While many healthcare facilities still lack sufficient language support for their limited-English proficient (LEP) patients, a growing number now invest in professional language services. But with advancements in machine translation, how do clinicians feel about the appropriateness of this technology in healthcare settings? In the following article, we examine the pros and cons of MT in healthcare from the medical perspective.

Every year, nearly 3 million patients with significant communication barriers require ER care. For this very reason, healthcare providers across the country face the growing challenge of how best to communicate with their LEP population to ensure health equity, no matter the language their patients speak. — Propio Language Services

Lack of Language Services in Healthcare

Despite the growing need for healthcare translation, many hospitals still do not offer language services. A 2016 American Hospital Association (AHA) survey of over 4,500 hospitals showed that approximately 56 percent offered some linguistic and translation services, a slight increase from the 54 percent recorded in 2011.¹

Data Source: American Hospital Association²

Why, with so much at stake, are many healthcare providers still reluctant to invest in language services? It really boils down to an overwhelming number of obstacles.

Challenges Healthcare Facilities Face

In theory, partnering with language services providers (LSPs) would solve all of the communication problems healthcare facilities encounter when caring for their LEP population. However, in practice, this becomes a little more complicated. Below, we list just some of the challenges healthcare practitioners face when it comes to engaging the services of LSPs.

Work Burden

Healthcare is a fast-paced, high-stress industry.³ In fact, traditionally, healthcare providers have reported working well beyond the average 40-hour workweek, and some report working as much as 80 hours a week. This work burden often interferes with a practitioner's ability to research, vet, and ultimately engage the services of LSPs.

Lack of Time

Although literature varies, "studies indicate that doctors have spent roughly 13 to 24 minutes with patients for at least the past three decades."⁴ As a result, waiting for a professional interpreter to show or spending the added time to ensure documents are professionally translated often get overlooked.

Lack of Resources

In smaller, more rural healthcare settings, there just isn't enough of a budget to afford professional language services or to hire an in-house team of medically qualified translators and interpreters.

This isn't to say healthcare professionals are not engaging the services of LSPs. In fact, when faced with language barriers — especially in higher stakes scenarios — clinicians refer to professional healthcare interpreters and translators as the golden standard. However, as a time- and cost-savings alternative, many are now turning to machine translation (MT) when and where appropriate.

Clinicians Weigh in — MT or Human Translation?

Machine translation has come a long way since the early days of rule-based and even statistical MT. With the advent of neural machine translation (NMT), businesses across industries are enjoying the many benefits this advanced technology has to offer. But what about healthcare? With so much at stake, is MT as reliable as a human translator in medical settings?

In June 2022, the ACM Digital Library published a UC Berkeley qualitative report entitled, Reliable and Safe use of Machine Translation in Medical Settings.⁵ The researchers interviewed 20 clinicians — including physicians, surgeons, nurses, and midwives — to gauge how they felt about the adoption of MT in healthcare. Here is what they had to say. (Bear in mind, that the only MT engine mentioned in the survey was Google Translate).

Why Clinicians Turn to Machine Translation

Time Savings

Due to the high-speed nature of healthcare, back-to-back patient consultations are often short. As a result, clients often must modify what they ask their patients. Survey respondents shared that the additional time it would take to track down an on-site interpreter or call a language translation line (not to mention the additional time to communicate with the patient via an interpreter) was time they didn't have to spare.

Resource Constraints

Clinicians explained that resource constraints further complicate their ability to engage with professional linguists. Some of these constraints included the time of day or the rarity of the patient's language. "In such cases, clinicians have to reschedule appointments… or settle for imperfect means of communicating with patients."⁶

Accuracy

Surprisingly, in situations that required language services, clinicians expressed how an interpreter could make patient visits longer.⁷ Clinicians also expressed seeing a variance in the quality of the interpretation.

Accountability

In situations that require patient consent, the clinicians agreed that engaging with a professional linguist should be mandatory. Although they believed there was no legal requirement to do so*, using a professional linguist to confirm patient consent provided clinicians with a protective layer of accountability that an MT system would not.⁸ "The question of accountability in the event of a mistranslation from an MT also gave some clinicians pause. Generally, MT was a last-resort option"⁹, an opinion with which we strongly agree.

The High Risks Associated with Google Translate

The researchers warn clinicians to proceed with caution regarding the use of Google Translate in healthcare settings. They point to one study in which Google Translate mistranslated common medical discharge content into Spanish 8 percent of the time and into Chinese 19 percent of the time. Even worse, the research found that 2 percent of the Spanish mistranslations and 8 percent of the Chinese mistranslations "could cause clinically significant harm."¹⁰ In another study, common medical phrases were incorrectly translated into two African languages an average of 55 percent of the time.

Data Source: ¹¹, ¹²

The Bottom Line for Clinicians

In the end, the clinicians rely on a recurring three-way tradeoff when deciding between MT or human translation:

  1. The time it would take to receive translation services
  2. The urgency of the medical situation
  3. Whether or not the clinicians had a baseline familiarity of the patient's language

The researchers found that "when faced with language barriers, clinicians preferred to rely on certified medical interpreters when they had access to one, had enough time, and for higher stakes conversations. But they tended to resort to MT when that was not feasible or seemed too costly given the circumstances."¹³

But Google Translate isn't the only MT in town. A growing number of LSPs now offer advanced machine translation with post-editing solutions. In essence, they offer a one-two punch machine translation + human linguists.

About Propio, a Conductiv Contracts Supplier

Founded in 1998, Propio Language Services is an industry leader in over-the-phone interpretation, video remote interpretation, in-person interpretation, and document translation services. Propio offers superior interpreter quality and technology-oriented solutions to clients, driving the highest value in the industry. Visit Propio-LS.com to learn more.

References

1, 2 AHA Hospital Statistics, 2018 edition: AHA. American Hospital Association. (n.d.). Retrieved September 2, 2022, from https://www.aha.org/statistics/2016-12-27-aha-hospital-statistics-2018-edition

3 Average physician workweek: How doctors' hours are changing. Staff Care. (n.d.). Retrieved September 2, 2022, from https://www.staffcare.com/locum-tenens-blog/news/physicians-average-hours-worked-per-week/

4 Franklin, R. (2021, October 9). Are doctors spending less time with patients? Mobius MD. Retrieved September 2, 2022, from https://mobius.md/2021/10/09/how-much-time-do-physicians-spend-with-patients/

5 - 10 Reliable and safe use of machine translation in medical settings. (n.d.). Retrieved September 2, 2022, from https://dl.acm.org/doi/fullHtml/10.1145/3531146.3533244

11 Elaine C Khoong, Eric Steinbrook, Cortlyn Brown, and Alicia Fernandez. 2019. Assessing the use of Google Translate for Spanish and Chinese translations of emergency department discharge instructions. JAMA internal medicine 179, 4 (2019), 580–582.

12 Anita Panayiotou, Kerry Hwang, Sue Williams, Terence W H Chong, Dina LoGiudice, Betty Haralambous, Xiaoping Lin, Emiliano Zucchi, Monita Mascitti-Meuter, Anita M Y Goh, Emily You, and Frances Batchelor. 2020. The perceptions of translation apps for everyday health care in healthcare workers and older people: A multi-method study. Journal of Clinical Nursing 29, 17-18 (Sep 2020), 3516–3526. https://doi.org/10.1111/jocn.15390

13, 14 What documents are considered vital? - hrsa.gov. (n.d.). Retrieved September 2, 2022, from https://www.hrsa.gov/sites/default/files/hrsa/about/organization/bureaus/ocrdi/written-translation-vital-documents.pdf