communication verbally or using gestures, alert the parties if having any confusion regarding terminology or information in general, and request or assist the speaker to better describe a word or analogy if there aren’t any equivalent words in either language.

Example: Professionally interrupting the provider while they’re communicating because the patient looks confused from the last sentence that was interpreted

3. Cultural Broker/Clarifier: The interpreter must be alert to any cultural rds or concepts that lead to misunderstanding and trouble clarification during the communication process.

An example of this is when a patient uses terminology and phrasing that might be plausible to use in their language but the interpreter has to be alert when conveying the information and alerting both parties on the cultural implications of the information received.

4. Patient Advocate: The interpreter may bring a concern they observed to someone in charge, or who can correct it before the situation becomes a bigger problem.
Example: If an interpreter witnesses a case in which the patient or provider is discriminated against they may bring that concern to attention with someone who can correct the issue.

[Lesly Betancur]

Yona, I like how you explained the message conveyor role. It’s essential for interpreters to stay true to the original message, without adding or omitting details that could alter the meaning. Your example about kidney stones highlights how small changes, like removing or adding information, can lead to confusion or even misdiagnosis. It really shows why accuracy and being ethical are essential in this role.

[Milleny Arantess]

Hi Yona, I still think it’s crazy that we go to the same school!
I agree with all of the points you brought up and I love the examples you used to explain what each role means. I especially love the example of cultural broker/clarifier becsuse it’s kind of a hard role to explain and understand and with your example it’s very understandable.

[Lesly Betancur]

The four chief roles of a medical interpreter are message conveyer or conduit, message clarifier, cultural broker/clarifier, and patient advocate. Each of these roles plays a crucial part in ensuring effective communication between patients and healthcare providers in a medical setting.

1. Message conveyor or Conduit
Role: The interpreter acts as a neutral, accurate conduit for the message, meaning they convey the source message, whether it’s from the provider or the patient, without altering the meaning, tone, or content. They translate everything verbatim without adding personal opinions or judgments.
Example: If the healthcare provider tells the patient, “You need to take this medication three times a day,” the interpreter’s job is simply to convey this message in the patient’s language, without adding anything like, “This is very important, you must remember!” or altering the phrasing. A good interpreter takes the utterance from one party and transfers it to the other party without adding or subtracting.

2. Message Clarifier
Role: The interpreter may need to clarify or seek clarification if a message is unclear or confusing, especially when terminology or cultural context may not be easily understood by either party.
Example: If a provider uses a medical term that the patient might not understand for example “hypertension”, the interpreter could ask the provider to explain the term in simpler language for the patient. On the other hand, if the patient uses a term that doesn’t directly translate, the interpreter may need to ask the patient for more information or suggest a term that could make the communication clearer.

3. Cultural Broker/Clarifier
Role: The interpreter helps bridge any cultural gaps between the patient and provider, ensuring that culturally sensitive issues are addressed appropriately. This role often requires the interpreter to explain or mediate cultural differences that might affect the conversation or understanding.
Example: Interpreters are alert to cultural words or concepts that might lead to misunderstanding, triggering a shift to the cultural clarifier role. If a patient is from a culture that values modesty and is uncomfortable with a physical exam, the interpreter might inform the provider about the patient’s cultural sensitivities before the exam begins. This helps the provider understand why the patient may be hesitant or anxious and allows them to approach the situation in a more culturally respectful manner.

4.Patient Advocate
Role: The patient advocate role of a medical interpreter goes beyond just translating language. It involves ensuring that the patient’s voice is heard and that their needs, concerns, and preferences are understood by the healthcare provider. This role ensures that the patient receives the care they deserve, even if there are communication barriers. Limited-English speakers can face major cultural and linguistic barriers in accessing and utilizing services at all levels of the healthcare systems.
Example: Before a patient undergoes surgery, the provider explains the procedure. The interpreter ensures that the patient understands the risks and gives clear consent, making sure that no critical information is overlooked due to language barriers.

[Leonisa Avelino]

Hi Lesly, I really enjoyed reading your breakdown of the four interpreter roles—you explained each one clearly and gave great examples. I especially liked how you emphasized the importance of accuracy and neutrality in the message conveyor role, and how you pointed out that interpreters help bridge cultural gaps, not just language. You did a great job highlighting how each role supports better communication and patient care!

[Yona Souza]

Lesly, I love that you gave a great example of the patient advocate role. When a patient is going into an important procedure such as surgery, being a patient advocate is an extremely crucial role that has to be played by the interpreter. Every information including risks and cautions should be mentioned and accounted for. That way the patient knows what they’re truly going through without any doubt.

[Leonisa Avelino]

The four chief roles of a medical interpreter are: message conveyor, clarifier, cultural broker, and advocate.

The first and most fundamental role is the message conveyor. In this role, the interpreter transmits the spoken message from one language to another without altering, adding, or omitting any part of the message. This is done in the first person to maintain the connection between patient and provider. For example, if a doctor says, “You need to take this medication twice a day,” the interpreter repeats this exactly as it was said, without adding or changing anything.

The second role is the clarifier. This role is used when something said during the encounter is not fully understood by the patient, provider, or even the interpreter and clarification is necessary to avoid misunderstandings. For example, if the provider uses a medical term that the patient or the Interpreter doesn’t understand, the interpreter may need to pause and ask for clarification. Even the provider might need clarification if a cultural concept or expression used by the patient is unfamiliar. In all cases, the interpreter must manage the communication flow carefully and professionally, always maintaining transparency when stepping out of the message conveyor role.

The third role is the cultural broker. In this role, the interpreter helps both the patient and provider understand each other’s cultural perspectives, especially when traditional health beliefs or expressions don’t have direct equivalents in the other language. Sometimes, what one party says may come across as inappropriate or confusing to the other not because of disrespect, but because of cultural differences. For example, a provider might ask a patient direct questions about their mental health, like “Are you feeling depressed”? In some cultures, discussing mental health openly could be shameful. The patient might respond vaguely or deny any issues out of discomfort. As a cultural broker, the interpreter could explain to the provider that in the patient’s culture, mental health is often viewed differently, and they may not feel comfortable discussing it in a direct manner. This helps the provider approach the conversation more sensitively and encourages better communication.

The fourth and most limited role is advocate. This is used when the patient’s well-being is at risk and the interpreter must step out of their neutral role. For example, if a provider begins making discriminatory remarks about the patient’s language, immigration status, or cultural background either directly or in a way that undermines the patient’s care the interpreter may need to intervene. In this case, the interpreter could respectfully raise the concern or alert a supervisor or patient advocate, ensuring that the patient receives fair and respectful treatment.

[Cristina Restrepo]

The chief roles of the medical interpreter are message conveyor, message clarifier, cultural broker and lastly patient advocate.

To further explore what each roles entails let’s start with the message conveyor which transports the verbal and non verbal messages from provider to patient and vice versa. As a message conveyor the interpreter listens to both parties, observe body language, and convert the meaning of all messages from the source language tío the target language, without unnecessary additions, deletions or changes in meaning. In order for this to happen interpreters need to be in charge of the flow of communication, meaning deciding who and for how long each party needs to speak. An example of this would be the doctor asking the patient if they take any medications and the interpreter saying exactly the same thing in the target language without adding or changing anything such as what medications you take for instance.

The message clarifier role alert for possible words or concepts that might lead to a misunderstanding. When there is evidence of confusion the interpreter needs to address the issue before moving on with the encounter. Also, it is important for the interpreter to let patient and provider know when the message being spoken is coming from themselves personally and not being converted through interpretation. The message clarifier role also takes into account the educational background of the patient and maintains the same register as the patient and provider. An example of this would be the interpreter asking the provider for clarification after noticing a confused facial expression from the patient after a procedure was explained.

In the cultural broker role the interpreter acts as a bridge between patients and providers with different cultural backgrounds, facilitating communication, understanding, and potentially resolving conflicts. An example of this would be the interpreter finding a similar expression or word to convey a message that has no literal translation from one language to another. Another example could be when the patient refuses to have eye contact with a male doctor because her culture does not allow it.

In the patient advocate role the interpreter ensures that the patient’s voice is heard and their needs are met, particularly when language barriers exist, by facilitating communication, clarifying messages, and acting as a cultural broker, with the ultimate purpose of promoting patient-centered care as well as patient health and wellbeing. It is important to mention that this role of the medical interpreter is optional in light of the high skill level required and the potential risks to both patient and interpreter. An example would be the interpreter asking the front desk person to make a morning follow up appointment after the patient had disclosed during the encounter that this is the only time the patient has transportation available.

[Leonisa Avelino]

Thanks for breaking down the interpreter roles so clearly, Cristina. I really liked how you gave specific examples for each one—it made everything easier to understand, especially the part about the cultural broker role.

[Cristina Restrepo]

Hi Leonisa, I am glad you found my examples helpful when it comes to understanding each role of the medical interpreter. I really liked how you highlighted the importance of stating to both patient and provider when the message is coming from the interpreter and when you have stepped out of the message conveyor role, as you said. As it makes it clear to both parties that the message being conveyed is not coming from either the provider nor the patient but from the interpreter itself.

• This reply was modified 1 month ago by Cristina Restrepo.

[Milleny Arantess]

Hi Cristina,
the way you explain the first role, message conveyer, is so clear and understandable it’s amazing.

[Joseph Matthews]

Hello Lesly. I found your presentation in explaining the four roles of the Medical Interpreter to be very effective. Aside for the content therein – you post each in its respective title, role explanation followed by an example – much as one would do at a high-level business presentation where much is conveyed with astute use of the language employed as well and keeping the number of words within a target range. This tells your audience you are well versed in the subject and keeps the reader attent.

[Joseph Matthews]

Yona – you describe very well the sometimes [delicate} but functionally important instance(s) when during the provider’s choice of words / terms in explaining a certain point to the patient is not being fully understood by the latter. The medical interpreter has to “how to” tactfully / professionally interrupt the provider to request other terms that will resolve this disconnect. Your use of the term “professionally” demonstrates to the reader the keen need for the medical interpreter to be constantly focused on both the patient and the provider in a fluid environment such as this.

[Joseph Matthews]

The four chief roles of the medical interpreter are as follows: (1) Message Conveyor or Conduit, (2) Message Clarifier, (3) Cultural Broker / Clarifier and (4) Patient Advocate. These four roles provide a complete 360º view of the varying interlinking activities that define this profession. Herewith is a brief description of each role along with a corresponding application to provide additional context.
1. Message Conveyor or Conduit
Role: The medical interpreter is a conduit, i.e., a vehicle to transport / transmit a message from the provider to the patient and vice-versa. The medical interpreter has to ensure that the message is delivered to the recipient with no deletions, no additions, no enhancements, no leaks and always making sure that the content of the message is delivered exactly as it was received from the other party.
A Contextual Application: The provider informs the patient that he / she has to refrain from any strenuous physical activity for the next 10 days. It is the medical interpreter’s professional duty to convey exactly that – nothing more, nothing less.

2. Message Clarifier
Role: In some cases, the medical interpreter will come across certain word(s) or terminology that can cause a misunderstanding of the message being transmitted. When this occurs, it is the medical interpreter’s role to tactfully pause the exchange, either verbally or via a gesture to alert one (or both) parties that the term in question is conveying an unfamiliar concept to the recipient and request that the speaker rephase this in a simpler more understandable way.
A Contextual Application: The provider, for example, is demonstrating how the patient should take his / her temperature with a special new thermometer using the sub-lingual method. In certain cultural communities this is a totally unknown method, therefore the interpreter should tactfully intervene and ask the provider to describe an alternative method with which the patient is familiar – such as placing the thermometer underneath the armpit.

3. Cultural Broker / Clarifier
Role: Language always reflects the culture in any particular country, region or community. In certain instances, the culture of one area of the world has beliefs / practices in which the is no cultural equivalent in another country – therefore there is no clear term or expression which accurately conveys this. In sum, the role of the cultural-clarifier must go beyond that of word clarification as in the preceding interpreter role above. The interpreter should tactfully interrupt the exchange and alert both parties to the cultural gap which is creating a misunderstanding.
A Contextual Application: The provider recommends a mode of treatment that is frowned upon in the patient’s native culture as it is unknown. The interpreter should tactfully pause the exchange, alert the provider of this impasse and assist in conveying / educating the patient, in more understandable words, the biomedical concept of the treatment to, hopefully, bridge this gap.

4. Patient Advocate
Role: This role is the most delicate of the four and has many moving parts. In sum, the patient’s health and well-being is the key objective. For many Limited- English speakers, they face major cultural and linguistic barriers in efficiently navigating the host country’s health care system. This can range from not knowing the basics all the way to outright discrimination concerning access to health care. As this is a very delicate as well as a statutorily complex issue – the role of the interpreter as Patient Advocate must be optional to protect both the patient and the interpreter.
A Contextual Application: A patient is given an atypical medication for a rare disease which may have serious side effects. The interpreter should make sure that this message is clearly understood by the patient in view of the high risk(s) involved.

[Yona Souza]

Joseph, I like the way you describe the patient advocate role as delicate because it truly is! It’s important to know how to act in this role and when to interrupt the conversation when needed as well. You touched on important points and the description you used made me think more deeply about the advocate role. Thank you for your presentation.

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