Telephone Interpreting in Health Care Settings: Some Commonly Asked Questions
By Nataly Kelly,
the director of product development,
NetworkOmni Multilingual Communications,
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The following frequently asked questions regarding
telephone interpreting in health care settings may be helpful
for interpreters, language service companies, and health
care providers who wish to learn more about telephone interpreting,
as well as its potential benefits and limitations in health
care scenarios. Electronic copies of this guide for educational
purposes may be downloaded at no charge from www.atanet.org/chronicle/feature_articles_monthly_archive.php,
or by e-mailing the author at email@example.com.
What is telephone interpreting?
Telephone interpreting is provided when an interpreter,
who is usually based in a remote location, provides interpretation
via telephone for two individuals who do not speak the same
language. Most often, telephone interpreting is performed
in the consecutive mode. This means that the interpreter
listens to each utterance first and then proceeds to render
it into the other language, as opposed to speaking and listening
Who performs telephone interpreting
in health care settings?
In the U.S., the majority of telephone interpreting is performed
by for-profit companies that are external to health care
organizations. However, many large health care providers
have interpreting services departments with staff interpreters
who also perform telephone interpreting. In some countries,
telephone interpreting is provided as a free service by
Is telephone interpreting a replacement
for face-to-face interpreting in health care?
No. Telephone interpreting and face-to-face interpreting
both have important roles in health care settings, but the
two types of interpreting do not replace each other.
When is face-to-face interpreting
preferable to telephone interpreting?
Telephone interpreting should be avoided, if possible, in
preference to face-to-face interpreting, in the following
health care situations:
1. When mental health services are
being provided: Telephone interpreting should not
be used in most mental health settings. The presence of
telephone equipment could itself present a hazard, since
it could be used as a weapon. In addition, with certain
mental health conditions, telephone interpreting might confuse
2. When serving patients who are
hard of hearing: Some patients who are hard of
hearing and/or elderly may rely more on lip reading than
they realize. In these instances, it is preferable to have
a face-to-face interpreter.
3. When communicating with children:
Children often have difficulties communicating
over the telephone. Therefore, when a provider is communicating
directly with a child, it is usually preferable to have
a face-to-face interpreter. If the provider is communicating
with an adult about the child, however, telephone
interpreting can normally be used.
4. When providing patient education
with visual components: Often, for sessions in
which the provider is giving instructions to the patient
(e.g., wound care, blood sugar testing), teaching aids or
equipment is used. When this occurs, it is usually preferable
to have a face-to-face interpreter, since an over-the-telephone
interpreter will not be able to see what is being demonstrated.
However, if all of the patient’s instructions will
be provided verbally, with no equipment demonstrations or
visual aids, telephone interpreting may be an acceptable
5. When there are multiple individuals
present with limited English proficiency: Telephone
interpreting is best suited to conversations between a provider
and one patient only. Telephone interpreting is not ideal
when the provider is speaking to multiple patients at the
same time (e.g., health education classes) or when multiple
individuals are present (e.g., the patient and several family
When is telephone interpreting preferable
to face-to-face interpreting?
Telephone interpreting is preferable to face-to-face interpreting
in the following health care situations:
1. When both parties (patient and
provider) are already communicating via telephone. Face-to-face
interpreting is not a practical option when the primary
interaction is taking place via telephone, so telephone
interpreting is advisable in these cases. With the rise
of telemedicine and a variety of services being provided
over the telephone, these situations are increasingly common.
For example, when patients call appointment lines, triage
lines, nurse advice lines, and other numbers for service
over the telephone, telephone interpreting is the best option.
2. When trained interpreters are
not available in person. When it comes to choosing
among the patient’s family member, friend, an untrained
bilingual staff member, or a telephone interpreting service,
it is usually preferable to choose the interpreting service.
This assumes, of course, that the telephone interpreting
service being used has professional, trained interpreters.
Most health care organizations ensure this through the process
of procuring a service provider. You also may ask the individual
telephone interpreter what kind of training he or she has
received, and what professional standards of practice he
or she observes.
3. When it is preferable not to
have another party in the room. Depending on cultural,
religious, and individual preferences, some patients may
prefer not to have another person physically present in
the room, especially when discussing sexual health issues.
Some patients may fear judgment from another member of their
culture, a member of the opposite gender, or speaker of
their language. Conversely, however, some patients may have
a greater sense of trust when an interpreter is present
in person. Patient preferences may vary even among groups
of speakers of the same language. Each circumstance is different,
but it is worth considering that the anonymity of a telephone
interpreter can be an advantage at times, especially where
modesty might be a consideration.
What type of equipment should be
used for telephone interpreting?
A speakerphone is often less than ideal, as it can reduce
audibility for all parties and pick up unwanted background
noise that can interfere with the interpreter’s ability
to hear both speakers properly. Telephones with two receivers,
commonly known as “dual receiver telephones”
or “dual handset telephones,” can be rented
or purchased from providers. These devices can enhance audibility
and improve the quality of the communication. Another option,
if allowed by the facility, is to use cordless telephones
with two handsets. Most handsets have the option to connect
a headset, allowing both the patient and the provider to
move around freely without being restricted by telephone
cords. It is important to sterilize the equipment before
and/or after each use. Disposable mouthpiece and earpiece
covers may also be advisable.
Is it true that telephone interpreters
cannot perceive any nonverbal cues?
No. A large amount of nonverbal information can be perceived
through tone of voice, inflection, breathing patterns, hesitations,
and other auditory input. Interpreters who work via telephone
should be trained specifically in listening skills that
enable them to perceive and process this type of nonverbal
information better. Interpreters working via telephone cannot
perceive information that is transmitted visually,
such as gestures and facial expressions.
How necessary is the visual aspect
It depends greatly on the context and the circumstance.
For some settings, such as one where patient education is
being provided, an interpreter might benefit from seeing
the process that is being described in order to interpret
accurately. Also, if an interpreter has not been trained
in telephone interpreting and is accustomed to interpreting
in face-to-face settings, he or she may feel at a disadvantage
when visual elements are removed. To ensure quality, what
matters most is that the interpreter is competent in the
type of interpreting being performed, be it face-to-face
or telephonic, and that he or she follows professional standards
How can I ensure that confidentiality
and privacy of health information are maintained when using
Professional interpreters should always be guided by a code
of ethics and standards of practice. Many providers of telephone
interpreting endorse the National Code of Ethics and Standards
of Practice issued by the National Council on Interpreting
in Health Care. Confidentiality is an important aspect of
both documents. In addition, many companies have internal
guidelines and policies, as well as confidentiality agreements
that are signed by all interpreters. When a health care
organization contracts with a telephone interpreting provider,
these issues are usually addressed contractually to ensure
that privacy is maintained.
How should medical records be documented
when telephone interpreters are used?
For most telephone interpreting companies, the single most
important item to note when tracking a call is the time
at which the call took place. Therefore, it can be useful
for providers to note the start time of a call with an interpreter,
as well as the end time of the call. In addition, the provider
should note the identification number of the interpreter,
if applicable, and the name of the interpreter. Some companies
do not allow the interpreters to provide their last names.
If this is the case, the first name and the identification
number are sufficient to track the call if a need ever arises.
Aside from noting when the call took place and the interpreter’s
identifying information, if more than one telephone interpreting
provider is used in your facility, it may be helpful to
note the name of the company as well.
Can a telephone interpreter help
me convey written information (patient education materials,
consent forms, prescriptions, etc.)?
Telephone interpreters can provide limited “auditory
translation” by listening to the health care provider
read information aloud from a written source document, and
then rendering it into another language. However, this is
not advisable for a variety of reasons. Any legal document,
such as a consent form, should be made available in a language
the patient can understand, if possible, in writing, as
should patient education materials. It is preferable to
translate such materials in advance. Doing so will also
provide significant cost savings to organizations in the
long run, especially when compared to the cost of paying
for telephone interpreters to produce this same information
verbally, to multiple patients, over time. In some cases,
it is not possible to translate information in advance.
For example, when a provider writes a prescription, there
may be no choice but to have the telephone interpreter explain
to the provider how to write those words so that the patient
will understand them.
What about video interpreting? Does
it have the potential to replace telephone interpreting
and on-site interpreting completely?
Video interpreting combines some benefits of both on-site
and telephone interpreting. High-quality video interpreting
equipment can be cost-prohibitive, but as the costs associated
with the technological requirements decrease, video interpreting
is becoming a viable option in some cases. Still, there
are certain settings for which having an on-site interpreter
is usually preferred. In some situations, such as when dealing
with a person with a terminal illness or mental health issue,
there is no replacement for having another human being present.
Likewise, there will continue to be situations in which
telephone or audio-only interpreting is preferable, especially
in situations where modesty and/or anonymity are important.
As technology becomes more accessible and economical, it
is likely that there will simply be audio and video streams
when calls are placed over the Internet. If a patient prefers
not to be seen, or if only the audio portion is required,
it would be easy to choose to have either or both options
available using Internet telephony. Also, both providers
and interpreters will require extra training in video interpretation
techniques and equipment use in order to provide a high-quality
Where can I learn more about telephone
interpreting in health care settings?
There are not many resources devoted specifically to telephone
interpreting in health care settings. However, the resource
list below can be helpful for those interested in obtaining
additional information, guidance, and practice.
Online Training for Doctors on Working with Interpreters
This web-based program, developed by Cindy Roat and Dr.
Elizabeth Jacobs, confers up to 2.5 continuing medical education
credits through Rush Medical College. It uses video and
case studies to train doctors on: how to work with professional
interpreters; how to guide an untrained interpreter; how
to work with a telephonic interpreter; how to work with
interpreters in mental health settings; and how to start
to develop a language access program internal to a hospital
or clinic. For more information, contact Bob Amend at (520)
722-1970 or firstname.lastname@example.org.
Kelly, Nataly. Telephone Interpreting: A Comprehensive
Guide to the Profession
(U.K.: Multi-lingual Matters, 2007). .multilingual-matters.com
This publication includes a “Client Considerations”
section with detailed advice, as well as a mnemonic with
20 guidelines for working effectively with telephone interpreters.
The publication also includes model standards of practice
for telephone interpreting in health care, along with practice
scenarios. A free electronic sample chapter may be requested
at the above link.
The Art of Working with Interpreters: A Manual
for Health Care Professionals.
This article by Holly Mikkelson provides helpful information
on working with health care interpreters in various settings.
It is available for download at the above link.
Moreno, Aura, and Lilian Ramsey.
“Telephonic Interpreting in Health Care:Answers to
a Few Questions.” Interpreters Voice (Fall
This article from the newsletter of ATA’s Interpreters
Division includes several questions about telephone interpreting
that are answered by professional health care interpreters.
Getting the Most from Language
This article by Emily Herndon and Linda Joyce from Family
Practice Management includes a small section with guidelines
for working with telephone interpreters. It is available
for download at the above link.
The majority of telephone interpreting providers offer free
client training materials (in print and electronic formats),
web tutorials, newsletters, training sessions, and/or multimedia
Nataly Kelly is an independent
consultant based in New Hampshire. She is also a certified
court interpreter (State of Missouri) for English and Spanish.
A former Fulbright scholar in sociolinguistics, her research
interests focus on interpreter certification, quality improvement
programs, and telephone interpreting. She currently serves
on the National Council on Interpreting in Health Care’s
Outreach Committee. She is the author of Telephone Interpreting:
A Comprehensive Guide to the Profession (Multilingual
Matters, 2007). Contact: email@example.com.
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