By Tatiana González-Cestari, PhD, CHITM, Director of Language Service Advocacy.

“The medical provider asked me to not interpret because she is fluent in the patient’s (non-English) language” or “the patient was fluent in English” are some statements medical interpreters have reported hearing when working with healthcare providers. These scenarios don’t seem to make sense. Leading some to wonder, why request an interpreter in the first place? Language is rarely as black and white as we want to make it.


United States law requires a healthcare interpreter to assist a limited English proficient speaker when meeting with a medical professional. In many of these cases, the medical professional or the patient may be fluent enough to communicate but not fluent enough in all the vocabulary needed in the language that they share. When this happens, session participants may request an interpreter be present in case communication breaks down. The interpreter will monitor the situation, take notes, but not actively interpret unless necessary. This is called shadow interpreting.

What is shadow interpreting?

In shadow interpreting, interpreters allow the participants to communicate directly while remaining engaged and ready to “jump in” (interpret) as soon as they are needed. This concept and practice are applicable to any interpreting modality (face-to-face or remote).

When would interpreters shadow interpret?

Shadow interpreting is only appropriate when all parties agree that the healthcare interpreter is not necessary for all communication. However, the interpreter must remain engaged to ensure participants are communicating clearly and there are no signs of communication breakdown. Shadowing shows respect to all parties’ ability to accurately convey important information. Demonstrating this trust can help build rapport between the provider, patient, and additional session participants like a patient’s family member.

There will be times, however, when it is not appropriate to shadow interpret. It is not appropriate to shadow interpret if there is anyone in the room that requires an interpreter and cannot communicate accurately without one. For example, when an underage patient converses directly with the medical provider in English, but the patient’s legal guardian, who only speaks Ilocano, is present an interpreter is needed. The situation requires an interpreter to clearly share communication between all parties. In another instance, an interpreter is necessary when a LEP patient is accompanied by a family member who can speak English clearly. The family member may be able to interpret for the patient, but the healthcare interpreter working with the hospital is necessary to prevent any missed or left out information, problems with sensitive issues, a breach in confidentiality or upset relationships and hierarchies rooted in culture. 

General process of shadow interpreting

When performing shadow interpreting, interpreters must remain transparent. Part of being transparent means informing all participants how shadow interpreting works, even if it feels obvious. Possible shadow interpreting scripts are:

“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.”

As an interpreter, it’s important to remain engaged in the conversation, since at any time one participant may falter in their expression or ask how to say a specific word in the other language. Shadow interpreting requires taking notes and staying attentive to the conversation as if the person were actively interpreting. If the patient and provider start discussing complicated procedures, prescription instructions, or medical jargon, it is important to monitor for understanding. Additionally, if the patient or provider uses slang or unclear language, interpreters should step in and verify.

Intervening during shadow interpreting

Deciding when to intervene or not

No interpreter can read minds. However, when shadow interpreting, interpreters should look out for cues of confusion or misunderstanding. Whenever doubt arises, interpreters should politely intervene to advise all parties that they will 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 he remembers “enough” to speak to his 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 never comfortable to bring attention to someone’s lack of language proficiency, the risks are too great if the interpreter does not intervene. In addition, remote interpreters may have limited opportunities to fix any communication errors that may have occurred compared to face-to-face interpreters. When in doubt, interpreters should interpret.

How to intervene: Scripting

The interpreter may be able to shadow the communication and not necessarily intervene (or start interpreting). But if the interpreter notices partial comprehension, or the interpreter is specifically asked for help, intervention is necessary. Otherwise, the interpreter should stay alert and follow along.

Example scripting for intervening during communication breakdowns:

[if interpreter notices communication is not flowing] “This is the interpreter. To ensure   the patient understands, I will resume interpreting.”

What happens next?

Once the interpreter has successfully clarified or interpreted part of the session, they can return to silently shadowing the interaction. However, in some cases, the interpreter may continue to interpret for the rest of the session.

In conclusion, interpreters utilize shadow interpreting when participants are able to communicate in a shared language without the interpreter’s help. However, interpreters need to remain engaged and ready to start interpreting when needed.

The author would like to thank the members of the Interpreting Quality and Training Department for providing valuable input on best practices in remote healthcare interpreting.


Cloudbreak’s Interpreting Quality and Training Department Tip: Help! They’re Communicating Without Me! Recommendations for Shadow Interpreting.