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There has been a better option for a long time, called on-staff Medical Interpreters. In fact, my spouse worked as one for approximately seven years. Unfortunat

There has been a better option for a long time, called on-staff Medical Interpreters. In fact, my spouse worked as one for approximately seven years. Unfortunately due to hospitals consolidating into medical networks and cutting costs wherever they could, this went from on-staff interpreters, to contract interpreters, to on-call phone interpreters (works incredibly poorly), to google translate. Blame the beurocrats running your hospital. The systems were in place, just have been absolutely gutted.

not2b 5y ago
That approach is best for cases where it works, for example in areas where there is a large minority of speakers of a given language (Spanish in the US, for example). But if the patient speaks a language that is unusual for the area, finding an interpreter is going to be more difficult, or maybe not possible in some cases.
- pseingatl 5y ago
  You have a similar problem with respect to criminal trials of defendants who speak minority languages. You can find a Khmer interpreter easily enough in Los Angeles, but good luck in Miami.
  - sokoloff 5y ago
    Criminal trials are at least scheduled, permitting travel or other advance arrangements.
    - pseingatl 5y ago
      Ha! If only it were universally so. How many times have I heard, "Counsel, be ready tomorrow."
  - School-Cotton 5y ago
    I’ve heard anecdotally from lawyer friends that despite how fucked up the US justice system is in so many ways, one bright spot is the lengths to which they’ll go to find interpreters. 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.
munk-a 5y ago
My SO had to seek medical attention in rural southern France (we were visiting Carcassone) - she initially sought care at the local emerg where there was not a translator available, she speaks high-school french but most of the conversation was carried out through miming and charades. A few days later, as instructed, she followed up with a local clinic where she prepared a written version of her condition and brought it in to show the doctor, they consulted that and again went through a song and dance to try and mime out the response. 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.
- Cd00d 5y ago
  I had experience with the charades act. Got food poisoning or a stomach bug in Sofia, Bulgaria and had to act out vomiting and diarrhea at the chemists desk. Eventually they got the drift, opened a box of pills and gave me a sheet of them with no further instruction. 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.
  - Xenoamorphous 5y ago
    > 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.
kvathupo 5y ago
What are countries with more functional healthcare systems doing differently? 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.
- oblvious-earth 5y ago
  Aaron Carroll did a Youtube Series back in 2014 on the topic, even if you don't want to watch the videos there's a lot of good links in the description of each one: https://www.youtube.com/watch?v=yN-MkRcOJjY&list=PLkfBg8ML-gIngk82SUbTp6Og_KkYfJ6oF https://www.youtube.com/watch?v=yN-MkRcOJjY&list=PLkfBg8ML-g... 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.
- wswope 5y ago
  Career healthtech worker; opinions are my own; focusing only on the provider-specific questions you're asking: 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.
standardUser 5y ago
Having multiple full-time paid translators on hand 24/7 at every hospital in the country would be nice, but probably not realistic.
brianwawok 5y ago
> By 2028, it is expected that health care spending in the U.S. will reach nearly one fifth of the nation's gross domestic product 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.
- w-j-w 5y ago
- slackfan 5y ago
  Bluntly speaking, this is not a problem that tech can solve. Because nothing, no video calls, no vr, no phone calls, can replace an on-site professional. There are approximately top 10 languages you want to have staff for, and then the rest can be handled by contractors. But you have to remember that most "staff" are actually 1099 contractors now because they can be paid submarket wages that way. Thanks, monopolies.
  - trimbo 5y ago
    > Bluntly speaking, this is not a problem that tech can solve. Because nothing, no video calls, no vr, no phone calls, can replace an on-site professional. 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.
nradov 5y ago
Medicare and most private insurers will pay for medical translation or interpretation services when necessary. It's HCPCS billing code T1013. Generally hospitals would make a small gross profit on it, so I'm puzzled why they would eliminate those positions if there is enough demand to keep them busy.
makeitdouble 5y ago
This is a better option in quality, but seems more difficult to handle at any significant scale. Having a wide availability of highly trained, on premise professionals in every single location looks unrealistic to me. 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 ?

not2b 5y ago

That approach is best for cases where it works, for example in areas where there is a large minority of speakers of a given language (Spanish in the US, for example). But if the patient speaks a language that is unusual for the area, finding an interpreter is going to be more difficult, or maybe not possible in some cases.

pseingatl 5y ago
You have a similar problem with respect to criminal trials of defendants who speak minority languages. You can find a Khmer interpreter easily enough in Los Angeles, but good luck in Miami.
- sokoloff 5y ago
  Criminal trials are at least scheduled, permitting travel or other advance arrangements.
  - pseingatl 5y ago
    Ha! If only it were universally so. How many times have I heard, "Counsel, be ready tomorrow."
- School-Cotton 5y ago
  I’ve heard anecdotally from lawyer friends that despite how fucked up the US justice system is in so many ways, one bright spot is the lengths to which they’ll go to find interpreters. 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.

munk-a 5y ago

My SO had to seek medical attention in rural southern France (we were visiting Carcassone) - she initially sought care at the local emerg where there was not a translator available, she speaks high-school french but most of the conversation was carried out through miming and charades. A few days later, as instructed, she followed up with a local clinic where she prepared a written version of her condition and brought it in to show the doctor, they consulted that and again went through a song and dance to try and mime out the response. 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.

Cd00d 5y ago
I had experience with the charades act. Got food poisoning or a stomach bug in Sofia, Bulgaria and had to act out vomiting and diarrhea at the chemists desk. Eventually they got the drift, opened a box of pills and gave me a sheet of them with no further instruction. 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.
- Xenoamorphous 5y ago
  > 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.

kvathupo 5y ago

What are countries with more functional healthcare systems doing differently? 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.

oblvious-earth 5y ago
Aaron Carroll did a Youtube Series back in 2014 on the topic, even if you don't want to watch the videos there's a lot of good links in the description of each one: https://www.youtube.com/watch?v=yN-MkRcOJjY&list=PLkfBg8ML-gIngk82SUbTp6Og_KkYfJ6oF https://www.youtube.com/watch?v=yN-MkRcOJjY&list=PLkfBg8ML-g... 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.
wswope 5y ago
Career healthtech worker; opinions are my own; focusing only on the provider-specific questions you're asking: 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.

standardUser 5y ago

Having multiple full-time paid translators on hand 24/7 at every hospital in the country would be nice, but probably not realistic.

brianwawok 5y ago

> By 2028, it is expected that health care spending in the U.S. will reach nearly one fifth of the nation's gross domestic product 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.

w-j-w 5y ago
slackfan 5y ago
Bluntly speaking, this is not a problem that tech can solve. Because nothing, no video calls, no vr, no phone calls, can replace an on-site professional. There are approximately top 10 languages you want to have staff for, and then the rest can be handled by contractors. But you have to remember that most "staff" are actually 1099 contractors now because they can be paid submarket wages that way. Thanks, monopolies.
- trimbo 5y ago
  > Bluntly speaking, this is not a problem that tech can solve. Because nothing, no video calls, no vr, no phone calls, can replace an on-site professional. 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.

nradov 5y ago

Medicare and most private insurers will pay for medical translation or interpretation services when necessary. It's HCPCS billing code T1013. Generally hospitals would make a small gross profit on it, so I'm puzzled why they would eliminate those positions if there is enough demand to keep them busy.

makeitdouble 5y ago

This is a better option in quality, but seems more difficult to handle at any significant scale. Having a wide availability of highly trained, on premise professionals in every single location looks unrealistic to me. 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 ?