Using Google’s Translate to translate discharge instructions into another language provides accurate information with fewer errors with potential to cause serious harm than expected, shows a study* published in JAMA Internal Medicine.
US doctors are increasingly using Google Translate to translate written instructions for patients to take home so they stand a better chance of following medical advice.
Researchers at UC San Francisco analysed 100 sets of emergency department written discharge instructions translated by Google's new machine learning algorithm, which was rolled out in 2017, into Spanish and Chinese.
They found that the translations were 92% accurate for Spanish and 81% accurate for Chinese and that only a small minority of the inaccurate translations – 2% in Spanish and 8% in Chinese - had the potential to cause clinically significant harm.
"Google Translate is more accurate than a lot of clinicians believe, and I think it's definitely more useful than not providing anything at all," said researcher Elaine Khoong, a UCSF primary care research fellow in. "We cautiously support its use."
The inaccuracies that occurred were mostly due to grammar or typographical errors, and medical jargon and colloquialisms in the original written English instructions, which would have been understandable in the original English.
The algorithm had difficulty with colloquial terms, such as "skip a meal", a phrase that Google translated into Chinese as "jump over" a meal, and "hold the kidney medicine", meaning to stop taking it, was translated into Spanish as, "keep the medication" and into Chinese as "keep taking" the medication, mistakes that the research team deemed "life threatening".
Medical jargon, and long, complicated sentences also increased the risk of errors. "Please return to the emergency department for worsening abdominal pain, inability to eat or drink due to vomiting, bloody diarrhoea, if you pass out or any other concerning symptom," translated into Chinese as: "If you pass, vomiting, bloody diarrhoea, unable to eat or drink or any other symptoms; come back to the emergency department for treatment."
"It confused the machine because the sentence structure was so complicated," Khoong said. "It's certainly an argument for doctors to check themselves when they are writing instructions. We get used to communicating in these very complicated sentences."
The researchers said Google Translate is best used in combination with human interpreters, who can interpret the physician's verbal instructions for the patient, that way patients can amend errors or confusing passages as they are listening and reading. They also recommended that clinicians give their patients the English as well as any translated version of written instructions, so English-speaking family members or friends can compare them.
Khoong said patients would be worse off with no written translation at all. She described a non-English speaking patient with a neck injury, who left the emergency department with a cervical collar but did not understand the need to put it on. The patient later showed up with the collar in one hand, and the English discharge instructions in the other, saying, "I know these are important. Can you tell me what they say?"
*Khoong EC, Steinbrook E, Brown C, et al. Assessing the Use of Google Translate for Spanish and Chinese Translations of Emergency Department Discharge Instructions. JAMA Intern Med. Published online February 25, 2019. Doi:10.1001/jamainternmed.2018.7653