As an ASL instructor at HardcoreASL.com, and as co-author of books on American Sign Language and as co-sponsor of the sosASL.com emergency communication website and, most importantly — as the Hearing husband of a Deaf Wife — I was shocked to learn a major hospital interpreter teaching program in the New York City area is instructing its students that the role of an interpreter in the patient/doctor dyad is one of a “clarifier.”


I vehemently argue today, an interpreter is an interpreter — just an expresser only of only what is being said.  An interpreter is never to elaborate or extend ideas or concepts beyond the narrow niche of the actual communication — and an interpreter must NEVER be a “clarifier.”

The danger in being a “clarifier” instead of an interpreter — especially in a medical situation — is the risk that the interpreter will incorrectly “clarify” for a patient what the interpreter has no business knowing.

The communication dyad between patient and interpreter must be one of transparency

The interpreter is merely a tool, not a person, for the Deaf to use to communicate.  When that middling role becomes more obtuse and vague, fuzziness in which person is actually providing the healthcare becomes an issue.

If a Deaf person does not understand what the doctor is saying, it is the responsibility of the doctor to re-explain, clarify, say again, repeat and even “act out” the issue at hand if necessary. 

It is not the role of the interpreter to do those things because interpreters are passive modes of communication between the Hearing and the Deaf.  For the interpreter to even try to take an explanatory or instructive role is a violation of any moral code of ethics.

If a doctor notices an interpreter is explaining and “clarifying” — it is the responsibility of the doctor or nurse or healthcare provider — to actively stop the interpreter from crossing inappropriate boundaries by saying, “Let me explain it to my patient, not you.”

That abruptness of concern must also be active on the Deaf side.  If the Deaf person is lost in the conversation, the Deaf must demand that the health professional explain it and not the interpreter.  “Let the doctor clarify for me, not you.”

Interpreters love to take control and manage situations that they should really not be so deeply involved in — their role is necessarily passive. 

Interpreters are not helpers or enablers or communication experts or clarifiers or teachers or doctors.  Interpreters, like it or not, are just there to provide an unemotional and bland even exchange between modes of communication.  Interpreters are mechanisms and computers, not leaders or performers.

Interpreters do not determine intention.  

The value of having a knowledgeable healthcare professional actually taking charge of the health of the Deaf patient is paramount and now, I hope, you can see the inherent danger in having hospitals teach interpreters they must “clarify” instead of remaining invisible, inactive, and appropriately passive.

18 Comments

  1. I am reminded of certain Hebrew books which come with straight translations versus books which come with elucidation, that elaborate on what the text is trying to tell you. While that may be good for academic purposes it is certainly not good in the example you give, where what one person says has to be translated word for word, phrase for phrase without any added color. Great article, David!

  2. That’s a wonderful point, Gordon! Is an interpreter a translator? Is a printed work differently interpreted than “spoken” conversation?
    You also remind me that this issue isn’t just about Hearing and Deaf interpreters. A Spanish, German, Italian, etc. interpreter must never be a clarifier, too. The dangers are the same. Doctors and patients must take time to understand each other even if that process is slowed down by live translation.
    One of the hardest things for any actor to overcome — because it is the easiest thing to do — is to “vote” on the emotion of a scene by going big and grand and loud. I’M ANGRY! I’M SHOUTING! i’m sad i’m whispering. Adding meaning to the performance without having to stereotypically “vote” is an incredibly pleasing event to watch on stage because it is so tough to naturally accomplish.
    The same issue is at play in interpreting. Don’t vote. Don’t get emotional. Just translate what is being said. If one side is yelling and acting out, the interpreter doesn’t have to add their own interpretation of that emotion to the dyad.

  3. That’s an interesting find, Gordon!
    The only problem with “explaining” is that if the interpreter doesn’t explain something right in court or in school or in the doctor’s office as a “clarifier” — it’s the person on the other end of the “explaining” that has to deal with the ramifications — and often the source of the original information has no idea there was “explaining” being done on their behalf.
    It’s always better to have something “explained” by the source doing the information sharing or you can quickly get into a tragic version of the “the telephone game” as information is passed back and forth and on and on and on… until the original message is completely lost when finally delivered.

  4. This is a good conversation. Translating is a terrible job for anyone. You’re always making choices for synonyms and the like. Mistakes are made a lot but that’s the way the job goes. So what if a deaf person asks the interpreter for help. what then.

  5. You’re right, Anne, interpreting is a tough job and it isn’t for everyone.
    If a Deaf person asks an interpreter for help or to explain or to clarify — and I know that happens all the time — the interpreter should voice the questions for the other person to answer. I know that takes more time, but that’s the fairest way to do it for everyone in the room.
    Sometimes, in school settings, Deaf students aren’t getting the concepts being taught and many interpreters then become sort of translator/tutors during class. That, too, is wrong. The student must rise or fail based on their own understanding of the material being taught, and if they do not understand the interpreter, then another one must be found.

  6. Even finding a good book translator is hard. They want 50% of future payments. Might not be any good. Often choose wrong words. End up rewriting the whole thing.

  7. Hi David,
    Agree with you – 100%; asking an interpreter to “clarify” is dangerous, any bit of information missing or misunderstood can easily be detrimental for the patient’s helth.

  8. The “clarification” role in healthcare interpreting is really a misnomer–or more accurately, a shorthand term for a process where the interpreter intervenes (who else is in a position to know when something isn’t understood?) to ASK for clarification. The interpreter intervenes, the healthcare provider clarifies.
    Incidently, it’s not uncommon for doctors to actually ask interpreters to explain things (i.e. clarify) to patients. Good interpreters will always refuse.

  9. Gene —
    As you explain it, the situation is clear-cut and cogent, but in practice — I’ve seen the teaching materials from the East Coast hospital program — the role of the “clarifier” is precisely what I describe and object to in my article.
    In your example, I wouldn’t call the process “clarification” but, rather, “interpretation” — and I think there’s a big difference between the two. One is not acceptable, while the other is the label for the job: If your client is lost and needs help, your role is to make that need known through the interpreting process.
    We deal a lot with the Deaf and Hearing first responders — see http://sosASL.com — and I agree doctors are the worst when it comes to communication with patients. Many have little patience and often look with dismay upon an individual with communication difficulties.
    As you know, there are few interpreters working who are properly trained in pure ASL and who have a strong and unbreakable Code of Ethics. CODA interpreters are always the best because they’ve lived through the harshness and the discrimination.
    In an ideal world, the Interpreter would leave the room before the patient and doctor finish and disappear — but that doesn’t happen. The interpreter and the patient usually leave the building together and that’s where a lot of the wrongful “clarifying” and “re-explaining” comes into play… after the job is finished… on the way to the elevator or car or shared subway stop. It’s a natural human process that doesn’t really fit into the appropriately negotiated client/interpreter dyad.

  10. Thanks David, I’m in total agreement with you on the substantive and ethical principles here. In fact what originally got my attention was that any hospital program could teach something so out of sync with currently accepted practices. That leaves the semantical problem, which I suspect is still in play here. NCIHC and IMIA both refer to “clarification” (IMIA: ” …interpreters may need to intervene for clarification”). It’s all in how you define and refine concepts to accurately portray situations. Heck, you could argue that the interpreter’s job is not to “interpret” (e.g. put her own spin on the message) but to simply “convert”!
    I believe that there are times in the encounter where the interpreter may have to step out of the conversion role to ask for clarification. It’s important for the interpreter to be aware that she’s shifting gears. It’s active, not passive.

  11. Gene —
    That’s the biggest problem in the interpreter/client dyad: There can be an unscalable cultural crevasse that cannot be crossed in the limited timeframe of the session and that’s a bad thing.
    In the hospital “Clarifier” workshop, there were lists and lists of medical terms that the interpreters were supposed to “learn” for use in interpreting. Now we both know there are no Deaf Signs for those technical terms, so a pidgin will have to be created, or a sign invented or fingerspelling employed — and none of that does one bit of good to help the ASL-only patient understand the doctor.
    How does one resolve the separation in technicality and understanding? Add a CDI to the mix? Go straight to mime and drawing diagrams?