Choosing A Role

Adapted from "Bridging the Gap", Interpreter Training Program
Courtesy of Cindy Roat, Cross-Cultural Health Care Program

What is the appropriate role for the interpreter? In a given session, you may have to switch between different roles because every patient will have different needs. The "appropriate role" for the interpreter is the least invasive role that will assure effective communication and care.

A pyramid with Advocate at the top of the point, followed by Culture Broker, Clarifier, and Conduit at the bottom represents the amount of time that medical interpreters routinely spend in any one role. These roles are defined below. As you go up the pyramid, the roles become increasingly intrusive, but the role is used relatively less often. For example, interpreters always act as Conduits and some patients or some encounters may require no more than that. However, because of the complexity of medical terminology, medical interpreters are routinely called upon to be Clarifiers. Some patients and encounters require culture brokering or advocacy as well. You must gauge the needs of the patient and the provider in choosing your role.

But why do we say that the interpreter should choose the least invasive role possible? In any interpreted communication, there are really three relationships that have been established:

1. provider-patient,
2. interpreter-patient,
3. provider-interpreter.

Which is the most important? It is clear that the most important relationship is that of the patient and the provider, because the other relationships exist only so that this one can occur. As the interpreter, however, you provide the means for the development of that crucial patient/provider relationship and so must take care to support, not undermine that relationship. The more invasive a role you take, the greater the risk of "getting in the way" of the patient-provider relationship. However, if you limit yourself to an inappropriately limited role, fundamental misunderstandings may occur that not only undermine the patient's relationship with the provider, but may endanger the patient's life.

To summarize, the medical interpreter can be seen as a bridge over a wide gap. This gap represents the differences between the two monolinguals; the interpreter builds a bridge to allow these two monolinguals to cross over to meet in the middle. Some interpreters see themselves more as the hole in the wall of the language barrier: the hole which allows monolinguals to converse as if the barrier were not there. However, we disagree. Language and culture are not barriers; the barrier is the misunderstanding that can arise from differences in language and culture. Also, the interpreter can never really be "invisible" as this model would suggest. But, like a bridge, the interpreter can be present in an unobtrusive way, not coming between two people, but supporting them in bridging the gap between them.

Definitions of roles:

Conduit: This is the most basic of the roles and involves rendering in one language literally what has been said in the other: no additions, no omissions, no editing or polishing, This is the "default" role of the interpreter, which you should adopt unless you perceive a clear potential for misunderstanding.

Clarifier: In this role, the interpreter adjusts register, explains or make word pictures of terms that have no linguistic equivalent (or whose linguistic equivalent will not be understood by the patient) and checks for understanding. You should take this role when you believe it is necessary to facilitate understanding.

Culture Broker: In this role, the interpreter provides a necessary cultural framework for understanding the message being interpreted. You should take this role when cultural differences are leading to a misunderstanding on the part of either provider or patient.

Advocate: Advocacy is any action an interpreter takes on behalf of the patient outside the bounds of an interpreted interview. The advocate is concerned with quality of care in addition to quality of communication. An on-site interpreter would appropriately become an advocate when the needs of the patient are not being met due to a systemic barrier such as the complexity of the health care system or racism.

For more information, contact

Cross Cultural Health Care Program
PacMedical Clinics
1200 12th Avenue S., Seattle, WA 98144
206-326-4161, fax 206-326-2471
e-mail:training@pacmed.org

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