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.