Transforming translationBMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e596 (Published 25 January 2012) Cite this as: BMJ 2012;344:e596
All rapid responses
Touch Screen Tablet Computers and Patients
Usman Ahmed ST2 Trauma & Orthopaedics, Sandwell, West Midlands
Subodh Deshmukh Consultant, Trauma & Orthopaedics, Sandwell, West Midlands
The potential role of touch screen tablet computers (TSTC) in medicine is evident by the number of articles and applications available. One particular online store has over 6000 applications as of 28/5/12 in its ‘Medical Category’. Some of these applications are dubious, but any concerns can be allayed by checking out the reviews of best applications on the numerous websites that have popped up dedicated to these portable applications.
There are plenty of hospitals in the UK and indeed throughout the western world that look at portable computers and tablets for everyday use and there are many success stories too1,2. Other potential uses have been explored previously by Robertson et al.3 and include hospital, community, individual and group options.
Another question is what can TSTC do to improve the patient-doctor consultation?
In areas where there are large immigrant populations, an individual’s first language may not be the same as the healthcare providers (HCP). The ability for a HCP to communicate with a patient is of fundamental importance especially with increasing encouragement for patient autonomy and their right to make informed decisions regarding their health. In these cases the role of the interpreter has become more pronounced in ensuring that patients are understood, and also that they understand what is happening to them.4
Most hospitals, especially those in diverse areas, have policies in place for using interpreter services. These services are usually provided by external contractors who on a consultation-by-consultation basis with a retainer or subscription. In addition to this, other services such as ‘Language Line’ offer translation services over special telephone sets that have two receivers. In literature the use of interpreters has yielded better results in terms of quality of care provided, time efficiency and overall cost savings as compared to not using these services.5,6 However, with the recent report of more than £23m spent by the NHS on translation services in 20117, it has become of paramount importance to find alternative cheaper translation services.
The capacity to use technology for translation offers the benefit of being ready and available in house, and long-term potentially cheaper than interpreter services and there are several applications available for translation and a couple of them are designed for medical purposes such as MediBabble8 (which is primarily designed for the iPhone). None of these apps have undergone any testing to assess accuracy and efficacy in the clinical setting, but strides are being made by independent firms to develop dedicated software9.
The biggest consideration one has to make is the appropriateness of using an
TSTC or such device in the clinical setting for communication purposes but as with everything in medicine, each situation must be judged on its own merits. Factors to consider include the potential legality of using such software, the patient’s ability to interact, and the impact of using a technological middleman in the consultation.
Ultimately, there is great potential for the language barrier in consultation to be bridged by technology, but until adequate software is developed current translation services will continue to be the primary form of language support.
The authors have no competing interests.
1. News & Star | News | Hi-tech checks keep Cumbrian hospital ward standards high. at
2. The University of Chicago Internal Medicine Residency Chief Residents. at
3. Robertson, I., Miles, E. & Bloor, J. BMJ Careers - The iPad and medicine. at
4. Chan, Y.-F. et al. Interpreter Services in Emergency Medicine. The Journal of Emergency Medicine 38, 133-139 (2010).
5. Jacobs, E.A., Shepard, D.S., Suaya, J.A. & Stone, E.-L. Overcoming Language Barriers in Health Care: Costs and Benefits of Interpreter Services. Am J Public Health 94, 866-869 (2004).
6. Karliner, L.S., Kim, S.E., Meltzer, D.O. & Auerbach, A.D. Influence of language barriers on outcomes of hospital care for general medicine inpatients. J Hosp Med 5, 276-282 (2010).
7. NHS translation bill “tops £23m.”BBC (2012).at
8. MediBabble. at
9. Software “may save NHS millions.”BBC (2011).at
Competing interests: No competing interests
I have been trialling Google Translate for the last six months as an alternative to the often cumbersome telephone interpreting services. Overall it has been a positive experience. You are quite right in pointing out its many benefits: rapid access, no (inappropriate/biased) 3rd party, apparent reliability and accuracy, harnessing power of spoken and written word. I've hooked up the system to my existing voice recognition software so talk 'directly' into the prompt box whereupon it is automatically translated.
It's certainly proved popular amongst some of my patients (especially the technically savvy with a smattering of spoken English). I find myself using a repository of stock phrases that aid the brief consultation around minor illness eg "your infection is caused by a virus; antibiotics will not work in this instance etc."
However it does have limitations. Primarily the complex algorithms underlying the software do sometimes get things wrong and a patient's puzzled face may be the only cue to an unfolding linguistic disaster. The tool also relies on literacy: the patient needs to be able to read their preferred language of communication. Perhaps the option to have the translated phrase spoken out aloud (currently only available in some languages) will negate this concern?
The issue surrounding privacy does need greater fleshing out though: should doctor and patient use separate devices? Given Google's new privacy laws should we ensure that browsers such as Google Chrome are not signed in during such interactions?
Google Translate has been a godsend for the short consult that would otherwise have relied heavily on my growing repertoire of theatrical health-related sign language. Needless to say this latter skill is still drawn upon on occasion to bolster what remains a message on a screen.
Competing interests: No competing interests