Doctors who use Google Translate to talk to patients want a better option
statnews.com
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The pendulum has fully swung from "pain is a vital sign" to "suck it up" and "anyone who complains about pain is a liar or a drug seeker unless they're older than 65 or have a visible external wound."[1] It's difficult even when you speak the same language. I'm sure it's nearly impossible when you don't.
[1]: https://rehabs.com/pro-talk/how-to-get-labeled-a-pill-seeker...
Veterinarians deal with this daily as well.
In both cases, there are professional protocols to deal with the situation.
Legitimate chronic pain patients are being abused at this point in order to save face for the broken, rent-seeking pharmaceutical system that enabled the prescription opioid 'crisis' in the first place.
After doing "new patient" appointments (which by the way were like $200 to $300 each) and not having a doc willing to take me on as a patient unless I dropped the opioids, and making several calls (who refused to tell me over the phone whether the doctor was even open to controlled substances without that $300 "new patient" appointment) I gave up. Since coming off the opioids my quality of life has plunged. I struggle with depression and thoughts of suicide now, especially when I'm unable to leave the house or my bed. I went from stable and productive and what doctors used to say is the model patient, to being miserable. Every doc has offered to give me additional antidepressants or crank up the doses of those, but none are willing to treat the pain that is exacerbating it.
I absolutely believe that what the medical establishment is doing to people like us (withholding treatment that we know works) is cruel and borders on torture. It is the epitome of taking macro-level stats and explanations and applying them broadly on the micro-level, regardless of the harm caused.
I believe Hippocrates would be rolling over in his grave to hear that these people took an oath to "do no harm."
For the record. I mostly don't blame the doctors. They are protecting their medical licenses, which the DEA and FDA have proven they are willing to revoke over the slightest anomaly. When the feds started throwing pain specialists in federal prison because some tiny percent of their patients were abusers, it really drove home that individual doctors are not allowed to think anymore. You implement government policy, or you risk financial ruin and even jail time. I don't blame them for being cowards. I probably wouldn't risk imprisonment on a stranger either.
Further, the bulk of use in illegal opioids stateside, such as fentanyl and its analogues, is not (at least today) driven by the conversion of the legal opioid user to an illegal drug user. Fentanyl is now commonly found in drugs that never previously would have contained an opioid, such as counterfeit benzos and MDMA. Further, the majority of fentanyl users on the street arrive at its use after consuming other illegal/street drugs. For those who started on other opioids, their first opioid will tend to be the illegally diverted pills or liquid cough treatments containing codeine/hydrocodone called "lean". Very few new users of fentanyl and fentanyl analogues come from legal opioid users, mainly because very few new users are now inducted on reckless prescriptions such as an immediate script for 180 Oxycontin and 240 benzodiazepene pills a month. Your narrative is about a decade out of date at this point.
Thomas Kline is a superb resource if you want to take a deeper dive into the actual statistics and how the narrative of a crisis was used to systematically deny law abiding patients the pain treatment they should receive. https://twitter.com/thomasklinemd
https://journals.lww.com/pain/Abstract/2015/04000/Rates_of_o...
1. The meta-analysis occurred during the period of time that pill mills and other unscrupulous prescribing was rampant. See that there was no note regarding patients' (legal) polydrug use or by morphine equivalent dosing, nor was there any modification to the analysis of the data to see how this period in the legal drug market impacted patient outcomes.
2. This analysis selects for chronic pain patients, which tends to mean the long term users of opioids while excluding the acute patients who, particularly among the in-patient subset, pretty much never become addicts during their course of use - which is what we'd expect if these compounds were as addictive as claimed.
3. These cohort selections often do not include some or all palliative care patients. I won't accuse them of doing this to sensationalize their numbers but it does have a significant impact on results, as again palliative care patients very rarely cease their use and carry forward afterwards an opioid misuse disorder.
4. They do not control for or look at the specific impact of the main problematic legal opioid - Purdue Pharma's original OxyContin formula. Because this drug did not have the pharmacodynamic profile claimed by the firm and represented in the safety studies, it was considerably more likely to cause opioid use disorder, as patients would be much more likely to take extra doses to cover the shortfall in the dosing window. This would lead to patients who otherwise would exist on a steady dose asking for increasing doses - or, worse, turning to the street to acquire diverted doses.
They were incentivised to not properly prescribe opioids. Don't be so quick to let the doctors off the hook. They're pleading ignorance isn't going to work. These were highly intelligent people who knew what they were doing and did it anyway in exchange for bribes from "Big Pharma".
The problem of people without health care is a bigger and separate issue.
Worth a shot, but I wouldn't recommend anyone getting their hopes up trying it.
Tiger balm, on the other hand, is nothing short of magic.
the actual probability depends on your location,
but in general:
the kids are FUCKED
Be smart and learn how to identify fakes. I can spot fake m30s by texture.
This is why immigrants bringing minor children to doctor's appointments as translators is so utterly stereotypical: it actually happens.
It's the next best thing to the alternative by self-preservation - you get creative and put in the work. There's no way to have translators available for any arbitrary doctor - it's too expensive and the language of medical interaction is generally the highest language complexity activity the average person will have to deal with.
I've experienced this while traveling overseas. And you have to prepare for doctor's visits far more than "back home" if you want to get the best care. When I was living in a non-English-speaking neighborhood, I'd have to spend time translating my symptoms to the local language. Without computers, I'd probably need to hand-copy it from a paper dictionary instead. 50 years ago it would be very much a pantomime/charades scenario.
And here's the kicker: talking symptoms is SUPER inaccurate even with both doctor and patient speaking the same language unless the doctor has time and skills for teasing out things the patient doesn't know are relevant. And the doctors on a bell curve of that skill - plenty don't know what they don't know because they are on the low side of the curve so they miss things also.
It was a truly perplexing and depressing outcome. Worse, as some of our team hadn't yet had their sense of possibility and belief in the US medical system destroyed, I saw first hand a number of talented persons simply walk away from doing any work in health or healthcare tech. It was a double blow that went beyond just the loss of the software that was being created; people who otherwise would have dedicated their lives to improving patient outcomes instead went elsewhere with their careers or volunteering lives.
I know the aforementioned EMR puts a lot of emphasis on their After Visit Summaries, which sounds somewhat similar to what you describe.
For what it is worth, we never saw ourselves as a replacement for the After Visit Summaries but rather an adjunct that ensured said Summaries could be understood and utilized by non-speakers or ESL patients who perhaps are not as confident in their skills.
The issue with discharge templating is that EVERY single client under that company gets customized support from them until you are able to guarantee providing that level of custom support you don't have a shot in partnering with them.
There's a reason why Caregility is the solution instead.
https://www.healthcareitnews.com/news/mount-sinai-eases-tran...
Touching the templates themselves is never going to scale.
Those who are truly invested in EMR software are not developers and developers are not invested in EMR software. So, as a developer, it's a job you take because you need a job. And if you're competent, you can get a job elsewhere eventually. If you're not, well, it's not like medical software has a deep talent pool to draw from. You can coast for a long time.
Combined with that, you have to work with doctors and nurses. Doctors especially operate under the belief that demonstrated competence in one area correlates to expertise in all areas. No one bikesheds harder than a doctor. Except a doctor who fancies himself a programmer as well.
Then, most of them have superiority complexes. All users think using things makes them usability experts, doctors included. Couple that with the ego that comes with being in a profession where some number are responsible for life and death situations and you wind up with a user who truly believes that making the button cornflower blue is the single most important thing to take this thing over the top.
So you wind up basically with an absent, yet micromanaging, manager who also doesn't know how to develop software. That's kind of soul-crushing.
I know a handful of companies that went through YC trying to build EMR software and have met many more people since who are interested in this problem. It is not a lack of interest from engineers.
Blame the beurocrats running your hospital. The systems were in place, just have been absolutely gutted.
One Guatemalan defendant who natively spoke a Mayan language had to go through a chain of three court-appointed interpreters: one from his language to a different, more widely-spoken Mayan language, one to go from that to Spanish, and one from Spanish to English. He told my friend (his lawyer) something like: “this is amazing; in Guatemala they’d have just told me ‘sorry, the national language is Spanish’ and I’ve had been out of luck!”
I don’t believe it would be legally possible in the US to convict a monolingual Khmer speaker of a crime without providing an interpreter, in Miami or anywhere else.
I think it'd probably be nice if there was an english fluent person on staff at the emerg but I think it's unreasonable to expect local clinics to have support for translating especially when English is a rather unlikely language to be spoken in that area - having someone German and Italian literate would be nice and having someone Spanish literate (and, ideally, Basque literate) would be much more important.
If you're running a hospital in Vancouver you better have a French[1], Punjabi and Mandarin translator on staff - outside of those I think it's reasonable to rely on tools like Google Translate, it sucks but full language coverage isn't reasonable.
1. I think a French translator might be legally required due to the bilingual nature of Canada but it's honestly much less common on the west coast compared to Punjabi and Mandarin.
I think I could have been successful if I knew some French, but alas, I opted for Spanish in high school. At the time it seemed Bulgarians over a certain age had French for their second (or third) language, and the younger folks had English.
Yes this happens in Spain too. People over 50 or 55 or so were taught French at school but younger people were taught English.
However don’t expect most of them to speak much of it.
This isn't too far off how prescriptions work in many places in europe, east or west. If you're lucky, they'll hand-write instructions on the box (that are incomprehensible to me).
For added confusion, the chemists don't count pills/break packages. So if your order is for 7 doses, but they come in boxes of 5, you'll get 10 doses.
Or even a longer-term immigrant who never quite learned much medical vocabulary.
Far better than what was possible before, when as a tourist you maybe had a phrasebook or something similar.
This is part of the risk of travel into an area where you don't know the language.
Also if you are going to permanently move to such a place, it's incumbent on you to become functionally fluent in the local language. Nobody there owes you a special accomodation.
Functional fluency doesn't really cover hospital interactions though, right? I can live for decades in Paris without knowing what the word for chest pains or sprained ankle are.
I could certainly say “chest pain” though.
Of course nobody owes anybody anything. I do think that in countries with nationalized health care, at the very least having a call center to help out with language difficulties around this feels like almost a no brainer though.
There are doctors with specialized dictionaries and the like as well, of course.
And... yeah honestly, Google Translate (or my favorite solution of "go to wikipedia page and find the linked article in local language") can help a lot.
The only real benefit I found to in person is that it's a bit more personal feeling and you don't have as many issues with the patient not hearing what they said on the tablet and vice-versa.
I found the language barriers are not a huge deal with options like this. I've also worked for a 911 call center taking ambulance calls and it's much harder to manage language barriers there as it can be hard to tell someone who speaks none of your language that you're getting a translation service on the line.
When it comes to comparisons with other countries, much of the dialogue in the US is centered on insurance coverage. That said, I'm curious if other countries have found better solutions to similarly fundamental issues, such as doctors working long hours, doctors being forced to maximize the number of patients, continued medical education, and patient education about the doctor-patient relationship.
From what I remember: Insurance is one reason, Hospitals not engaging in collective bargaining (e.g. vs. NHS in England which makes decisions about what to spend money on and makes companies bid on contracts for the whole country), wasteful premium care that adds little to patient outcomes (e.g. vs Singapore which has a privatised tiered healthcare system but heavily regulates healthcare so this doesn't happen), and simply paying Doctors far more money.
Biggest problem (w.r.t. provider overwork and availability) is regulatory capture by AMA and hospital groups. The AMA has for decades induced an artificial shortage of MDs by limiting the number of available residency slots. In particular, there's an acute shortage of slots for primary care providers (gen practice, family med, internal medicine, OBGYN) - which combined with financial incentive, leads to an oversupply of specialists.
AMA is also very assertive about keeping alternative providers (e.g. nurse practitioners) from having the rights to perform certain procedures - again as a form of financial protectionism. I'm picking the worst possible example, because it goes wrong all the time, but in many LatAm countries for example, routine x-rays and ultrasounds are often read by technologists rather than radiologists. Broadly speaking, there's a chilling effect of provider liability, in that your PCP may not be a dermatologist, so instead of doing a mole screen themselves during your annual office visit, they send you for a specialist visit instead of doing it in house (to avoid the unlikely chance they miss something subtle the derm might've caught) - costing more money, fueling the oversupply of specialty care, and letting the "general" skills of GPs atrophy even further.
TLDR: The American Medical Association kills people.
P.S. I found this tidbit on tobacco particularly troublesome [2].
[1] - https://en.wikipedia.org/wiki/American_Medical_Association#C...
[2] - https://www.sourcewatch.org/index.php/American_Medical_Assoc...
It is a balance of features vs price. Right now, we need to do absolutely everything we can to keep the price of medical care as low as possible.
In the US it might make sense for most hospitals to have people on staff for Spanish. I don't think we as a country can afford 270 other languages of full time staff. We should use tech in any way possible to cut this cost.
Thanks, monopolies.
AFAICT, over the past 150+ years, a qualitative argument like this is made every time a skilled job can be replaced by automation, but the automation wins anyway. The automation quality ends up improving to the point where the economics are inescapable.
What would be your middle-ground proposition for the large swath of doctor cabinets and hospitals who won't win/can't afford enough of the on-staff interpreters lottery and still get patients that need support in different languages ?
To make the problem even worse, Google Translate only provides "Chinese (Simplified)" and "Chinese (Traditional)" instead of "Taiwanese Mandarin" or "Mainland Mandarin". While these two character sets can one to one map with each other, the result could be confusing for the user.
While Taiwanese people not speaking Mandarin natively are somewhat rare abroad, it would explain the difficulties in interpretation.
It does list 'Chinese (Traditional)' and I guess that's what they were using.
I tend to feel that the Taiwan lyrics are better, but I'm not a native or even fluent speaker. I'd be interested in native opinions.
The key is of course to use grammatically correct, unambiguous language to begin with.
If it's electronic communication, you can always reverse the translation to check it translates back to your original.
On the other hand, if you are complaining about the quality of Google Translate, that is another matter. Deepl.com's translations are better, but they support fewer languages. Google Translate works on the amount of source material available in the foreign language and what kind of source material. Mandarin can be quite good. Legal Arabic isn't that bad either, after a United Nations project to translate all Iraqi laws into English. There's not that much Burmese; Thai translations are uniformly horrible and as for Mizo? Forget it.
Even with native speakers, medical instructions can be difficult. You can find lists of commonly confused English medical terms: https://www.antidote.me/blog/medical-terms-a-to-z-common-and... https://www.2ascribe.com/articles/health-wellness/40-words-t...
And, of course, there are still plenty of illiterate people.
You can see the results here: https://github.com/MoserMichael/duckduckbang/blob/master/REA...
I didn't manage to automate the use of DeepL in python; The translators pypi package (https://pypi.org/project/translators/) tries to automate the REST api of DeepL, but it doesn't seem to work. Are there any alternative solutions for automating DeepL? (Well, i could probably give it a try with selenium)
On the other hand: when you take short descriptions - like labels that appear in a UI, then that's a very hard thing to translate, it is very easy to pick up the wrong synonym, to begin with... It would probably have an easier job with the site descriptions, these tend to be longer texts.
Hokkien is spoken outside Taiwan (e.g. Fujian).
It would be pretty shocking if that wasn't the case, since Hokkien is spelled 福建.
I've only really dabbled in the language, but I quickly got the impression it's not exactly standardised. Even something as simple as 'I' seems to have two pronunciations (gua and wa).
[0] https://www.mkdict.net/results?query=%E8%AA%9E+&page=1&q_typ...
When writing: not a relevant question, as Google Translate is for the written form, not spoken dialects.
I mean services have existed for on-demand language translation by phone for a long time. You call them up, tell them what language and they connect with a translator.
Hell, they probably have cool apps and stuff now.
No doubt not cheap, but hey let's keep using Google Translate for life-and-death issues.
Medical emergencies (or, to be honest, routine medical care) can be required for anyone, anywhere, for no particular reason. Care workers are no doubt familiar with that.
For people to want to improve the situation for hospitals doesn't seem bad if it's possible. Do you think that we cannot achieve better?
Sure, my wifes English is very good but not perfect. I accompany her so I can give quick translations to medical terms she might not know.
If we ever bring her parents here to live, guess whose job it's going to be to make sure they understand doctors? Well, mostly hers... but you get my point. The onus is on us.
I have no expectation that every hospital should be able to communicate in every language on earth.
Having optimism, and deciding to challenge existing limitations can both be useful too, though.
> I have no expectation that every hospital should be able to communicate in every language on earth.
I like the way you stated that. At first it made me think about how to improve translations. Now it's making me wonder whether there is a more universal common medical language (in many situations, I think that human care for each other doesn't require much communication at all).
They put me up in a hotel for 10 days. Fed me 3 times a day. Checked on me twice a day. And on day 10, opened the door and I was on my own.
How I could have managed that without Google translate, I don't know. None of the doctors or nurses spoke more than a few words of English. And I could barely say hello, goodbye or thank you. (I can now!)
As you say, life would have been difficult. It was difficult even with google translate. But it made the interactions much easier on both parties involved.
I would hope that if someone was visiting my country on holiday, or to visit their relatives, and happened to get sick, that the hospital would do all they could to communicate with them and not treat them like they shouldn't even be there.
(And your example, Poland, has a pretty big influx of people right now who had different priorities than ensuring they speak the language first)
HN really is a stifling place whenever the discussion veers anywhere close to politics. I give up, you win.
As stated in this article, the woman was receiving service in Arizona. The official language in that state is English, so you should expect services to be offered in that language.
Frustrating that this continues to be an acceptable stance a half century later.
I remember that when it was introduced many years ago it was horribly bad but it's badness was a hope that things will improve quickly.
And after so many years and so much data available to google it's still that bad.
To be clear, I'm not suggesting that Google translate is good enough for medical translation; we should still be employing people for this job.
No.
We made the decision to move here. Why should Dr.s learn Spanish instead of us English?
Also, there are plenty of Dr. who speak Spanish (upper middle classes fetishize us and love to show off their basic Spanish)
Finally, Dr. training is brutal enough as it is without adding the burden of a new language. I want my family Dr. to focus their time on their cardiology classes. My mom can collect more funny anecdotes.
Im sure you feel well, but this suggestion is patronizing and reeks of what is now called “white savior complex”.
... because that's not the scenario the article is about? First sentence:
> The patient had just undergone a cesarean section, and now was struggling to put words to her pain in her native Taiwanese.