Why can’t a medical interpreter stay in the room alone with a patient?

Or, as some medical providers ask me when I express that I can’t be left alone in the room with the patient: then why did the last interpreter stay in the room with the patient, then?

The Short Answer

Here you’ll find a quick rundown of the medical interpreting ethical principles that may apply to this question, as well as other considerations. To read a more complete explanation of the considerations given, scroll down and read “The Long Answer.”

The Long Answer

So, to be fair, there is nothing written in stone in the U.S. medical interpreting codes of ethics and standards of practice that medical interpreters can’t be alone in the room with a patient.  That being said, this is a policy of many interpreting companies for which medical interpreters provide their services, and for good reason.  And despite it not being explicitly stated in the codes of ethics and standards of practice, there are ethical implications to be considered when it comes to a medical interpreter staying alone in the room with the patient.

The Reasons that Don’t Have an Ethical Basis

One of the biggest reasons interpreting companies have policies prohibiting interpreters from being alone in the room with a patient is likely that of legal liability.  Exam rooms are not subject to monitoring by video camera or anything of the sort, so what happens behind closed doors can’t really be verified.  God forbid a patient accuses an interpreter of inappropriate conduct without a witness present, then it’s the interpreter’s word against the patient’s.

If someone is a medical interpreter providing their services on behalf of an interpreting company, there’s a high probability that they’re not an employee, but rather an independent contractor.  As a contractor they do not have the same relationship with that company as an employee.  The people at the company likely don’t know that interpreter as well as they would an employee, and they do not exercise the same level of oversight over a contractor either.

This legal liability or risk can extend to the interpreter as well.  If we go back to the previous example of the interpreter being accused of inappropriate conduct behind closed doors with no witnesses, even if there is no company policy prohibiting the interpreter from doing so, they may still get in trouble with the interpreting company.  Contract interpreters have had their contracts terminated for far, far less.  Contractors don’t have the same legal protections as employees.  Unfortunately there is no shortage of examples of companies that don’t have their interpreters’ backs, so it’s not unreasonable for an interpreter with one of those companies to believe that they might lose in a situation where it’s their word against a patient’s.

I gave the explanation a little earlier that the interpreter may be a bit of an unknown or unfamiliar person to the companies they work for if they are a contractor, but this unknown element also extends to the patient.  Contrary to what some medical professionals seem to believe at times, the interpreter rarely, if ever, knows the patient for whom they are interpreting.  As much as we interpreters may sometimes feel an affinity with the people we are tasked with interpreting for because we speak the same language, the patient is likely, in all reality, a complete stranger.  How should we look at being shut in a small room in a place we’ve likely never been to before with someone we don’t know?

The Ethical Reasons

One of the ethical principles medical interpreters should follow is that of confidentiality.  We are supposed to keep patient information private, unless we have the patient’s consent to share it, or if we’re required to share that information by law (for instance, in cases of mandatory reporting).  This comes straight from the National Council on Interpreting in Healthcare’s (NCIHC) Code of Ethics and Standards of Practice, but is echoed in the California Healthcare Interpreting Association’s (CHIA) California Standards, and the International Medical Interpreting Association’s (IMIA) Codes of Ethics as well.  However, we may also be ethically, if not morally, obligated to share information the patient shares with us if it might put the patient’s health in danger.

Many patients would, if left alone with the medical interpreter, talk with them.  What would you do if you were surrounded by people who didn’t speak English, but suddenly found yourself alone with someone who did?  Wouldn’t you feel the same way?

What would you do if you were surrounded by people who didn’t speak English, but suddenly found yourself alone with someone who did?

There’s always the possibility that behind closed doors, a patient could tell us something that we might legally be required to share, or something that ethically (if not morally) needs to be shared.  These situations are always incredibly uncomfortable.  First, if the information must be shared, we have to encourage the patient to share that information with the provider.  This is per the ethical principle of respect, which includes respecting the patient’s autonomy.

If for whatever reason the patient refuses to share this information with the provider, then we have to share it with the provider. This is effectively going against the patient’s wishes, and likely negatively affecting the trust that patient not only has in us as an individual interpreter, but also every interpreter that comes after us.  To add insult to injury, it may even make it appear to the patient like we’re taking the provider’s side and not being impartial.

Another issue arises if the patient begins asking us questions.  There are four particularly problematic lines of questioning for a lot of the same ethical reasons:

1. Asking for medical advice 
   Medical interpreters cannot give medical advice.  Not only is this incredibly dangerous for us to do and a huge liability for all parties involved, the patient is effectively asking us to take on the role of a provider.  If we were to do this, this would be a clear violation of the ethical principle of maintaining boundaries.  Even just saying we can’t answer such questions and reminding the patient to address such questions to the provider can become a source of distrust or even conflict between the interpreter and the patient.
2. Asking us to do things that are outside of our role
   Aside from asking us to give medical advice, patients can and do ask interpreters to do other things, like give them a ride home or help them call the bank to figure out why they’ve been leaving repeated voicemail messages in English.  Neither of these things are within the role of the medical interpreter, and even politely declining can occasionally create tension between the interpreter and the person they are called to interpret for.  Additionally, I’ve personally been asked by patients to come to their home for a meal, go to their child’s birthday party, or even accompany them to church on Sunday, even while repeatedly making the boundaries of my role clear.  But doing any of these things would go against medical interpreters’ professional boundaries, as well as their impartiality, because they would create a conflict of interest.
3. Asking us personal questions
   In addition to making personal requests, patients may feel inclined to ask us personal questions that, outside of the interpreted encounter, would be perfectly appropriate questions to ask a new person you’ve just met.  Where are you from?  Do you have any children?  Are you married?  Do you live nearby?  It’s once again against the ethical principle of maintaining boundaries to “share or elicit overly personal information”.  This is an example given in the NCIHC’s standards of practice.  Try as we might to be polite in declining to answer these questions, some patients can be taken aback if we don’t.
4. Asking for our opinion
   As we’ve already established, asking for medical advice is one way for a patient to ask for our opinion that can be especially problematic.  But patients can (and do!) ask our opinions on other things.  Do you think Dr. Smith is a good doctor?  Can you believe so-and-so won the election?  How many kids do you think I’ve had?  Yes, these are all real questions asked of real interpreters (minus the doctor’s name, of course).  But, per the ethical principle of impartiality, we’re supposed to keep our thoughts, opinions, and beliefs to ourselves.  Sometimes even humoring a patient and answering what is seemingly an innocent question can potentially become problematic.  In order to remain a neutral party, we have to skillfully avoid answering these questions when faced with them, or we can avoid them (almost) entirely by not remaining alone in the room with the patient.

So it’s true: nowhere in our codes of ethics and standards of practice does it explicitly prohibit interpreters from staying alone in the room with the patient, however nearly anything that happens in that room between the patient and the interpreter is likely to lead to an ethical dilemma.  Additionally, closed doors are for patient privacy, and what is the ethical principle of confidentiality for if not protecting patient privacy?

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