When does a hug cross the line?

[Holly DeVivo]

Now, I know you might be thinking, “a hug always crosses the line,” but hear me out. In many Spanish-speaking cultures, a hug or kiss is an appropriate greeting, even for people you’ve just met. As an interpreter it is quite probable for us to interpret for the same patient many times, especially if they are receiving treatment for a chronic illness. This inevitably builds a relationship with the patient. I’ve had a few instances when patients I’ve interpreted for repeatedly have tried to greet or say goodbye to me with a hug or kiss. My question is: do you guys think this is ever okay? And if not, how do I avoid it without offending or upsetting the patient?

[Iantha Fyolek]

For this reason I’ve always made sure to keep lots of things in my hands. My VFH Interpreting Binder, my phone, a pen, etc. In Spain we greet with a hug and a kiss on each cheek, whether you are greeting your grandmother or meeting someone’s classmate for the first time. I’d really prefer not to touch my patients because I don’t want them to get attached to me. Like you said, it is inevitable that eventually we will interpret for the same patient a few times and they may be quite happy and/or grateful (or not) but I try to avoid contact like the plague. Also, especially in medical and social services settings, they may actually have the plague and you don’t know it! 😉

Joking aside, I don’t. And I can think of 3 situations where the patient was visibly offended that I didn’t hug her, and when the husband was upset that I politely declined their offer of taking me (“and your family – you have family, right?”) out to dinner.

I think it’s one of the things that just comes along with the territory.

[Michelle Scott, RN]

Good question, Holly!

Let’s start with your premise…”always crosses a line.” I’m assuming that you are referring to professional boundaries and the dictate that interpreters “never touch a patient.” In which case, yes, presumably a hug would violate that rule. This can seem confusing furthermore, because doctors and nurses sometimes hug patients (don’t they have to adhere to setting professional boundaries, too?). I know that among interpreting leadership, the “no touch” rule is sacred. In my conversations with healthcare providers, however, they do not see simple, occasional, appropriate touch between an interpreter and a patient as being problematic. In fact, some staff interpreters may be expected to shake hands or put a hand on a shoulder as a way to show a compassionate connection in the interest of “good patient relations.”

Having said that, Iantha makes a good point about “professional comfort zone.” This is something that each individual needs to determine for himself/herself. And, yes, infection control is certainly a practical and important consideration.

Which brings me back to the difference between providers hugging a patient versus interpreters hugging a patient. Providers are comforters, healers, helpers. Interpreters are communicators. Does hugging a patient perhaps create confusion among patients about the interpreter’s role? (And, for example, could you shake someone’s hand instead to show respect while not confusing your role?)

[Leopold Nsengiyumva]

Hi,
I am then lucky as I don’t have to deal with that problem. In Africa, we culturally don’t hug or kiss. However we shake hands and it would be so rude not to shake hands with the other person; patients or not. I hope there is no ethical issue by shaking hands!

[dawnr]

4. The interpreter maintains the boundaries of the professional role, refraining from
personal involvement. (Page 17) last section reads:

Personal Involvement and Conflicts of Interest
‘This principle also admonishes interpreters to refrain from becoming personally involved with the people for whom they interpret… …This does not mean that interpreters cannot be friendly and caring or that interpreters are prevented from establishing a rapport with both patient and provider, as can occur during a formal or informal pre-session. The development of rapport with patients and providers during a pre-session is part of the interpreter’s professional role and does not necessarily represent personal involvement. Establishing rapport means that the interpreter interacts with the patient in a respectful, culturally appropriate, and courteous manner, not only within the interpreted encounter but also on other occasions. In fact, good rapport between the interpreter and the patient can contribute to the development of a therapeutic relationship between the patient and the provider. If the patient feels comfortable with the interpreter, it is likely that the patient will transfer this feeling to the provider.
The question of maintaining professional boundaries that precludes personal involvement with the patient can sometimes pose dilemmas for interpreters who come from the same small or closely-knit cultural-linguistic community as the patient. In such communities, it is inevitable that the interpreter will have some level of personal involvement with the patient outside the world of the health care system. The responsibility of interpreters in these cases is to ensure that any such personal relationships do not interfere with the ethical performance of their duties both within the clinical encounter as well as outside the clinical encounter. For example, interpreters are bound by the principle of confidentiality not to discuss what they may have learned about the patient while in the clinical encounter with members in the community or even with family members unless given explicit permission to do so by the patient. For interpreters who are part of the social fabric of the community for whom they interpret, there is often a fine line between information gathered only while in the performance of their interpreter duties and information that might have might have been learned outside the encounter. Dealing with this fine line is not an easy task, but the interpreter’s ethical obligation is to make appropriate decisions in order to maintain the privacy of the patient. ‘

Then, this section:

‘9. The interpreter must at all times act in a professional and ethical manner.
The intent of this principle is to ensure that interpreters always strive to act in a manner that maintains the integrity of their work and upholds the values and ethical principles of their profession. This means that they perform their duties competently; monitor their own performance and behavior, including knowing when to withdraw and when to admit and correct an error; conduct themselves with dignity; respect other professionals at the same time that they expect respect for their profession; and do not discriminate against anyone in the provision of their services whether based on personal characteristics such as race, class, sexual orientation, or ability to reward them for their services.’

So, after reading all that, I would say that it is fine to shake hands at interpreting appointments if it will not imply anything beyond a professional relationship and if you feel it would help establish a rapport with the patient and help them feel more at ease in the encounter.

[Holly DeVivo]

Thanks for the replies everyone! Luckily I’ve only had this situation occur once. I agree that a handshake is probably the best bet and I like Iantha’s idea of keeping her hands/arms full to make a hug less likely. It can be difficult sometimes to walk the line between professionalism, safety (i.e. germs) and humanity. We have feelings and compassion too!

Michelle’s statement about a provider hugging a patient brings up a good point. I know that many times I’m perceived as someone who is just there to “help” the patient and not as someone who is there to facilitate communication between the patient AND the provider. I wonder if hugging the patient would contribute to the notion of interpreters as patient “helpers” and not an integral part of the health care team. (Unless we start hugging the providers too!)

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