Who interprets for your mother at the doctor, if not you?

If you have always been the one interpreting at your mother's medical appointments, and her doctor does not speak her language, ask the doctor's office to provide an interpreter instead. Call the office ahead of the appointment, because the office may need to plan for an interpreter to be available.

Is anyone at the practice supposed to do this instead of you?

A practice that receives federal financial assistance, which includes some Medicare funding, must take reasonable steps to provide meaningful access to its programs for people with limited English proficiency, and that duty is the practice's, not yours. It is a legal obligation, under Title VI of the Civil Rights Act of 1964 and Section 1557 of the Affordable Care Act. How far those steps go depends on the organization, which can work out how much language help it should provide by weighing four factors:

• the number or proportion of people with limited English proficiency who are eligible to be served by it or likely to be encountered by it
• how often they come into contact with it
• the nature and importance of its service to the people it serves
• the resources it has, and what language services cost

Whatever level it settles on, the organization should give patients notice, in their own language, that an interpreter will be provided at no cost to them. A notice posted in the reception area or an examination room is one way to do that, so look for one on the walls when you arrive.

Any organization serving people with limited English proficiency should also develop a language access plan, a document that spells out how it will serve people who do not speak English or have limited English proficiency. Whether the legal duty reaches your mother's office, and what that office offers, the office itself can tell you.

What can her doctor's office use when nobody there speaks her language?

Her doctor's office can bring in an interpreter by telephone or video, so nobody in the building has to speak her language. Telephone and video interpreters are among the kinds a practice may use, alongside dedicated staff interpreters, contracted interpreters and qualified bilingual staff. Organizations often use a combination of these, and the approach is meant to fit both the need and the resources available.

To find an interpreter who speaks the right language, an office may show her an "I speak" card, also called a language identification card. It carries the words "I speak" followed by the name of a language, written out in a variety of languages, so she can point to the one she understands. Offices may make their own version with the languages most commonly spoken in their area, so if hers is missing from the card, tell the staff which language she speaks.

An interpreter without a certificate can still be qualified to interpret for her. Many qualified interpreters are not certified, although many states have licensing and certification requirements, and qualifications and testing can vary.

If her doctor knows a few medical terms in her language, ask her doctor's office for the interpreter anyway. Some English-speaking doctors know basic medical terms in Spanish or other languages, yet she may feel more comfortable speaking in her own language, especially about sensitive subjects such as sexuality or depression.

Is there a reason not to interpret, when you have always done it well?

The reason is that bilingual family members often are not well equipped to interpret, and their use is highly discouraged. Speaking a language fluently does not guarantee competency in medical terminology, and relying on unqualified individuals to interpret can lead to a lack of understanding, poor outcomes and even death. A word you would never get wrong at the dinner table can still be a medical term you have never had to interpret.

Family dynamics may also complicate a situation where a family member is asked to interpret, and your own reluctance about this appointment is reason enough to ask for someone else. Ask the office for an interpreter first, and leave room for your mother to want you beside her as well.

What do you do in the room when someone else is interpreting?

In the room you are her companion, and a companion has real work: you can remind her of what she planned to discuss with the doctor if she forgets, take notes for her, and help her remember what the doctor said. Before you go, ask her what she wants from the visit and how you can be most helpful, because a companion who knows that in advance can do more of it.

In your notes, write down what the doctor or other provider tells her during the appointment. Help her bring up any changes in her appetite, weight, sleep or energy level since her last visit, too (see A parent losing weight without trying should see their own doctor).

You can also help her get ready to work with an interpreter she has never met. Before and during the visit, she can:

• tell the interpreter, before the appointment, what she wants to talk about with the doctor
• use universal terms for her symptoms and concerns if her language is spoken in more than one country and the interpreter comes from a different country or background
• let the interpreter know when she did not understand something, even if she needs it repeated several times
• tell the doctor, the interpreter or the staff if she does not understand her diagnosis or the instructions the doctor gives her

The visit is between your mother and her doctor, and a companion should not take too strong a role in it. She may want some time alone with the doctor to discuss personal matters, and if she is alone with the doctor during or right after the physical exam, that might be a good time to raise private concerns. Or she could ask you to stay in the waiting room for part of the appointment. Ask her before you arrive whether she wants part of the visit without you, so you can step out without a discussion in front of the doctor.

Calling her doctor's office to arrange an interpreter

The person who answers at the front desk is a sensible one to ask. Staff training on language services should include everyone who interacts with patients, receptionists among them, and cover how to request and work with an interpreter. When you call her doctor's office:

1. Ask for an interpreter for her appointment, and name her language. If the language is spoken in more than one country, say which one she is from.
2. Ask whether the interpreter will be in the room, on a phone line or on a video screen, so she knows what to expect.
3. Ask whether there is any charge for the interpreter.
4. Ask whether her forms come in her language, and whether help is available at check-in and when she pays.

That last question matters because people with limited English proficiency need language help at different points within an organization, such as checking in at the reception desk, filling out paperwork or paying a bill, as well as in the examination room. The documents an organization should consider translating may include consent forms, intake forms and patient instructions, such as what to do in follow-up from an appointment.

A NicoCares care team writes to patients in Spruce, the secure app it uses for messages. If your mother is one of those patients, she can ask her care team there, with your help if she wants it, whether they can write to her in her language, before you take on translating those messages as well.