It’s been a rough week, and I’m well past overdue for a solid update to this blog. Still, sometimes it is the little things that stand out in a day, so as a study break I would like to take you for a little behind-the-scenes look at how interpreter call lines work.

In the hospital setting, especially at a big, public hospital, there are often language barriers between doctor and patient. The best way to deal with something like this is to get a family member or friend to translate. The second best scenario is to enlist the help of someone on staff who speaks the language. Still, there will be times when an on-site interpreter cannot be found, and for those occasions many hospitals have hotlines hospital staff can call to gain access to an interpreter.

For our patient presentation this week, we had a doctor interview a gentleman who recounted for us his experience with an illness we had been studying in the past few weeks. He also spoke almost no English

If communicating to your patient through a third party via phone sounds awkward and cumbersome, that’s because it is. And if you happen to think presenting such an awkward and cumbersome activity to an auditorium of 150 medical students sounds like it might present some logistical problems, you would again be right.

The presentation was sent up with the doctor and the patient in the front of the auditorium. A microphone was positioned over a cell phone lying on the table in front of them. The cell phone was on speaker, and the microphone actually managed to pick up most of the call surprisingly well, given the technical difficulties we’ve had with sound during many of our lectures.

On a screen above their heads was a list of basic guidelines for using an interpreter hotline.

  1. Introduce yourself and your patient to the interpreter
  2. Write down the interpreter’s ID in the patient’s chart
  3. Speak directly to the patient and make eye contact
  4. Speak in short, direct sentences

The physician dialed and we listened to the phone ring. Then, like with any hotline, a recording answered.

“Thank you for calling the interpretation hotline. Please enter your ID number and PIN.”

(ID and PIN, I thought. I guess you wouldn’t want just anyone taking advantage. I could picture a lonely patient looking for the sound of a familiar language sneaking a call in the middle of the night.)

I believe a real person picked up then, but it was hard to tell the difference from the recording. “Please state the language you need translated,” she said.

The doctor leaned forward and spoke slowly into the phone and the mic at the same time. He requested the patient’s primary language and then added a backup in case they couldn’t find a translator for the first.

“Please hold while a translator is located,” said the woman on the other end. There was a click followed by the all-too-familiar strains of hold music drifting up through the mic. The class laughed.

The hold music played for a minute. There was another click and recording announced, “All translators are currently busy. Please hold for the next available translator.” Another little laugh passed through the crowd.

A few moments later the operator returned and told us an interpreter for the primary language was available. We were transferred over.

Through all of this, our patient sat…well…patiently, looking down at the phone. I wondered how much of this process he understood; certainly he must have been through it dozens of times. He seemed pretty calm, but I couldn’t help thinking how uncomfortable I would be, sitting in front of so many white-coated students, unable to understand most of what was being said around me.

The interpreter came onto the phone. She introduced herself and gave her ID. The doctor introduced himself and the patient. I waited for him to explain to her that she was on speaker in front of a classroom full of medical students, but he never told her the situation directly. Instead he dove right into the interview, asking the patient if he was nervous to be in front of us all and tell him that we were just kids and didn’t know anything. I wondered what the interpreter was picturing on her end of things. She gave no hint at being surprised or annoyed at being called upon for demonstration purposes.

I don’t know if it was the awkwardness of the set-up, or the convention of such translations, but the doctor was robotic throughout the interview. He spoke slowly and loudly in simple sentences, probably to make the translation as easy as possible, but there was no inflection or emotion in his voice. I found myself looking away when he would ask his question, embarrassed by his stiffness and unsure if the extent of his simplicity was entirely warranted.

The patient spoke in short affirmatives at first–we quickly learned the word for “yes”–as the doctor narrated his background. Eventually he began to answer real questions and fill in the pieces of his tale, the soft flow of his words melodic in contrast to the short, direct sentences of the physician.

Despite my interest, it was hard to sit through. The translation took a long time; even beyond having to wait through the interpretation and reply, there were times when seemingly short answers seemed to necessitate far more words in translation. There were times when I could hear the interpreter struggling to find the right words or phrase in both languages. Sometimes her translations hinted at a nuanced answer that simply couldn’t be conveyed adequately in the given situation.

On the other hand, we were able to find a translator who spoke a very specific language fairly quickly , and went from a complete language barrier to effective communication in a short period of time. Clumsy though it may feel, that is something of a miracle.