In a world filled with thousands of different languages and cultures, genetic counselors (GCs) must be equipped with the skills and confidence to work effectively with interpreters to deliver accurate information to patients in their preferred language. However, recent publications have highlighted tensions between GCs and interpreters. GCs appear to show a strong preference for verbatim translation and are largely concerned about information accuracy, trusting interpreters, time constraints and building rapport (Lara-Otero et al., 2019; Padilla et al., 2025). In contrast, interpreters are concerned with the lack of support and understanding regarding the specialized service they provide, feeling distrust from medical providers, and the mental and emotional burden following genetics appointments (Lara-Otero et al., 2019).

We propose that by promoting an understanding of why verbatim translation is practically impossible in clinical genetics, we can better prepare GCs to work more collaboratively with interpreters, fostering an appreciation for the enormous responsibility and challenges associated with the role.

Why Interpreting Genetic Medical Language Is So Complex

Despite GCs’ preference for verbatim translation, this is not always feasible. Firstly, many of the key terms used in clinical genetics don’t have direct equivalents in other languages. Similarly, words with double meanings in English might have two completely different translations in a patient’s preferred language. For example, in Spanish, the correct translation of the scientific term “carrier”  is “portador;” however, it is frequently misinterpreted as the layperson’s term “portero,” meaning “doorman” (Gutierrez et al., 2017). 

It is also important to highlight that someone who considers themselves fluent in multiple languages may not have the same degree of familiarity with scientific concepts across all of them. As someone who grew up speaking a different language with my family to the one I used in school, if you asked me to explain my favourite poem or historical figure, I could do so easily, but I occasionally struggle to name everyday objects. I simply didn’t use those words at home. Similarly, interpreters who went to an English-speaking school may not know the right term for “sex-linked” or “mitochondrial,” even if a direct translation exists in their language. The intersection of health literacy and linguistic privilege is far more complex than many realise. As GCs, we have a duty to ensure that patients have sufficient information on their condition to make an informed decision about testing. In order to uphold this when counseling non-English language preferring (NELP) (Ortega et al., 2022) patients, we must also ensure that interpreters are given the tools to accurately convey it.

Balancing Concerns for Both Parties

While patient care is our main priority as GCs, the evidence suggests that we must be more mindful of interpreters, who help us deliver equitable access to patients, often to the detriment of their mental health (Lara-Otero et al., 2019). Having provided translation services, one of the authors remembers staying up all night reviewing difficult medical terminology, such as how to translate certain syndromes, tumor names and preventative surgeries such as “oophorectomy.” Though bilingual, worries came up about not interpreting a medical word correctly when under pressure, despite knowing exactly what would be covered in the session. These experiences deepened understanding of the expansive terminology and quick thinking an interpreter must possess.

It's hard to imagine the stress and emotional burden that envelop interpreters with no genetics training who must translate live, verbatim, while also responding to emotional reactions and maintaining neutrality. This led to thinking of ways to aid an interpreter's experience in genetic counseling sessions, improve the session flow and ultimately improve patient care and understanding.

What Can We Do?

Firstly, we can try to be more empathetic toward the tremendous challenge of interpreting genetics jargon without prior training. We, the authors, feel that having pre-session briefings about which conditions will be discussed may improve flow and give the interpreter time to mentally prepare for the session before translating it. Similarly, we also feel that debriefing may be beneficial to ensuring shared confidence of patient comprehension and identifying if follow-ups are needed. Interpreter-mediated sessions also take longer on average, so allocating more time to them can improve accuracy and build rapport (Padilla et al., 2025). Additionally, we as GCs can try to use shorter sentences and speak more clearly, without being condescending; a more flexible approach to working with interpreters has been shown to have a positive effect on patient outcomes (Watermeyer, 2011; Padilla et al., 2025). 

Talking to the patient directly, being mindful of their culture and beliefs, and having a clear take-home message can all foster a clearer understanding and a deeper emotional connection  (Padilla et al. 2025). From experience, we have also found that using resources in patients’ preferred languages can be beneficial to all parties involved. Similarly, we enjoy greeting patients in their own language whenever possible, which we have found creates a more open-minded and understanding environment, which facilitates rapport and result delivery. Lastly, where possible, it would be beneficial for genetic counseling training and continuous professional development programs to include competencies on working with interpreters through didactic lectures, role-play scenarios, workshops or placement requirements (Latimer et al., 2009; Padilla et al., 2025).

We must remind ourselves that the perfect interpreter is hard to come by and should not be expected. Additionally, we, the authors, having experience of interpreting, would like to raise awareness of the tremendous amount of pressure involved with translating life-changing medical news on the spot, with no preparation. We need to see interpreters as more than just an intermediary, offer interpreters more support during and after genetic counseling sessions, and balance our dual responsibilities more effectively. We feel that GCs could benefit from more training to familiarize themselves with the challenges associated with interpreting and offer recommendations on how to work with interpreters more effectively to enhance the quality of NELP patients' care. If we can shift our mindset as GCs toward an awareness of these challenges, as well as an understanding of the solutions, we could potentially facilitate better rapport and communication with all parties, ensuring that we continue to uphold the competency standards required for GCs. 

References

Gutierrez, A.M., Robinson J.O., Statham E.E., Scollon S., Bergstrom K.L., Slashinski M.J., Parsons D.W., Plon S.E., McGuire A.L., Street R.L. (2017). Portero versus portador: Spanish interpretation of genomic terminology during whole exome sequencing results disclosure. Per Med ;14(6):503-514. doi: 10.2217/pme-2017-0040.

Latimer, B., Robertiello, G. and Squires, A. (2019). Integrating Health Care Interpreters Into Simulation Education. Clinical Simulation in Nursing 32, pp. 20-26. doi: https://doi.org/10.1016/j.ecns.2019.04.001

Lara-Otero, K., Weil, J., Guerra, C., Cheng, J. K. Y., Youngblom, J. and Joseph, G. (2019). Genetic Counselor and Healthcare Interpreter Perspectives on the Role of Interpreters in Cancer Genetic Counseling. Health Communication 34(13), pp. 1608-1618. doi: 10.1080/10410236.2018.1514684

Ortega P., Shin T.M., Martínez G.A. (2022) Rethinking the Term "Limited English Proficiency" to Improve Language-Appropriate Healthcare for All. J Immigr Minor Health, 24(3):799-805. doi: 10.1007/s10903-021-01257-w. Epub 2021 Jul 30. PMID: 34328602; PMCID: PMC8323079.

Padilla, L. K., Hodges, P. D., Ricker, C. and Geurts, J. L. (2025). Interpreter use in telehealth genetic counseling sessions. Journal of Genetic Counseling 34(2), p. e2026. doi: https://doi.org/10.1002/jgc4.2026

Watermeyer, J. (2011). “She Will Hear Me”: How a Flexible Interpreting Style Enables Patients to Manage the Inclusion of Interpreters in Mediated Pharmacy Interactions. Health Communication, 26(1), 71–81. https://doi.org/10.1080/10410236.2011.527623

 

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