Google Translate Mostly OK for Patient Instructions, With Some Tips

Marcia Frellick

February 25, 2019

Google Translate's updated algorithm is able to translate physicians' orders from English into Spanish with 92% accuracy and Chinese with 81% accuracy, according to research published online today in JAMA Internal Medicine.

However, 2% of the Spanish translations and 8% of the Chinese translations have the potential to cause clinically significant harm, report Elaine Khoong, MD, a primary care research fellow in the Division of General Internal Medicine at University of California, San Francisco, and colleagues.

Bilingual translators found that most of the problems in translations started with poor grammar or typographical errors in the original orders.

Based on those findings, Khoong and colleagues urge physicians who use machine translation tools, such as Google Translate, to shorten sentences, avoid jargon that could be misinterpreted, and double-check spelling and grammar. They also advise including automated warnings about translation errors.

Errors Can Be Life-Threatening

To assess the accuracy of Google Translate, Khoong and colleagues examined 100 sets of emergency department discharge instructions. They judged sentences for overall accuracy not word-for-word accuracy.

Harm potential for inaccurate translations was judged by two clinicians, with a third weighing in when there were differing opinions. Potential harm was then classified as clinically nonsignificant, clinically significant, and life-threatening.

In one instance, an unusual word choice led the algorithm to generate what the clinicians deemed a "life-threatening" mistake: A physician told the patient to "hold the kidney medicine," meaning stop taking it. However, the algorithm translated that into Spanish as, "keep the medication" and into Chinese as "keep taking" the medication.

Long, convoluted sentences and jargon also led to translation problems, as in this example: The physician's original instructions were "Please return to the emergency department for worsening abdominal pain, inability to eat or drink due to vomiting, bloody diarrhea, if you pass out or any other concerning symptom."

When translated to Chinese, it read: "If you pass, vomiting, bloody diarrhea, unable to eat or drink or any other symptoms; come back to the emergency department for treatment."

Still, Khoong writes in a press release, "We cautiously support its use."

"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," she said.

Patients Should Also Get English Instructions

Additionally, the authors recommend giving patients a copy of the instructions in English so English-speaking family members can help double-check the orders.

The authors say the algorithm works best in conjunction with a human interpreter, even if that person is connected by phone or video. The interpreter can translate the physician's verbal instructions while the physician shows the patient the written instructions on a computer or on paper.

As they listen and read, patients can have any errors or confusing phrases explained before they return home. 

The authors note that prior studies of Google Translate found limited accuracy with the program, but had used an earlier version of the algorithm. The current one was put into place in 2017.

The study authors have disclosed no relevant financial relationships.

JAMA Intern Med. Published online February 25, 2019. Full text

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