Formal interpreter services during patient interviews? Good idea, clear solution. Discharge instructions? Still up for debate. Pre-populated discharge instructions exist in common languages like Spanish and Cantonese, but what if your patient speaks Polish? And what if their complaint is slightly more esoteric than "abdominal pain?" Or what if you have specific instructions on how to take that steroid taper?
In 2014 the fidelity of Google Translate was studied with multiple generic discharge instructions and found to have woeful accuracy, with approximately 60% of translations inaccurate, and in some cases, dangerously so. The study cautioned against the use of Google Translate and recommended formal translation for the time being.
Since then, Google Translate has changed its translation algorithm, using existing human translations as input to create machine-led translation algorithms. This happened in 2017 and since then much has been touted about the improvement in translations (up to 60% improvement according to some resources.) However...
What about medicine? This past month, a research letter was published in JAMA Internal Medicine that investigated this very question. 100 free-texted emergency department discharge instructions were translated into Spanish and Chinese and then bilingual translators translated the text back into English.
Overall the results show some improvement. 92% and 81% of sentences were accurately translated into Spanish and Chinese respectively. One error: "you have a low back stain," became "You have a low patch on your back," in Spanish and "You have a low back spot" in Chinese, because of a spelling anomaly in the original English. Another error hinges primarily on the difficulty of translating a word like outpouchings: "You do have an abdominal aortic aneurysm (an outpouching of the major blood vessel in your body)," became the infinitely more horrifying "aortic aneurysm (an evacuation of the main blood vessel in your body)" in Spanish and "(exudation of the internal major blood vessel)" in Chinese.
While many of the translations were merely obtuse and sometimes nonsensical, there remained the possibility of potential clinically significant harm in 2% of Spanish sentences and 8% of Chinese. For example, "hold the kidney medicine until you have a chance to speak with your kidney doctor," when translated into both Spanish and Chinese, encourages the patient to continue taking the medicine.
In conclusion, news is promising, but make sure that patients are still being discharged with all of the following:
1) a healthy helping of formal verbal interpretation
2) discharge instructions written in a language with which the writer is comfortable
3) an electronic caveat if machine translation is used.
Khoong EC, Steinbrook E, Brown C, Fernandez A. Assessing the Use of Google Translate for Spanish and Chinese Translations of Emergency Department Discharge Instructions. JAMA Intern Med. 2019 Feb 25.