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Medical translation
Wioleta Karwacka
University of Gdańsk
If medical communicators are not to betray the same commitment of the very au-
thors they are asked to translate – primum non nocere – we need to acknowledge
and correct certain problems(…): differences in scientific terminology, deceptive
lexical equivalence, misconceived readership level, out-of-focus translator training,
misjudged translation expectations, etc.
(Fischbach 1998:1)
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1. Introduction
2. Medical language
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2.2 Eponyms
1
For more information on the history of medical language and medical translation see
Martí-Ibáñez (1962), McMorrow (1998), Segura (1998) and Zieliński (2004)
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Medical Translation
Table 1. Examples of English eponymous terms and their eponymous equivalents in Polish
English eponym Polish eponym
Achilles tendon (Achilles’ tendon) ścięgno Achillesa
Adam’s apple jabłko Adama
Down syndrome zespół Downa
Creutzfeldt–Jakob disease choroba Creutzfeldta-Jakoba
Table 2. Corresponding pairs of eponymous and non-eponymous terms in Polish and English
eponymous term non-eponymous term
Lyme disease borelioza
Fallopian tube jajowód
metoda Vojty reflexlocomotion
odczyn Biernackiego (OB) erythrocyte sedimentation rate (ESR)
Concepts may be referred to with eponymous terms which also have non-
eponymous equivalents, sometimes a concept will be referred to with
such doublets in one language, and only eponymous or only non-
eponymous terms in other languages.
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Wioleta Karwacka
Table 4. Examples of abbreviated forms used in English and Polish medical language
English Polish
X-ray Rtg
CT (computed tomography) TK (tomografia komputerowa)
℞ (prescription) Rp. (recepta)
CNS (central nervous system) OUN (ośrodkowy układ nerwowy)
COPD (chronic obstructive pulmonary POChP (przewlekła obturacyjna choro-
disease) ba płuc)
pRBC (packed red blood cells) KKCz (koncentrat krwinek czer-
wonych)
GCF (gingival cervical fluid) PD (płyn dziąsłowy)
2
cf. Esch & Petersen (2013)
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Medical Translation
Word compounding, affixation and the doublet phenomenon are three features of
fundamental medical English (FME) described by Salager-Meyer (1983). Com-
pound nominal phrases (heart failure, patient safety, contrast medium)
are common in FME (Salager-Meyer 1983: 61). Therefore, preparing a
functional medical translation which uses fairly natural language may
involve syntactic shifts (phrase change) (cf. Chesterman 1997). The extract
below shows such shifts based on two bolded phrases, whose literal translation
would result in pro-ducing the following prepositional phrases in the target
units, respectively: inju-ries of the orbit, means of the protection of the head.
The affixation process is not only common in the lexis of fundamental medical
English (fail – failure, relate – relationship/correlation - unrelated, define –
definition – undefined, improve – improvement) (Salager –Mayer 1983:61) – it is
also observed in specialized terminology. What is especially characteristic of
specialized terminology is the use of Latin and Greek affixes (e.g. prefixes:
all(o) –another, different, adip(o) – fatty, carni(o) – of the cranium, onco- relat-
ing to cancer, hyper – excessive, hypo – insufficient, suffixes: - itis – inflamma-
tion, - algia – pain, -lepsy – attack, seizure, -logy – the knowledge of something),
and the obvious correspondences between suffixes, roots etc. and the meaning of
the term. Polish medical terminology is also heavily based on Latin and Greek
affixes, besides borrowings and descriptive terms.
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Wioleta Karwacka
3
See e.g. Soltesz Steiner (2003) for more exhaustive information on Greek and Latin
affixes in medical English
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Medical Translation
tigate, shot – injection, heart attack – myocardial infarction. The doublet phe-
nomenon is well observed in adjective vs. noun roots. That feature is of great
importance in writing or translating information materials for lay readers, which
is discussed in section 2 of this chapter.
Table 8. The doublet phenomenon observed in adjective vs. noun roots (Polackova 2006: 131, cf.
Salager-Meyer 1983)
Nouns Adjectives in use
bone osseous tissue (Lat.)
eye optic nerve (Lat.)
liver hepatic carcinoma (Greek)
fat adipose tissue (Lat.)
neck cervical vertebrae (Lat.)
backbone spinal canal (Lat.)
kidney renal artery (Lat.)
stomach gastric juices (Greek)
forehead frontal bone (Lat.)
navel umbilical cord (Lat.)
mouth oral cavity (Lat.)
windpipe tracheal intubations (Lat.)
ear auditory canal (Lat.)
breast mammary duct (Lat.)
lungs pulmonary embolism (Lat.)
teeth dental caries (Lat.)
heart cardiac muscle (Greek)
brain cerebral cortex (Lat.)
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Medical Translation
readability which would employ applied linguistics approaches and the paradigm
of patient-centredness.
Apart from the Declaration of Helsinki, there are a number of national and
international laws which regulate access to medical information in patient’s na-
tive language; they include regulations concerning the package leaflet (PPI)
Directive 2004/27/EC provides that
the package leaflet must be written and designed to be clear and understandable,
enabling the users to act appropriately, when necessary with the help of health pro-
fessionals. The package leaflet must be clearly legible in the official language or
languages of the Member State in which the medicinal product is placed on the
market.
What is more, “the package leaflet shall be drawn up in accordance with the
summary of the product characteristics”. Under Directive 2001/83/EC the lan-
guage of PPIs should be easily understood:
the package leaflet must be written in clear and understandable terms for the users
and be clearly legible in the official language or languages of the Member State
where the medicinal product is placed on the market.
Package leaflet is the subject of research especially for its user-friendliness (cf.
Askehave & Zethsen 2000; Hall 2006; Ezpeleta 2012; Montalt & García-
Izquierdo 2014; Pilegaard 2014). The lack of user-friendliness may be a result of
two factors: inter-linguistic translation (between two languages) and inter-
generic translation (from one genre to another e.g. transferring information from
the product summary to package leaflet) (Askehave & Zethsen 2000: 64). The
requirements under Directive 2001/83/EC mean that PPI should contain the
same information as the product summary (PS). That requires structural and
lexical simplification, determinologizing, synthesizing information, expanding
relevant information, and adjusting tenor (Ezepleta 2012, 2014).
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term over-dosing could result in signs become too high. Prolonged overdose
and symptoms of gigantism and/or may result in a greater than normal
acromegaly consistent with the growth of ears, nose, lips, tongue
known effects of hGH excess. and cheekbone.
Treatment is symptomatic and support-
ive. There is no antidote for somatropin
overdose. It is recommended to monitor
thyroid function following an overdose.
Nevertheless, PPIs are still notorious for being vague and overcomplicated. The
main problem areas include: the use of synonyms, syntax and complicated sen-
tences, the use of passive, impersonal style and information overload (Askehave
& Zethsen 2000: 64). As a result, PPIs simply support management and trade
strategies of pharmaceutical companies rather share knowledge and
empower patients (Hall 2006), possibly because their main purpose is to meet
requirements and not to educate lay audiences (cf. Pilegaard 2007).
There are also a number of regulations which should secure the rights of
ethnic minorities and immigrants with regard to full access to medical services.
They result from the Universal Declaration of Human Rights, International Con-
vention on the Elimination of All Forms of Racial Discrimination, Convention
on the Rights of the Child, International Covenant on Economic, Social and
Cultural Rights, European Constitution, European Convention on Human Rights,
Framework Convention for the Protection of National Minorities and respective
constitutions and laws applicable in particular countries (Baráth et al. 2007). In
the light of those regulations, patients should be granted with access to relevant
documents in their native language and interlingual communication with medical
staff should be facilitated. In reality, however, foreign patients with limited L2
skills are not always sufficiently assisted, which may lead to significant prob-
lems – there is sufficient evidence that language barriers may severely affect the
quality of medical services (Heine 2003; Flores et al. 2003; Chung 2006;
Sanchez 2007; Chen 2009).
Apart from the genres discussed above, there are other texts translated in
order to ensure interlingual communication in healthcare settings – brochures,
patient diaries, questionnaires, forms etc. Medical translation can bridge the
linguistic gap between medical professionals and patients, thus becoming a fac-
tor in improving the overall quality of medical services. Ongoing research will
hopefully shed more light on achieving lay-firendliness of original and translated
materials (cf. Pilegaard 2014; Montalt & García-Izquierdo 2014).
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Regulatory requirements do not only concern medical documents for lay readers
Under international regulations, instructions for use (IFU) and user manuals of
medical devices also have to be translated, even if a given device is a highly
specialized tool only used by specially trained professionals, unless a formal
approval is granted for the English version of the documents. Exhaustive EMA
(European Medicines Agency) documentation covering the characteristics of
pharmaceutical products needs to prepared in the twenty-four official languages
of the European Union. Pharmaceutical dossiers are also translated into the
languages of countries outside EU – and that is only the European perspective,
with medical research and development activities, being a global issue requiring
international communication and thus translation worldwide (cf. Andriesen
2006). Clinical trial documents, including clinical trial synopses are also a large
portion of the translation turnover.
The most typical features of specialized medical texts, i.e. terminology,
nominalization, heavy pre- and postmodification, long sentences, use of passives
(cf. Askehave & Zethsen 2000), hedges ( Salager-Meyer 1994), metaphors and
rich images4, and, occasionally, the language of evidence-based medicine
(EBM) (cf. Gajewski 2003; Górnicz 2007, 2009) may constitute the areas of the
greatest challenge to translators, as presented in the passages below – extracts
from research papers translated from Polish to English by the native speakers of
the source language.
Extract (a) is an example of terminological density, the use of English acro-
nyms in a Polish text. The beginning of the target sentence is not written in natu-
ral English, posing more problems than highly specialized terminology. Sen-
tences (b) – (e) show the use of EBM lexis, with the controversial choice in (e) –
intervention vs. investigated. Target sentences in (c) and (d) are more explicit
than their source counterparts. Extract (f) is an example of information and ex-
plicitness changes, possibly related to significance threshold (cf. Chesterman
1997): przyspiesza osiągnięcie celów terapeutycznych – improves rates of blood
pressure control and requires less time to achieve target blood pressure, kwesti-
ami – benefits, korzyści ekonomiczne – cost savings, efektywniejsza współpraca
z pacjentem – better compliance; the linking expression z tego względu is omit-
ted, by most patients with hypertension is added, information that the monother-
apy concerns antihypertensive drugs is removed (but can still be implied).
4
“rich images are metaphorical expressions that are ‘rich’ in detail and in associations”
(Shuttleworth 2014: 35)
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Such maneuvers influence the explicitness of the text and its cohesion. The sen-
tence „Fototrichogram jest metodą rzadko stosowaną w praktyce” is not ren-
dered in the target text. The subsequent sentence is where clarity and cohesion
seem to be prioritized in the translation, and are achived also by means of a unit
change, information change skóry owłosionej głowy – a shaven scalp area and
adding allow the percentage of telogen hairs to be assessed:
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Medical Translation
Table 10. Extracts from medical research papers translated into English5
Source Target
a) Ustalenie rozpoznania żylnej Making a diagnosis of venous
choroby zakrzepowo-zatorowej thromboembolism (VTE), mani-
(VTE), na którą składają się za- festing as deep vein thrombosis
krzepica żył głębokich (DVT) i (DVT) and/or pulmonary embo-
zator tętnicy płucnej (PE), wyma- lism (PE) requires clinical assess-
ga zarówno oceny klinicznej, jak i ment, as well as imaging and — in
wykonania dodatkowych badań selected clinical settings — labora-
obrazowych, a w wybranych sytu- tory tests.
acjach klinicznych — także testów
laboratoryjnych.
b) Przeprowadzone w ostatnich latach Large clinical trials performed in
duże próby kliniczne dowodzą, że the last few years prove that com-
terapia złożona nadciśnienia bined therapy of essential hyper-
tętniczego ma już ugruntowaną tension has reached a secure posi-
pozycję. tion lately.
c) W grupie kobiet z otyłością In the clinical sample of women
stwierdzono istotne statystycznie with obesity revealed significant
zależności pomiędzy ekspresją statistical correlations between an-
złości a dążeniem do szczupłości ger expression and drive for thin-
oraz symptomami depresyjnymi i ness, depressive and anxiety symp-
lękowymi. toms.
5
See the ‘References’ section for details
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The variety of strategies used by medical translators is neither greater nor poorer
than that of translators who deal with other disciplines. The key factors here are
the requirements and conventions of particular genres –translators of informed
consent documents are expected to be very accurate and close to the original,
while translators of research papers need to consider e.g. the stylesheet used by a
particular publisher. Various aspects of the translation of specialized medical
translation are discussed in Translation and knowledge mediation in medical and
health settings edited by Vicent Montalt and Mark Shuttleworth (2012).
The dynamic development of medicine and natural sciences as well as the global
nature of the international community, the demand for medical translation is
significant, but it still remains a controversial question who should translate
medical text – a medical professional or a linguist or a linguist with some medi-
cal background (cf. O’Neil 1998; Heine 2003; IMIA 2009; Nisbeth and Zethsen
2012). Ideally, a medical translator would not be a medical professional, but an
especially trained translator, i.e. a linguist who underwent appropriate training, a
view which is also supported by IMIA (2009: 4-5). According to IMIA (Interna-
tional Medical Interpreters Association), medical documents should be translated
by professionals who have “a native or near-native, formal level of language
proficiency, analytical capabilities, and deep cultural knowledge in the source
and target languages” (2009: 3), other requirements include at least college level
formal education covering courses in translation theory and practice, proficiency
in the source and target languages, expert knowledge of the subject matter ter-
minology, terminology research skills and adequate writing skills. Other compo-
nents of medical translator competence include: application of translation strate-
gies, relevant procedures, conventions or standards, use of medical databases,
text banks, dictionaries, CAT tools etc. as well as certain psycho-physiological
features such as decision making, thoroughness, honesty etc. (cf. PACTE 2011;
Nisbeth & Zethsen 2012; Karwacka 2012, 2014)
A medical translator’s command of medical English and his or her writing
skills involves a range of genres and registers. Transferring medical information
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Another related issue is quality assurance in medical translation since the quality
of translation may have clinical consequences (cf. Flores et al. 2003). The verifi-
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Wioleta Karwacka
cation guidelines involve a pre-translation preparation and analysis of the ST, its
actual translation and multi-step verification of the TT (cf. IMIA 2009). A valid
verification process also involves the conventions and requirements regarding
various text types and functions (cf. Mobaraki and Aminzadeh 2012), including
readability and clarity in expert-lay communication.
IMIA (2009: 6-11) suggest the following steps in the translation process:
preparing the final version of the ST (poorly written or confusing passages are
likely to be awkward and ambiguous in the target language), which is followed
by commissioning a translator who decides if she or he is qualified to translate
the text, then - translation, and finally - verification: the translated document is
reviewed and edited by another professional, who ideally should have more sub-
ject area expertise and be more experienced than the translator. It is then proof-
read, ideally by a third person. That, however, is not actually the final stage of
the process, as it may be necessary to adapt the TT to local requirements con-
cerning a informed consent documents and other medical texts (cf. Fernández
Piera and Ardura Ortega 2012: 291).
A fairly frequently applied but controversial method of translation review is
back-translation, i.e. the of translation the TT ‘back’ into the source language
by an independent translator who did not handle the original 'forward' translation
of a given text. IMIA advise against applying back-translation as a method for
verification for the reason that it might not reveal “the target language contextual
and usage nuances” (IMIA 2009: 2) or awkward literal translation. On the other
hand, what may appear as an inaccurate rendition in the back-translation is actu-
ally a passage written in idiomatic language (IMIA 2009: 3). Nevertheless, the
blind back-translation technique is frequently used to verify the accuracy of
translation (cf. Andriesen 2006; Fernández Piera and Ardura Ortega 2012), and
its advantages have been proven (Berkanovic 1980; Andriesen 2006). The back-
translation method is widely used in the sector of medical research and clinical
trials, as it is required by Ethics Committees and regulatory authorities in a
number of countries (see Grunwald and Goldfarb 2006: 2), but it should not be
implied that the sole purpose of back-translation is compliance with formal re-
quirements. If it is handled in a professional manner, it can be a useful error
detection tool (Andriesen 2006: 15-16).
The International Society for Pharmacoeconomics and Outcomes Research
(ISPOR) has developed a complex review method which involves two parallel
forward translations, reconciliation, two back-translations, comparison and
reconciliation, a review and harmonisation of the target text. As effective as the
method may appear, it is not frequently employed possibly due to time and
budget constraints (Andriesen 2006: 15-16).
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