In medical settings, language is rarely as straightforward as it seems. Healthcare providers and patients may believe they can communicate effectively in a shared language, yet critical details can still get lost, especially when it comes to medical terminology. That’s where shadow interpreting plays a critical role.
Shadow interpreting is a practice where a medically qualified interpreter listens while the provider and patient communicate directly, stepping in only when needed. This approach respects the linguistic abilities of both parties while ensuring that no vital information is missed. However, shadow interpreting requires careful judgment: interpreters must stay engaged, monitor for misunderstandings, and intervene when necessary to safeguard accurate communication and patient care.
Background
Sometimes interpreters hear statements like these from healthcare providers:
- “The medical provider asked me to not interpret because she is fluent in the patient’s (non-English) language.”
- “The patient is fluent in English, so we’ll just communicate directly.”
But why request an interpreter at all, if you’re not going to work with them to communicate? As it turns out, language is rarely as black-and-white as we want it to be.
What is shadow interpreting?
The law requires that healthcare providers work with medically qualified interpreters in encounters with limited English proficient (LEP) patients or their caregivers.
In many cases, the medical professional or the patient may be fluent enough in a shared language to communicate conversationally, but not adept in using the medical terminology of that language. In this case, the patient or provider may request that an interpreter be present in case communication breaks down. The interpreter will monitor the situation and take notes, but not actively interpret unless necessary — this is called shadow interpreting (Allen et al, 2023).
While shadow interpreting, interpreters listen as the participants communicate directly, while remaining engaged and ready to jump in to interpret if needed. Shadow interpreting can happen in face-to-face or remote encounters.
When would an interpreter shadow interpret?
Shadow interpreting is only appropriate when all parties agree that interpretation is not necessary for all communication. This practice shows respect for all parties’ ability to accurately convey important information.
Demonstrating this trust can help build rapport between the provider, patient, and any other participants like a patient’s family member or caregiver. In other words, it supports the communicative autonomy of all parties involved (García-Beyaert, 2015).
But, shadow interpreting is not appropriate if anyone in the room requires an interpreter and cannot communicate clearly without one.
For example, an interpreter is needed when an underage patient can speak with the medical provider in English, but the patient’s LEP guardian is present. An interpreter is needed to ensure clear communication between the provider, the patient, and the patient’s guardian.
Similarly, if an LEP patient is accompanied by a family member who speaks English, an interpreter is still needed. The family member may be capable of interpreting most of the conversation for the patient, but a healthcare-qualified interpreter is needed to ensure clear communication, handle sensitive medical information, and avoid cultural missteps (Allen et al., 2023).
How does shadow interpreting work?
When shadow interpreting, the interpreter should be transparent and clear about their role and how they will interact in the encounter.
Here are some examples of what an interpreter might say:
- “This is the interpreter speaking. I see you are communicating effectively in [English or other language]. Would you like me to stand by, ready to interpret as needed?”
- “Interpreter speaking. I will remain on standby as needed ready to assist with interpretation.”
- “Thank you for explaining that you need me to listen for any communication challenges. I will stand by, ready to interpret when needed.”
The interpreter remains actively engaged in the conversation, listening and watching for any participant to falter in their expression or words, or ask how to say a word or phrase in the other language.
Shadow interpreting requires taking notes and staying attentive as if the interpreter were actively interpreting. The interpreter monitors for understanding, especially when the patient and provider are discussing complicated procedures, prescription instructions, or medical jargon.
Additionally, if the patient or provider uses slang or unclear language, the interpreter should step in and verify (Allen et al., 2023).
When to step in during shadow interpreting
No interpreter can read minds. However, when shadow interpreting, the interpreter should watch for cues or facial expressions that mark confusion or misunderstanding. When in doubt, the interpreter should politely intervene and resume interpreting to ensure accurate communication.
WARNING: Shadow interpreting can become tricky when participants are overly confident of their own language skills (for example, a doctor who took some university Russian courses who feels they remember “enough” to speak to their Russian-speaking patient) or when someone is unfamiliar with interpreting ethics and standards of practice (for example, a companion omits a medical term when trying to interpret). While it is uncomfortable to bring attention to someone’s lack of language proficiency, the risks of not intervening are too great.
How to intervene: Scripting
If the interpreter notices confusion or limited comprehension, or is specifically asked for help, they should intervene. Otherwise, the interpreter should stay alert and follow along.
If the interpreter notices a breakdown in communication, the interpreter might say something like:
“This is the interpreter. To ensure the patient understands, I will resume interpreting.”
Based on the way the encounter is going overall, the interpreter should judge whether to resume shadow interpreting after a brief clarification or continue interpreting the rest of the session.
Key takeaways:
- Shadow interpreting is only appropriate when all parties agree that interpretation is not necessary for all communication.
- Shadow interpreting requires that the interpreter be engaged and use good judgment about the flow of communication during the entire encounter.
- Interpreters should be alert for any indication of confusion or communication breakdown so they can jump in to clarify.
- When in doubt, the interpreter should intervene for clarity, as often as needed, or for the remainder of the session, if appropriate.
- Intervening as a shadow interpreter may be uncomfortable, but it is not rude; it’s a professional best practice and it’s vital for interpreters to bridge communication gaps and ensure quality care.
The author would like to thank the members of the Equiti Interpreting Quality and Training Department for providing valuable input on best practices in remote healthcare interpreting.
References
Equiti’s Interpreting Quality and Training Department Tip: Help! They’re Communicating Without Me! Recommendations for Shadow Interpreting.
García-Beyaert, S. (2015). The Role of The Community Interpreter. In M.A. Bancroft (Ed.). The Community Interpreter®: An International Textbook. Culture & Language Press, pp. 359-442.
Allen, K., Bancroft, M.A., González-Cestari, T., Meder, D., Remer, C., Runge, D., Stockler-Rex, S. (2023). The Remote Interpreter: An International Textbook, Volume 1, Foundations in Remote Interpreting. Columbia, Maryland: Culture & Language Press.
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