[Joseph Matthews]

Leonisa – your point is well taken of specific physical techniques such as foot tapping and knee slapping also enhance the brain’s ability to retain information. Every lit but helps!

[Joseph Matthews]

As pertains to sound mental retention techniques, the video placed key emphasis on visualization and association which facilitates the interpreter connecting new information with vivid mental images. This makes abstract ideas more tangible and easier to recall. Concentrating of rote word memorization is a dead end while focusing on images connects the dots in a much more effective manner. We also need to practice backward drills when repeating a phrase as the brain tends to recall best what is said last and then moving backwards from there. It works!
Counterintuitively, our ears are poor tools for mental retention. It is what we see that is key as most of the information processed by the brain is via our eyes. Additionally, face-to-face encounters increase and enhance brain stimulation and mental retention as we learned in the example of Triadic Positioning in chapter 2.
We also need to hone our skills in effective note taking. Once again, the ear is deceptive. We need to portray our notes in images such as exclamation points, arrows, equal signs, etc. that convey the message in a much more effective manner. Moreover, we need to focus our notes on the key issues in the encounter such as numbers, medicines, dosages, name and timelines. To tie this section off, the integrity of the message is more important than getting the sequencing of what is said.
Finally, we need to develop (1) How to employ sound idea mapping to enhance mental retention. Discard the “fluff” while pictorializing the exploratory questions and then follow that up with the information that adds the real value, (2) Learn the key vocabulary via practice and repetition and (3) Good exercise and a sound diet are great tools to oxygenate the brain which lead to enhanced mental retention.

[Joseph Matthews]

There are a cadre of common factors that inhibit good mental retention. Some of the more significant ones are lack of focus and especially attention to detail. When we allow ourselves to get distracted or become mentally fatigued, due to lack of proper sleep for instance, our brain has difficulty in processing information in an effective manner. Additionally, anxiety and constant exposure to high-stress environments can also hamper mental retention, as they often disrupt cognitive processing which makes it more difficult for the brain to retrieve the needed information. Finaly, improper diet and lack of exercise result in less oxygen to the brain which also impair sound mental retention.
Good mental retention is especially crucial for interpreters, not just for understanding but also for immediate and accurate recall of what is spoken in the interaction – especially under conditions of high pressure and time constraint. If an interpreter forgets key terminology, phrases, or even cultural contextual applications, this can lead to miscommunication and may jeopardize the accuracy of what is being said and potentially lead to incorrect diagnosis and treatments. Strong mental retention allows interpreters to stay alert and remained focused while ably managing several layers of information and ensuring accurate interpretations.
Ultimately, building good mental retention habits—through repetition, practice, active recall, and managing stress can make the difference between being an average interpreter and an excellent one. Just knowing both languages falls short of the mark. The critical success factor is being able to effectively retain and manage the key information while under pressure in a rapidly changing and evolving environment.

[Joseph Matthews]

Cristina – you are quite correct in pointing out the fact that sound knowledge of the prefixes and sufixes used herein help to better understand to roots of the terms and their respective meanings. This enhances quick assimilation of what is being conveyed and ensures more precise accuracy which is so key.

[Joseph Matthews]

Leonisa – the conclusion to your comment above on this topic was “center shot” when you state that having good knowledge of the prefixes and sufixes used in the medical terminology aide not only in the medical interpreter’s mastering of these complex terms but also improves the overall efficiency of the communication while preserving confidentiality. A “win-win-win” situation.

[Joseph Matthews]

Having a solid command of the key prefixes and suffixes used in medical terminology is crucial for the medical interpreter in better understanding and interpreting complex medical terms, making them more accessible and manageable. This allows for a more precise understanding of medical concepts and improves communication within the interaction among patient, health care provider and interpreter. Finally, as we are talking about the patient’s health and well-being here, the stakes are very high, and this knowledge goes a long way in preventing errors in diagnosis, treatments and procedures.

[Joseph Matthews]

Thank you, Lesly for pointing out a clear example of how this federal legislation has filtered down into a corresponding state regulation as, in your case, that of the Rhode Island. As I am not in the U.S. – your example shows how both federal and state levels operate in sync with each other while avoiding potential areas of conflict as we see in the section on State Law – specifically statutory preemptions and exceptions on page 19 of chapter 3.

[Joseph Matthews]

I find Cristina’s point to be quite on-the-mark about the insufficient access to qualified interpreters in general. I feel this is due to the ever-increasing mobility of the world’s population on one hand and the number of LEPs in the U.S. vis-a-vs even what it was just 10-15 years ago on the other. Imagine a health care provider in Casper, Wyoming that has three LEPs being attending to, one who speaks Farsi, one being the Portuguese dialect spoken in Gao, India and the other is Vietnamese? This is what I meant in my writre-up that the requirements the legislation puts on the health provider as pertains to LEPs to be no small task. Resources are finite in any organization, public or private and a balance has to found.

[Joseph Matthews]

In my opinion, Executive Order 13166 and the current HIPAA, Federal and State regulations, although quite thorough, are not enough as this social need and the statutory tools (i.e., rules and regulations) governing same are always changing in an environment that is dynamic and constantly evolving. This does not mean that I see these statutory guidelines as being weak with structural shortfalls. Having been exposed to many years with commercial contracts (such as oil & gas and banking) – which have to be in continuous compliance with federal guidelines – I have found the HIPAA Privacy Rule (PR) and Executive Order 13166 to amply cover the main points – even to the degree of fine minutia. The content of these regulations and legislation in general can get very technical and even a bit confusing as, for instance, in the case on page 18 of chapter 3 which addresses Group Health Plan disclosures to Plan Sponsors (see the middle paragraph, with focus on the second and third bullet points).

On the other hand – I see the big challenge that these large amount of requirements place on the health care providers, especially when it comes to LEPs, which can number into the hundred as pertains to languages, dialects and cultures. In sum, I do understand that if one wants to achieve minimum results – one has to aim high – which this legislation clearly does. As I have been living overseas since the 1970s, I cannot opine on any specific state law as pertains to the above.

[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.

[Joseph Matthews]

Leonisa – you cite a most valid point about when the provider is not aware of certain cultural idiosyncrasies / sensitivities that could confuse and possibly even offend the patient. The “trust factor” suffers here along with the many pitfalls it entails. Therefore, it is key that the interpreter identifies and conveys this beforehand, in the pre-session with the provider, to help avoid any such occurrence.

[Joseph Matthews]

Good point you make Milleny about when a pre-seesion with the provider is not necessary – in fact not possible – as in the case of an emergency treatment. This points out the reality that a medical interpreter does not always have the luxury of the “time factor” to plan out everything ahead and that he / she must be able to stay focused and on point in a rapidly evolving situation.

[Joseph Matthews]

There are solid benefits of conducting a pre-session among patient, provider and the interpreter. Being adequately prepared, before the formal session begins, is a good step towards a successful outcome for all involved.
It is key that the interpreter should first perform a quick inventory of his/her key deliverables in the session such as scope, specific body parts to be addressed, which overall vocabulary will be most applicable and how to interact with the provider before the session begins.
As pertains to the patient you want to make sure he/she has a clear understanding of what your role as interpreter is, which should include such things as your name, the organization you represent and that the patient can speak directly and candidly with the provider. There are a cadre of potential surprises that can be avoided by the interpreter first doing a quick environment scan of the patient, his / her cultural origin and the specific medical issue to be addressed.
The above will also help lessen the risk of miscommunications about expectations (such as medical advice for example) that may jeopardize the outcome and / or create potential issues concerning ethics.
A brief pre-session with the provider is helpful, when possible, especially in the case when the provider has not had prior experience with interpreters present.
It has been my personal experience that anticipating the key events of an upcoming commitment is always much more preferable than reacting to same as this is an earmark of what it means to be a professional. With the interpreter carrying out key preparations beforehand – this will aid in paving the way for a successful medical encounter between patient and provider.

[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]

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.

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