Speaking the Language of Health Care
Translation apps and other technology seek to eliminate language barriers for patients uncomfortable with English.
There's an app for relaying basic medical instructions in Fukienese, a group of dialects spoken in southeastern China. Need a way to help bedridden non-English-speaking patients instantly alert a nurse for assistance? Touch-screen software exists that allows patients to click a pained face — perhaps marked "pain" in Russian — to instantly alert a nurse. Both were created by New York City-based Transcendent Endeavors to improve communication between patients and health care professionals who speak different languages.
But while today's digital tools can help communicate basic information across language barriers, there's not yet a digital substitute for a trained medical interpreter or a fully bilingual practitioner. And some experts say that translation apps and other tools can even be dangerous if they lead to incomplete communication.
"The medical encounter is incredibly complex and nuanced," says Dr. Glenn Flores, director of the general pediatrics division at the University of Texas Southwestern and Children's Medical Center in Dallas. Patients and doctors need to communicate about the precise nature of symptoms, past medical history, prescriptions, and procedures. "If you just have a simple tablet that asks, do you have pain or not, that's going to give people a false sense of security," Flores says. "You're going to end up putting people at risk."
About 21 percent of people living in the U.S. speak a language other than English at home, and some 9 percent of U.S. residents aren't fluent in English, according to 2011 census estimates. Elderly people are most likely to say they don't speak English very well, and speakers of some Asian languages — like Chinese, Korean, and Vietnamese — are particularly likely to lack English fluency.
These language barriers can make it more difficult for patients to receive effective medical care. People who don't speak English well are more likely to be hospitalized for prolonged periods or to experience serious medical events while they're in the hospital, Flores says. Studies show that poor communication can hinder everything from colon-cancer screenings to care for asthmatic children.
Federal law requires all health care facilities that receive federal funding offer language services to patients who need them. Most hospitals accomplish this by relying on a mix on staff interpreters, bilingual staff, outside interpretation agencies, and phone-based services. Yet many facilities don't do a good job connecting patients with language services. Less than half of patients who need an interpreter say they usually get such assistance, according to 2001 survey from the Commonwealth Fund.
Each dot represents 100 Spanish speakers who say they speak English less than "very well." (U.S. Census Bureau's 2011 Language Mapper)Bill Tan, founder and CEO of Transcendent Endeavors, believes that there are lots of points of contact in health care — from home visits to emergency departments — where technology can make language services better and more accessible. Founded in 2002, the company uses National Institutes of Health grants to develop digital communication tools. Several small businesses have been launched by successful products.
Inspiration for one such product, Starling, came from Tan's personal experience. When his family moved to the U.S. from China in 1992, Tan was 15 and knew just a handful of English words. He picked up English quickly, but his grandparents — who were in their sixties when they left China — struggled. Toward the end of her life, his grandmother was hospitalized for a heart condition. She took to drawing on a notepad to tell her nurses what she needed. "Luckily, she was a good artist," Tan says.
Starling is software that an inpatient facility like a hospital can load onto a touch screen and put at a patient's bedside. By selecting a picture — of a toilet, say, or food — described in one of eight languages, patients can send an alert straight to a nurse's mobile device. The software also helps nurses track what services patients are requesting and when. "It can improve the communication process, and has the ability to improve health care delivery as well," Tan says. Since Starling launched in 2012, about six health care facilities have licensed the software.
Tan's company has also created a translation app and medical Spanish online training program, both called Canopy. The app — which can be downloaded for free — includes audio clips of about 1,500 routine medical phrases (like: "I'm going to listen to your heart and lungs") in 11 languages. A button on the app allows doctors to call a phone-based interpretation service when the conversation gets complicated.
"Something like that is useful if you need to look up a word, a single word," Dr. Dennis Clements, professor of global health and pediatrics at the Duke University School of Medicine, says of translation apps. He's a bigger fan of Canopy's online language-learning program, which medical school students at Duke are now using. "In the United States in their lifetime, [health-care professionals] are going to be at a great disadvantage in being able to see patients and in being able to be culturally appropriate with patients" if they can't speak Spanish, Clements says.
Calling in a trained medical interpreter is still the safest way to bridge a language gap between patient and health care provider. In a 2003 study, Flores found that ad-hoc interpreters — like nurses, social workers, or a patient's sibling — were much more likely to commit serious errors than professional interpreters. Errors included missteps like forgetting to ask about drug allergies and giving incomplete information about medication dosages.
The best interpreters can also relay cultural traditions that can help improve diagnosis or treatment plans. For example, Flores says, in some Mexican-American communities, local healers sell powders to aid indigestion that can contain toxic concentrations of lead. On the other hand, doctors might want to include harmless traditional treatments for indigestion, like rubbing the stomach with warm oil, in their treatment plans in order to set patients at ease.
For now, phone-based interpretation services are the best technological substitute for having a trained interpreter in the room. Some hospitals have made it their policy to use phone-based services in emergency rooms, because it's faster to call than to wait for an interpreter to arrive, says Catherine West, senior research scientist at the George Washington University School of Public Health and Health Services.
"What I think is exciting, but it's probably a number of years away, is we may at some point have a smartphone that's able actually to provide state-of-the-art, spoken-language translation," Flores says — a tool that accurately translates spoken language in real time. Google Translate's speech-enabled smartphone apps, an early attempt at this, aren't always grammatically accurate, he says, and shouldn't be used in a health-care setting.
As the number of truly bilingual doctors and nurses grows, digital tools may become less necessary. "Four of the last five providers I have hired — I'm in charge of the whole section, with 30 doctors — all speak Spanish natively," Clements says of Duke's primary care pediatrics department. In the two Durham hospital nurseries he oversees, doctors must be bilingual: Half the babies there are born to mothers most comfortable speaking in Spanish.