According to the most recent US Census Bureau survey, Spanish is the second most commonly spoken language in this country. While American Sign Language (ASL) was not considered when polling respondents about the primary language used at home, ASL is the leading minority language in the U.S. after the “big four”: Spanish, Chinese, Tagalog, and Vietnamese.  These numbers continue to grow and also contribute to the rising occurrences of foreign language and ASL interpreters in medical environments.

What happens when a patient encounter includes an English speaking provider, a Spanish speaking family member, and a Deaf patient? Depending on availability and qualifications necessary for the appointment, a trilingual interpreter may be the perfect fit. A Spanish speaking family with a Deaf patient is the most common trilingual arrangement encountered in a medical setting. When working with a trilingual interpreter, there are special considerations to make which are outlined below.


  • Interpreter Qualifications

As outlined in previous blog posts, it’s important to hire nationally certified ASL interpreters that have medical interpreting experience suitable for the patient’s needs.  Additionally, Spanish medical interpreters have their own national certification exam allowing them to “foster improved healthcare outcomes, patient safety, and patient/provider communication, by elevating the standards for and quality of medical interpreting through a nationally recognized and validated certification for medical interpreters.” Standardization continues to evolve for Spanish interpreters and extra diligence is required by the hiring entities to ensure appropriate qualifications before hiring. While there is not a national exam or certification for trilingual (Spanish/ASL) interpreters, the trilingual interpreter at a minimum should hold national certification in each language. Despite not having a national certification in trilingual interpreting, there are resources for trilingual interpreters to advance their skills. Mano a Mano keeps a list of local trilingual workshops.  A qualified trilingual interpreter will regularly attend training and workshops to strengthen their trilingual skills and will be familiar with these resources among others.


  • Working with a Trilingual Interpreter

When a qualified, medically experienced trilingual interpreter is found, there are a few key considerations for providers to make the experience as smooth as possible. The interpreter is expected to navigate the cultural nuances of each language represented. These cultural norms must be carefully mediated so that the speaker and their message is accurately and effectively conveyed.  The information processing necessary for a trilingual interpreter is significantly higher than an interpreter only working in two languages. All of this works together when providers and patients take turns speaking (less simultaneous interpreting and more consecutive interpreting) and when it is necessary for two trilingual interpreters to work together, for instance, in lengthy encounters. Trilingual interpreters actively manage a great deal of information; cultural standards, linguistic needs and medical terminology in addition to having transparency about their processes with the provider.


  • Benefits to the Patient When Using a Trilingual Interpreter

It may seem like a great deal of work to hire a trilingual interpreter instead of just a Spanish language interpreter and an ASL interpreter. However, the benefits to the patient and their families are innumerable. An interpreter that is aware of both the cultural norms of the Deaf community and the diverse Latino cultural norms understands how the two languages work together, especially among intimate relationships like family. This gives the patient and their family meaningful and accurate language access while freeing them up to focus on their healthcare.

It’s important to remember that language access is a right, not only to the patient but to the patient’s family and support system who are accompanying the patient during medical encounters. As the Spanish speaking population in this country grows, it will become far more common to encounter Deaf patients and/or family with Spanish speaking patients and/or family. Take a proactive step and reach out to your local interpreting agencies and Video Remote Interpreting (VRI) companies to learn about available trilingual interpreters before you need them. As always, remember to ask any and all Spanish interpreters, ASL interpreters, and trilingual interpreters if they have current national certification and medical interpreting experience so your patients can have the best opportunity to be active participants in their healthcare experience.


Special thanks to trilingual interpreter Sabrina Patino, RID-NIC, RIT-CHI, CCHI-Spanish