A Bible for Healthcare Interpreters? A new resource for our profession (Part 3 of 3)

English Version

The English and ASL versions have similar content but are not direct translations of each other. The goal in offering both is to provide more complete access to the information.

HealthcareBookFormatsThis is the third of a three-part series reviewing the book, Introduction to Healthcare for Interpreters and Translators by Ineke Crezee.  This segment focuses on the pros and cons of the different available formats.  Part 1 features an interview with the author and an understanding of the motivation for writing this volume.  Part 2 focuses on the actual content delivered in the book and how it can be used.

The Upshot

Introduction to Healthcare for Interpreters and Translators by Ineke Crezee is an extremely useful resource for interpreters working in healthcare settings and worth the $54 to purchase a copy.  Crezee has done the field a favor by distilling relevant information about healthcare settings and practice into a well-organized and accessible format that interpreters and translators will find invaluable to have as an ongoing reference.

Available from John Benjamins and GooglePlay.

The Formats

This part of my review focuses on how this book can be most practical for interpreters.  As I mentioned in the the first part of this series, I had the opportunity to review both the paperback version ($54 from John Benjamins) and the scanned eBook ($42.66 from GooglePlay.)  The other versions available are hardbound ($149 from John Benjamins) and eBook which is currently advertised as $149.  Note the term “currently” as I contacted the publisher about this price and learned that John Benjamins is developing their own eBook platform and plan to release their books at the price of the paperback if one is available.

Strengths and Drawbacks

Both the versions I reviewed were organized in a very logical manner and include an extensive index to allow interpreters and translators to find specific items quickly.  For example, if you were called to an angiogram, you could immediately ascertain that relevant information is to be found on pages 179 and 211. The layout of the text in both of these formats uses frequent lists and tables which make it easy to scan through the book to find relevant information—very helpful.

A paperback is more susceptible to being damaged over time. During my interview with the author, she stated that interpreters in New Zealand carried around dog-eared copies of the book; signs of use, but also signs of wear.  In addition, for a book to contain this much information in a well-organized format, it cannot be small.  The dimensions of the paperback: 9.5” x 6.75” x .875”. (That’s 24 mm x 17 mm x 2.2mm for you metric users.)  So, it is not a small book to carry around, but if you prefer a paper copy, it is one worth having and caring for.

The advantages of an eBook include it can simply be carried with you on a tablet or a phone.  For those of you on a budget (which probably includes all of us) it is hard not to notice that it is less expensive to purchase the eBook from GooglePlay than to buy the paperback or eBook from John Benjamins.

The GoogleBook version does have limitations.  It does not have flowing text.  This means that you cannot change how large the text is on the page.  Essentially, you are only able to see an image of each book page, so it works well on a tablet with its larger screen, but the pages would be too small on a phone to be functional.  Additionally, the search function in an eBook reader on an iOS device (iPad, iPhone, iPod Touch) does not work—nor can you take notes on topics the way it is possible in other eReaders like iBooks. The search function does, however, work on Android devices.

(As a workaround, the book does have an extensive index that can be manually searched and then the page number quickly found.  Not as fast as the Search function, but as effective as using the index in the printed version.)

When I first wrote this review, the version of the book did not include the images shared in the printed version which is of particular value for interpreters who work with a visual language like ASL.  That glitch has been corrected.  As one of the benefits of an eBook platform -I was prompted to re-download the book when I opened it on my iPad after the change had been made.

Regarding the possibility of having flowing text that can be re-sized and thus more useful on the smaller screen of a phone, I received this comment from Pieter Lamers, production manager for John Benjamins:

The Google Play edition is based upon the PDF version. It will be searchable but not have reflowable text. We are looking into adding ePub versions of select titles. The nature of ePub makes this (reflowable) format less trustworthy and thus unsuitable for most of our academic publications.

This is a challenge for publishers.  The state of the digital publishing


The price of the book means that most interpreters will need to give serious consideration when deciding whether or not to purchase it.  For those working in healthcare settings, I believe it is a worthwhile investment in the quality of our practice.  The amount of time it saves us in doing our research on a given setting is definitely worth $54.  Whether or not to go with the paperback version or the eBook really depends on how you use technology—though the trends in publishing are in the direction of digital books and if you have a tablet, this might be a good eBook to add to your library.

Personally, I will be using the eBook version because my tablet has already become an indispensable part of my practice for interpreting in healthcare settings. I also have it on my phone, and though the text is small on the phone’s screen, it is still legible to these 44-year-old eyes. So, having the eBook allows me to bring an incredibly valuable resource that I am able to navigate through quickly without it carrying any more weight.  It also means that I can more effectively prep even for the last minute assignments.   While waiting for the patient to be seen, I can review the relevant chapter to be more prepared for providing the highest quality service to both providers and patients.


Crezee, I.  2013.  Introduction to Healthcare for Interpreters and Translators.  Amsterdam:  John Benjamins.

Ordering information retrieved on November 11, 2013 from http://www.benjamins.com/#catalog/books/z.181/main

A Bible for Healthcare Interpreters? A new resource for our profession (Part 2 of 3)

English Version

The English and ASL versions have similar content but are not direct translations of each other. The goal in offering both is to provide more complete access to the information.

hc-book-contentsThis is the second of a three-part series reviewing the book, Introduction to Healthcare for Interpreters and Translators by Ineke Crezee.  This segment focuses on the content of the book.  Part 1 features an interview with the author and an understanding of the motivation for writing this volume.  Part 3 focuses on the pros and cons of the different formats of the book.

The Upshot

Introduction to Healthcare for Interpreters and Translators by Ineke Crezee is an extremely useful resource for interpreters working in healthcare settings and worth the $54 to purchase a copy.  Crezee has done the field a favor by distilling relevant information about healthcare settings and practice into a well-organized and accessible format that interpreters and translators will find invaluable to have as an ongoing reference.

Available from John Benjamins and GooglePlay.

A Guided Tour

In thinking about this text, I liken it to a guidebook for interpreters working in healthcare settings.  If you were planning a trip to a foreign country, a recommendation would probably be to get a dependable guidebook to help you navigate unfamiliar territory. Similarly this book was written at the request of Ineke Crezee’s interpreting students who wanted a guide to the healthcare settings in which they were not experienced.  So, rather than thinking about this as simply a text book for those of us interested in interpreting in healthcare, I find it more apt to think of it as a resource that we can carry with us as support in our professional journey—useful whether it is our first trip into this territory or one of many.

The Contents

The book is divided into three sections.

Part I focuses on “Interpreting” and shares more general thoughts on interpreting in general, the need and requirements for interpreting in healthcare settings, considerations on how culture shapes the work interpreters do in healthcare and how patients perceive the healthcare experience, and a framework for preparing for medical terminology.

Part II focuses more specifically on “Interpreting in healthcare settings” and gives some incites on the different types of settings and staff that interpreters might encounter, including the general categories of:

  • primary physicians/general practitioners,
  • outpatient clinics and specialist clinics,
  • hospitals,
  • Emergency Departments/ERs,
  • informed consent,
  • Pre-operative and post-operative procedures,
  • Intensive Care,
  • Obstetrics,
  • Child Health,
  • Speech Language Therapy,
  • Mental Health, and
  • Oncology

Each of these sections contains a description of what might be expected in this setting.  Many, though not all, contain “some notes for interpreters and translators” which provide practical considerations to prepare for working in this setting.

Part III focuses in on “Healthcare specialties.”   These sections have a consistent format that includes:

  • Latin and Greek roots of terminology you might encounter,
  • Anatomy (structure) and Physiology (function) of parts of the body that might be important in these settings,
  • Health professionals who might be encountered in the setting,
  • Disorders that patients might present,
  • Common drugs used, and
  • Common investigations or treatments employed.

The specialties addressed are:

  1. Neurology,
  2. Cardiology,
  3. Respiratory system,
  4. Hematology,
  5. Orthopedics,
  6. Muscles and motor system,
  7. Sensory system,
  8. Immune and lymphatic system,
  9. Endocrine system,
  10. Digestive system,
  11. Urology and nephrology (The urinary system), and
  12. Reproductive system.

How to Use this Book

In the opening of Chapter 1, Crezee share a suggestion for how to use this book.  She writes, “Health interpreter educators may want to use the book as a course text, while health interpreters may want to use this book as a reference, checking briefly on anatomy, terminology and most commonly encountered conditions before leaving to interpret in a certain setting.”  I think these two options are helpful to think about.  For interpreter education, I believe the book could be a wonderful introduction to what is involved for interpreting in a healthcare setting.

A larger benefit, however, comes from it serving as a resource for working interpreters.  For interpreters (whether students or experienced practitioners), it is not a reasonable expectation for us to gain mastery over every healthcare setting we may find ourselves in. However, we can learn to use a resource like this as a way to effectively prepare for an assignment in a time-limited way.  Much of the information contained in the book exists on the internet, but Ineke Crezee has done the field of distilling the information into a much more concise and trustworthy form.  It allows interpreters to have a “temporary mastery” of the information—that is, we can review a chapter, commit the information to our short-term memory, and use it within a short period of time that allows us to be more effective in a particular setting.  Having the resource at our fingertips means we do not have to commit the time and effort that medical professionals need to gain a more “long-term mastery” for access at a variety of times and settings.

Choosing Formats

With such a potentially useful book, the next step is to determine which format best meets your needs and budget.  View the next entry in this review for some insights into the pros and cons of the different formats.

[button link=”http://healthcareinterpreting.org/bible-healthcare-interpreters-new-resource-profession-part-3-3/” type=”big” button color=”green”] Formats: Part 3 of Review[/button]

A Bible for Healthcare Interpreters? (Part 1)

A new resource for our profession

This is the first of a three-part series reviewing the book, Introduction to Healthcare for Interpreters and Translators by Ineke Crezee.  This segment features an interview with the author and an understanding of the motivation for writing this volume.  Part 2 focuses on the actual content delivered in the book and how it can be used.  Part 3 focuses on the pros and cons of the different available formats.

English Version

As interpreters in healthcare settings, we often are called into a variety of settings that we may not have in-depth knowledge about. It may be a meeting with a rheumatologist, an appointment with a cardiologist, or a visit to a edicrinologist. Unless we work in a setting with a large staff of interpreters, we work as generalists in a field full of specialists. Out of this reality comes a need for an effective resource to support the quality of our services for both patient and provider.

Ineke Crezee

Dr. Ineke Crezee – click on the picture for more information about her background and academic career

Ineke Crezee, an interpreter, translator, and educator based at Auckland University of Technology, responded to this need by writing Introduction to Healthcare for Interpreters and Translators. In a conversation about her motivation for the book, Ineke was clear that the idea was not her own. Instead, it came from her students: in 1996, a woman who worked as a Vietnamese-English interpreter approached Ineke and explained the type of book that she was looking for as an interpreter in healthcare settings. Ideally, the student thought, the book would be divided into different specialties with each chapter including:

  • an overview of the particular body system,
  • an explanation of Latin and Greek roots in medical terminology that might be employed,
  • common conditions and their signs and symptoms, and
  • procedures or tests that might be utilized in diagnosis and treatment.

After hearing this request, Ineke realized that there was no such book, and “that I’m going to have to write that book myself.”  So, she took on this challenge and originally self-published a book that became a constant companion to numerous interpreters and translators working in healthcare in New Zealand.

The success of the “Blue Book,” as it was called (because of its cover) by the community of interpreters and translators who used it, provided the foundation for the updated edition published by John Benjamins.

I did have the opportunity to talk with Ineke (once we figured out the challenge of scheduling across the international date line.  I don’t often get the chance to be in Monday talking to someone on Tuesday.)  What was clear in our conversation is that her primary mission with the book is to provide a practical resource – both for practitioners and educators – that will help raise the standard for interpreters and translators in healthcare settings.  I am excited to have the chance soon to review the book and assess how well this resource fulfills its mission.

I look forward to sharing that assessment – along with more insight from my conversation with Ineke Crezee – in the next few weeks.

What the Book Contains

Part    I.    Interpreting
Chapter 1. Introduction
Chapter 2. Interpreting in healthcare settings
Chapter 3. A word about culture
Chapter 4. Medical terminology

Part    II.    Interpreting in healthcare settings
Chapter 5. Primary physicians and General Practitioners
Chapter 6. Outpatient Clinics and specialist clinics
Chapter 7. Hospitals
Chapter 8. Emergency Departments or ERs
Chapter 9. Informed consent
Chapter 10. Pre-operative and post-operative procedures
Chapter 11. Intensive Care
Chapter 12. Obstetrics
Chapter 13. Child health
Chapter 14. Speech Language Therapy
Chapter 15. Mental health
Chapter 16. Oncology

Part    III.    Healthcare    Specialties
Chapter 17. Neurology: Nerves and the nervous system
Chapter 18. Cardiology: Heart and the circulatory system
Chapter 19. The respiratory system
Chapter 20. Hematology: Blood and blood disorders
Chapter 21. Orthopedics: The skeletal system
Chapter 22. Muscles and the motor system
Chapter 23. The sensory system
Chapter 24. The immune and lymphatic system
Chapter 25. The endocrine system
Chapter 26. The digestive system
Chapter 27. Urology and nephrology: The urinary system
Chapter 28. The reproductive system


[button link=”http://healthcareinterpreting.org/bible-healthcare-interpreters-new-resource-profession-part-2-3/” type=”big” button color=”green”] Contents: Part 2 of Review[/button]

Demand Control-Schema Logo

Demand Control Schema Resources

Robyn Dean and Dr. Robert Pollard have created a wealth of resources for interpreter educators related to the demand control schema.  This schema supports interpreters in assessing the challenges they face and identifying their options in responding. Additionally, they have been at the forefront of promoting a practice profession approach to interpreting.  This includes the use of Observation-Supervision, case conferencing, and reflective practice to raise the level of service.  While applicable to all types of interpreting, it is very beneficial in healthcare settings.

The Towards Reflective Practice: Case Studies for Interpreting in Healthcare Settings manual incorporated application of demand control schema to the case study process, and suggests using the case study manual with the textbook The Demand Control Schema: Interpreting as a Practice Profession.

Click here to review their page hosted by the University of Rochester Deaf Wellness Program

Download the Case Studies for Interpreting in Healthcare Settings manual here (PDF)

Integrating Healthcare into Interpreter Education Programs

by Karen Malcolm

There are very few specialized programs preparing interpreters to work in healthcare settings, and yet many graduates of interpreter education programs will work in these settings. The following suggestions offer some ways that healthcare interpreting can be incorporated into existing interpreter education programs.


Students with elective courses in their program should be encouraged to consider taking the following courses (exact titles will vary by institution):

Medical interpreting:
Introduction to Biology
Human Anatomy and Physiology
Medical Terminology
Developmental Psychology
Death and Dying
Ethics and Healthcare

Mental Health Interpreting:
Introduction to Psychology
Developmental Psychology
Abnormal Psychology
Alcohol and Drug Addictions


Ethical Decision-Making in Healthcare Settings

Ethical discussions are an integral part of every interpreter education curriculum.  Discussion of ethical dilemmas and/or case studies focused on healthcare dilemmas can be incorporated into classroom discussion.  For some sample dilemmas, click here.

Another useful resource is the Treehouse video entitled Interpreting in Mental Health Settings. A number of scenarios are presented where the interpreter faces a dilemma in a mental health setting, followed by a commentary by the narrator.  A study manual accompanies the video. To obtain these materials, click here.

Local interpreters who work in healthcare settings, who are willing to be contacted, could be presented with an ethical dilemma by students and engaged in dialogue about their preferred course of action, and why they would select that option.  These discussions could be brought back to the classroom to share with the larger group.

Self Care

Dr. Michael Harvey is a psychologist in private practice in the Boston area, who has worked extensively with Deaf and hard of hearing clients. He continues to research vicarious trauma and interpreters, and the ways that interpreters are affected by their interpreting experiences. His website, www.michaelharvey-phd.com, offers valuable insights into the potential challenges interpreters face and can be used to generate discussion about the ways that healthcare interpreting could lead to vicarious traumatization.

Language development

Students working in healthcare settings need to develop their skill in discussing healthcare issues in both ASL and English.  One resource for developing English language skills is the website English for Medical Purposes (www.emp-tmu.net), a free resource offered by the Tokyo Medical University. It offers an extensive list of medical interviews conducted in English, which can be used for developing familiarity with medical discourse.  For programs teaching the Demand-Control Schema, an EIPI analysis could be conducted on an interview.  The participants are Australian so there may be some challenges engaging with a different dialect of English than an American one.  While the resource is free, you will need to register and create an account in order to access it.

This website offers some resources that can be used to facilitate language learning both in ASL and English.  One of these is the on-line resource, entitled “Body Language.”  This on-line program is designed so that interpreters work in cohorts, and involves reading about health conditions, looking at diagrams that describe the condition, and then seeing the condition discussed in ASL.  Students are able to tape themselves discussing the same condition, and then share their work with their cohort.

Another resource on this site can be found under “Medical Resources”, then “University of Minnesota, WEBANATOMY (or click here).  This site can be used to develop an understanding of anatomy and includes self-tests as well as games that can involve several participants.

Interpreting skills development

There are a number of interpreting skills development resources available on this site under “Professional Development”, “Independent Study”.  These cover topics such as the digestive system, cardiovascular health, taking medication, pregnancy, labor, and delivery, and interpreting in the Emergency Department. Several of these are available on line. These include both language development activities and interpreting skills activities.  Students can practice interpreting interactions, and also analyze modeled interpretations.

Another useful activity involves role play. Students can practice live interpretations related to healthcare topics.  Students can take turns role playing the participants, so that one student plays the Deaf patient or client, one plays the hearing practitioner, and another student interprets.  It is helpful for the “Deaf” patient to use earplugs or some other means of blocking out what is said, so s/he is actually responding to the interpretation. Similarly, the “healthcare practitioner” should avert his/her eyes so as to also be responding to the interpretation.

These role plays are more effective with actual Deaf participants and actual healthcare providers.  If your institution has any kind of healthcare programs (for example, nursing, psychiatric nursing, counseling, etc.), consider approaching them to involve students in these role plays. It benefits the interpreting students to practice with knowledgeable participants, and also benefits students in the healthcare programs to learn about working with interpreters.  It is also useful to have Deaf people participate in these role plays.  A small honorarium might be offered, or some other access to services at the institution as compensation for their time.

Prepare role play cards to hand to each participant (Deaf person, healthcare provider, interpreter).  (Note: the Deaf person could also be the healthcare provider, but given that this is less common, the majority of the role plays will likely still have the Deaf person as the recipient of service.) Participants look only at their own card, because there may be different goals for each of the participants.  They agree who will make the first utterance, and then continue for approximately 10 minutes, being as realistic as possible.  There should be several observers who can offer observations and ask questions afterwards.

For some sample role plays, click here.

Ethical Dilemmas in Medical Settings

created by Karen Malcolm

The following are a series of ethical dilemmas that can be used in Interpreter Education Program.

Dilemma 1

You have interpreted for a 15-year-old Deaf girl in various settings, and she recently confided in you that she was pregnant, and hadn’t told her mother yet because, “my mom will kill me! She doesn’t even know I’ve had sex yet.”

A few weeks later you are at the hospital where the girl is attending with her mother. She has been having back pain and she has been sent for an X-Ray.  The technician asks the girl if there is any chance she might be pregnant. She glances up at her mother, then responds, “no, I’m not pregnant.”

Dilemma 2

You interpret for a Deaf couple.  The wife has pancreatic cancer.  The doctor tells them that they have exhausted all possibilities, and no other treatment is suggested at this point. He tells them to go home, and enjoy what  time remains with their family.  The couple leaves looking very happy and smiling.  You have a strong sense that they did not understand that this was actually bad news.

Dilemma 3

You have been interpreting for a Deaf couple who are expecting their third child.  They have had tests done that confirm the sex of the child is female.  They start talking about this fact with the doctor, and it becomes clear that they want to abort the child because they already have two girls, and really want to have a boy. You find this very disturbing and are opposed to this kind of action.

Dilemma 4

A Deaf man with hepatitis has been told not to drink because it will worsen his condition. You see him at a community event, drinking quite a few beers. He approaches you and says,  hey, remember the doctor told me to stop drinking, so I stopped drinking scotch and now I just have beer.

Scenarios for Role Play

by Karen Malcolm

The following scenarios are presented for assistance in incorporating healthcare interpreting into interpreter education programs.  For more context on how to use these scenarios, please click here.



Acid Reflux – Doctor

A patient comes to see you complaining of heartburn and acid indigestion. You ask what they do to deal with the problem.  Find out how often this happens….if it is consistently more than 2X a week, it could be GERD (Gastroephageal Reflux Disease).  This is a problem in the esophagus where it doesn’t close properly and stomach acids come back up.  Can lead to bleeding and ulcers, can make swallowing difficult, and can lead to esphogeal cancer.  Treatment:
•    Use antacids
•    Stop smoking
•    Lose weight
•    Eat small frequent meals
•    Don’t lie down until 3 hours after meals
If the condition continues, will refer to a specialist to consider surgery as an option

Acid Reflux – Patient

You go to see your doctor because you have been having terrible heartburn after eating.  You used to get it every once in awhile, especially if you ate spicy foods, but in the last month it is happening at least 3 times a week.  You have been using Tums but now they don’t seem to be helping.  You are frustrated that you can’t enjoy eating and worried about what is wrong with you.

Acid Reflux – Interpreter

A Deaf patient is going to their doctor to talk about problems with heartburn, which is happening more and more often.

Back to List of Role Plays


Asthma – Doctor

You are seeing a regular patient of yours who is in her/his late 40s. S/he has very bad asthma, which is triggered by dust, smog, smoke and pollen, as well as by any exertion.  S/he uses two different puffers, a green one s/he can use up to four times a day, and an orange one that is only for serious breathing difficulties and should only be used once per day as needed.
You do monthly checks on her/him to make sure s/he doesn’t need to change medication.

Has anything changed since the last visit
How often does s/he use her green puffer, and how often the orange
Suggest s/he refrain from housework, because both the dust and exertion are bad for her/him

Asthma – Patient

You are in your late 40s and have had asthma for most of your adult life.  You see your doctor monthly to check on how you are doing.   Your asthma is triggered by dust, smoke, pollen, and smog, as well as by exertion.  You use two different puffers, a green one you can use up to four times a day, and an orange one that is only for serious breathing difficulties and should only be used once per day as needed.

In last month have been having a hard time—there is a lot of pollen, and also there has been more smog
When you clean your apartment, you get very out of breath, have to use the orange puffer, sometimes two or three times a day
Very important to you to keep you apt. clean and you live alone so who else can do i

Asthma – Interpreter

A Deaf patient in his/her late 40s is going to the doctor for a monthly check up. S/he has asthma and uses two different puffers to manage the condition.

Back to List of Role Plays


Car Accident – Doctor

You are seeing a patient of yours who was in a car accident.   S/he is complaining about bruises on her/his torso and her/his neck hurting.   S/he was struck by an oncoming car when s/he was turning left and her/his airbag deployed

  • When did the accident happen
  • What did s/he do (eg, get treatment at hospital)
  • What is the pain like on a scale of 1 to 10

If s/he complains of sore throat and bad taste in mouth, it is probably because of chemicals and dust in the air bag and will go away
Will need to take pictures of bruises for the insurance company
Will refer her/him to physical therapist but for now need to rest, put ice on neck
Will give her/him pain killers

Car Accident Patient

You are seeing your doctor because you were in a car accident two days ago. You were turning left when an oncoming car struck you and your airbag deployed. You were taken to the hospital and examined, and released that night.

You have a sore neck and sore ribs and abdomen, with bruising.  Also you have a sore throat and bad taste in your mouth and you wonder what that is from. You are worried that maybe you injured something and that has affected your taste buds.

Car Accident – Interpreter

The Deaf patient was in a car accident two days ago…s/he was broadsided while turning left and the airbag deployed. S/he has sore ribs and bruising, and a bad taste in her/his mouth.

Back to List of Role Plays



Jaw pain – Doctor

You are seeing a new patient who is coming in complaining of chronic jaw pain.  You want to determine:

  • Where the pain is
  • When did it first start
  • How long does the pain last when it begins
  • What time of day is it worse
  • Is there anything that makes it worse or better
  • Was there anything that seemed to start the pain
  • What has the patient tried to make the pain less (e.g., medication, hot and cold treatments, etc.)

You may decide to refer the patient to a dental specialist to investigate the possibility of TMJ.

Jaw pain – Patient

You are going to the doctor to seek help with chronic jaw pain.  It is something you have had all your adult life, on and off, but in the last six weeks it has gotten worse and is a throbbing pain.  You find it hard to eat at times.

You have tried taking Tylenol and that helps the pain lessen but you would like to find out if there is anything you could do that would get rid of the pain.

Jaw pain – Interpreter

The Deaf patient has had jaw pain on and off for year, but recently it has gotten much worse.

Back to List of Role Plays



Rapid heart beat – Doctor

A patient has come to see you who is complaining of rapid heart beat. You want to find out how often this happens, and what the patient is doing when it occurs.  The patient will need to wear a Holter monitor, which is a portable ECG (electrocardiogram) that will record their heart beat over a 24 hour period.  They will need to keep a chart of what activities they are doing at every point of the day (e.g., walking up a hill, sleeping, showering) so the results of the test can be co-related with activity.  After that, it can be determined how serious the problem is, and medication may be prescribed such as beta blockers or digoxin.

Rapid Heart Beat – Patient

In the last six months, you have sometimes felt like your heart is beating really fast. You are very worried about it. It seems to happen for no reason. When it happens, you lie down and rest and wait for it to stop.  Usually it goes away after 5 minutes but in the last 2 weeks it has happened twice when it lasted for up to 15 minutes.

You are very nervous about what might be wrong.

Rapid heart beat – Interpreter

The Deaf patient has been experiencing times of rapid heartbeat and is very worried about it.

Back to List of Role Plays

A list of the different domains - as spokes in a bicycle wheel

Concept Map for Medical & Mental Health Interpreting Education


St. Catherine University – CATIE Center; NURIEC; NCIEC.  2008
Karen Malcolm, Curriculum Consultant.  Laurie Swabey and Cathy Cogen, Project Directors.

Download PDF Version

1: Orientation | 2: Conditions/Treatments | 3: Language Use | 4: Ethics/Boundaries | 5: Interpreting Skills | 6: Interpersonal Skills | 7: Self-Care/Self-Awareness | 8: Professional/Research Skills

Module One: Orientation/Overview of Mental Health/Medical Interpreting

This module provides an introduction to working in medical and mental health settings.  Students will be introduced to the settings where this work is performed and the systems and structures in place; to personnel involved in the provision of services; and to the characteristics of mental health/medical interpreting that are unique to these settings.


  • Deaf, deaf-blind, hard of hearing people and their experiences with the medical/mental health setting
  • Systems in mental health/medical settings
    • 7 main fields in medicine (surgery, internal medicine, family and community medicine, pediatrics, obstetrics and gynecology, emergency medicine, psychiatry)
    • Overview of health care system
    • Structures and hierarchies
    • Private insurance and HMOs
    • Acute vs. chronic:  Emergency room, long term care, residential programs, rehab, out patient
    • Mental health continuum from psychiatrically disturbed to people who are seeking self-growth/enlightenment
    • Teaching hospitals
    • Difference between public and private systems
  • Personnel
    • Roles, function and relationship (e.g., case manager, doctor, psychiatrist, etc.)
    • Boundaries
  • Legal responsibility
    • HIPAA, duty-to-warn, legal privilege, informed consent, etc.
    • ADA, state human rights acts
    • Professional liability
    • Honest representation of credentials and training
  • Treatment protocols
    • Various health care approaches, e.g., Chinese medicine, ayurvedic, etc.
    • Policies, goals, dynamics, interventions, procedures
  • Role of interpreters in these settings
    • Ability to explain role/function without use of jargon
    • Staff vs. freelance
    • Boundaries
      • working with people with borderline personality disorders
  • Advance directives and living wills
  • Challenges and Rewards
  • Multicultural, multi-ethnic perspectives


  • Virtual hospital tours
  • DeMatteo, A.J., Veltri, D. and S.M. Lee. (1986). The role of a sign language interpreter in psychotherapy.  In M.L. McIntire (Ed.). Interpreting:  The Art of Cross-Cultural Mediation.  Silver Spring:  RID Publications. 135-153
  • RID Standard Practice Papers (Medical, Mental Health)
  • Taber’s encyclopedic medical dictionary

Teaching Approaches:

  1. observation, live and/or virtual tours
  2. readings
  3. structured discussion groups
  4. guest commentaries
  5. independent exploration
  6. demand/control

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Module Two: Conditions and Treatments

Students will become familiar with common conditions, procedures and treatments that present in medical and mental health settings.



  • Common conditions
  • Medical etiologies and syndromes, and impact on communication
    • Developmental disabilities, Usher syndrome, etc.
  • Anatomy and physiology
  • Treatments
  • Medication instructions
    • Medications and their impact on language and behavior
  • Procedures
    • common diagnostic procedures, e.g., X-Ray, CT scan, MRI, EKG, lab tests, endoscopies/colonoscopies, mammograms, PSAs, Pap smears, etc.

Mental Health

  • Common conditions
  • Medical etiologies and syndromes, and impact on communication
    • Developmental disabilities, Usher’s syndrome, anxiety disorders, DSM IV conditions, etc.
  • Abnormal psychology and diagnoses.
  • Intro to psychotherapeutic approaches
    • Cognitive Behavioral Therapy, EMDR, Family Systems Therapy, etc.
    • Role of the therapeutic alliance
  • Treatments
    • Medication instructions
    • Medications and their impact on language and behavior
  • Childhood trauma and sexual abuse
  • Substance abuse
    • 12 step programs, detox, relapse prevention, etc.
  • Common forensic mental health areas
    • Eg, NGRI, competency to stand trial, etc
  • Diagnoses  DSM IV


Teaching Approaches:

  1. readings and structured discussion
  2. lecture
  3. modeling/mentoring
  4. observation
  5. demand/control

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Module Three: Language Use in Mental Health/Medical Settings

Continuing to build on content learned in the previous module, students will consider the specific vocabulary and discourse used in medical and mental health discussions.


  • Vocabulary, both English and ASL


  • Medical  instructions
  • Discourse ( including the ways in which medical professionals talk to patients and family members)
  • Medical terminology
  • Sociolinguistic variation (age, gender, race, sexual orientation, SES, etc.)
    • Register
    • Politeness
  • Dysfluency
  • Assessments
  • Sight translation

Mental Health

  • Discourse (including deliberate ways in which mental health professionals talk to clients and family members)
    • assessing clients at risk of harming self and/or others
  • Sociolinguistic variation
  • Conveying level of nuance and feeling state
  • Emotionally charged language
  • Dysfluency
    • abnormal language features (e.g., rapid speech, rapid subject changes, etc.)
  • Assessments
    • Psychological tests
    • Mental status exam
    • Psychiatric tests
  • Sight translation



  • www.deafdoc.org  Definitions of common conditions, presented in ASL
  • www.medicalinterpreting.org Videos in ASL describing common conditions
  • Sign Media, Inc.  AIDS: Overview and Prevention. Simultaneous lecture
  • My Body, My Responsibility: A Health Education Video for Deaf Women.  Deaf Wellness Center
  • 2 Dialectical Behavior Therapy Videos:
    • Opposite Action: An Adaptation from the Deaf Perspective, and
    • Practicing Radical Acceptance: An Adaptation from the Deaf Perspective.  Deaf Wellness Center
  • St. Catherine University DVDs:
    • When the Law Meets Medicine.
    • Stomach This: the Digestive System in ASL and English
    • To the Heart of the Matter: the Cardiovascular System in American Sign Language and English
    • Birth Companions: Perspectives on Doulas and Midwives in ASL and English
    • All in Due Time: Perspectives on Childbirth from Deaf Parents
  • Howard, N., K. Malcolm and D. Still. (1999).Interpreting in a Medical Setting. Four videos including a range of Deaf people talking about personal medical experiences such as treating a skin condition, pregnancy and delivery, diabetes, HIV/AIDS, etc.

Teaching Approaches:

  1. readings and structured discussion
  2. lecture
  3. modeling/mentoring
  4. guest commentaries
  5. independent exploration

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Module Four: Ethics and Boundaries

Students will explore the ethical challenges that arise in medical and mental health settings, and consider how ethical codes are applied.


  • Values clarification
    • how might our values affect an interpretation
  • Decision making tools and skills
  • Morals and laws
  • Respect for consumers’ autonomy
  • Conflict of interest
  • Advocacy
    • When/how/who to share knowledge/evidence of possible language dysfluency
    • Referring to outside help/resources
    • Clarify assumptions re typical ASL behaviors (eg, eye gaze, facial affect)
    • Intervention to prevent serious harm (eg., if serious allergy has been overlooked, client talking about harming self or others)
  • Education re role
    • Discuss impact of interpreter on group dynamics
    • Gender issues and client preferences
    • Provide input to Deaf, deaf-blind, hard of hearing communities
    • Working as a mentor with other interpreters
  • Confidentiality
    • Supervision and professional conferencing
  • Staff vs. freelance
  • Cultural mediation
  • Boundaries
  • Transference and counter-transference


  • www.vch.ca/wbp/Docs/Psychotherapy_with_Deaf_Clients_2001.pdf
  • Gish, S. and M. Barnum. Ethics and Decision-Making for Interpreters in Health Care Settings.
  • Mills Stewart, K. and Witter-Merithew, A. The Dimensions of Ethical Decision-Making: A Guided Exploration for Interpreters. 2006 . Sign Media, Inc.: Burtonsville, MD.
  • Gordon, P. and M. Magler. (2008). The Mentor’s Companion. RID Publications.

Teaching Approaches:

  1. case studies and discussion groups
  2. readings
  3. guided discussion groups
  4. guest commentaries
  5. role plays

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Module Five: Interpreting Skills

Students will practice the delivery of equivalent messages in medical and mental health settings. They will consider the reasons for using CI and SI, determine when each is appropriate, and practice employing each effectively in these settings.


  • Preparing for the assignment
  • Management of interaction (e.g., requesting clarification, asking a speaker to pause, etc.)
  • Consecutive skills
  • Simultaneous skills
  • Appropriate decisions re use of CI/SI
  • Conveying meaning
  • Di and hearing interpreter teams


  • Interpreting pain levels
    Use of classifiers and SASSes

Mental Health

  • Conveying metaphoric meaning
  • Awareness of impact of linguistic choices on therapeutic message
  • Interpret extra-linguistic nuances of therapeutic communication


  • www.medicalinterpreting.org – College of St. Catherine’s DVDs:
    • Internal Discussions: An Appointment in Cardiology
    • Internal Discussions: An Appointment in Gastroenterology
    • Hurry Up and Wait: Interpreting a Visit to an Emergency Department
    • Take These Meds: Interpreting Visits to a Pharmacy
  • Treehouse Video: Interpreting in Mental Health Settings.
  • Howard, N., K. Malcolm and D. Still. (1999) Interpreting in a Medical Setting.  A set of four videos including scenarios for consecutive interpreting practice with Deaf people in a range of medical settings, conversing with actual doctors and nurses.  Scenario topics include migraine, back pain, diabetes, abdominal pain, and others.
  • www.asl_interpreting.tripod.com Interpreting for AA Meetings

Teaching Approaches:

  1. lecture
  2. small group practice
  3. video samples
  4. observation/supervision
  5. mentoring
  6. guest commentaries

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Module Six: Interpersonal Skills

Students will practice interpersonal skills pertinent to mental health/medical settings, and learn to effectively negotiate relationships with others involved in these settings.


  • Listening and observation skills
  • Problem solving skills
  • Teamwork
  • -working with spoken language interpreters
  • Professional Etiquette
  • Assertiveness
  • DI and hearing interpreter teams

Mental Health

  • Forming therapeutic alliance with therapist and all providers:
    • Pre- and post-sessions
    • Negotiating during therapy session
    • How and when to seek clarification or interrupt or not


  • Pollard, R., 1998. Mental Health Interpreting:  A Mentored Curriculum.Rochester, New York: University of Rochester. (manual and videotape)

Teaching Approaches:

  1. readings and structured discussion
  2. mentoring
  3. case studies
  4. role play
  5. observation/supervision

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Module Seven:Self-Care and Self-Awareness

This module addresses the importance of self-awareness and self-care, and
prepares students to manage their physical and emotional selves while providing mental health/medical interpreting.


  • Personal safety
  • Vaccinations
  • Universal precautions, including knowledge of isolation procedures
  • Environmental awareness (e.g., X-Ray)
  • Physical and emotional stamina
  • Awareness of own issues and their potential to affect the interpretation
  • Exploring and managing personal reactions and knowing personal limits
    • Developing somatic awareness and philosophy of detachment
    • Reactions to smells, sights and sounds
    • Both inside and outside of interpreting setting
  • Vicarious trauma
  • Strategies for self-care


  • Harvey, Michael. Shielding Yourself from the Perils of Empathy, and The Hazards of Empathy: Vicarious Trauma of Interpreters for the Deaf  www.michaelharvey-phd.com
  • Harvey, M. (2001). Vicarious Emotional Trauma of Interpreters: A Clinical Psychologist’s Perspective. In Journal of Interpretation, 85-98.

Teaching Approaches:

  1. lecture
  2. case studies
  3. mentoring
  4. field research/independent exploration

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Module Eight: Professional and Research Skills

This final module guides students into identifying and evaluating research in the field, and applying this to their professional practice. It also fosters the development of a professional identity as a specialist in the area of interpreting in mental health/medical


  • Awareness of current interpreting standards
  • Awareness of current health care and mental health practices
  • Legal issues in medical and mental health settings
  • Professional liability insurance
  • Establishment and implementation of annual professional development plans
  • Use of technology to access information
  • Familiarity with research in field
  • Ability to evaluate and apply research to professional practice
  • Commitment to life-long learning
    • Establishing avenues for supervision, debriefing, mentorship, collegial support and consultation


  • Angellini, C. (2002). The visible co-participant: The interpreter’s role in doctor-patient encounters.  In Metzger, M., S. Collins, V. Dively, and R. Shaw, Eds. From topic boundaries to omission: New research on interpretation. Gallaudet University Press: Washington, D.C.
  • Metzger,M. (1999). Sign language interpreting: Deconstructing the myth of neutrality. Washington, DC: Gallaudet University Press.
  • RID Standard Practice papers
  • www.futurehealth.ucsf.edu/pewcomm/html

Teaching Approaches:

  1. lecture
  2. guided readings and discussion groups
  3. mentoring
  4. guest commentaries

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St. Catherine University – CATIE Center; NURIEC; NCIEC.  2008
Karen Malcolm, Curriculum Consultant.  Laurie Swabey and Cathy Cogen, Project Directors.

Book on Educating Healthcare Interpreters

Laurie Swabey and Karen Malcolm have edited a volume which significantly expands the resources for our field in educating interpreters for healthcare settings.  The volume, In Our Hands:  Educating Healthcare Interpreters, was published in 2012 by Gallaudet University Press and is the fifth volume in the Interpreter Education Series.

Here is the description from the back of the book:

Deaf Americans have identified healthcare as the most difficult setting in which to obtain a qualified interpreter. Yet, relatively little attention has been given to developing evidence-based resources and a standardized body of knowledge to educate healthcare interpreters. In Our Hands: Educating Healthcare Interpreters addresses these concerns by delineating the best practices for preparing interpreters to facilitate full access for deaf people in healthcare settings.

The first section of this volume begins with developing domains and competencies toward a teaching methodology for medical and mental health interpreters. The next chapter describes a discourse approach that relies on analyzing actual transcripts and recordings to train healthcare interpreters. Other chapters feature a model mental health interpreter training program in Alabama; using a Demand-Control Schema for experiential learning; the risk of vicarious trauma to interpreters; online educational opportunities; and interpreting for deaf health care professionals. The second section offers four perspectives on education, including healthcare literacy of the clients; the education of Deaf interpreters; the development of standards for spoken-language healthcare interpreters; and the perspectives of healthcare interpreter educators in Europe. The range and depth of In Our Hands takes significant strides in presenting educational opportunities that can enhance the critical services provided by healthcare interpreters to deaf clients.

Here’s a listing of the contents:

  • “Domains and Competencies for Healthcare Interpreting:  Applications and Implications for Educators” by Laurie Swabey and Quincy Craft Faber
  • “‘What Happens Truly, Not Textbook!’: Using Authentic Interactions in Discourse Training for Healthcare Interpreters” by George Major, Jemina Napier, and Maria Stubbe
  • “Mental Health Interpreting:  Training, Standards, and Certification” by Charlene Crump
  • “Beyond ‘Interesting’: Using Demand Control Schema to Structure Experiential Learning” by Robyn K. Dean and Robert Q. Pollard
  • “An Ounce of Prevention Is Worth a Pound of Cure: Educating Interpreters about the Risk of Vicarious Trauma in Healthcare Settings” by Karen Bontempo and Karen Malcolm
  • “Just What the Doctor Ordered? Online Possibilities for Healthcare Interpreting Education” by Doug Bowen-Bailey
  • “Educating Interpreters as Medical Specialists with Deaf Health Professionals” by Christopher Moreland and Todd Agan
  • “Health Literacy and Deafness:  Implications for Interpreter Education” by Teri Hedding and Gary Kaufman
  • “Deaf Interpreters and Mental Health Settings:  Some Reflections on and Thoughts about Deaf Interpreter Education” by Pamela Morgan and Robert Adam
  • “Professionalizing Healthcare Interpreting between Spoken Languages:  Contributions of the National Council on Interpreting in Health Care” by Bruce Downing and Karen Ruschke
  • “Educating Sign Language Interpreters in Healthcare Settings:  A European Perspective” by Maya De Wit, Marinella Salami, and Zane Hema

The book is available from Gallaudet University Press in both a print version and as an e-book.  For more information, click here.

Mental Health Intepreting Curriculum

Mental health interpreting: A mentored curriculum consists of a 139 page text (9 chapters and a resource list) with an accompanying 32 minute video (VHS or DVD) of eleven interpreting vignettes.  Produced by the Deaf Wellness Center at the University of Rochester Medical Center, more information is available here.