How to Avoid Mistakes in Medical Translations

I have been planning to write about the impact of errors in medical translation for some time. But not without doing some research first. I tried to avoid the tabloid press approach by using headlines like:

“Young Mother had the wrong leg amputated due to a translation error.”

In my opinion, it is rather unresourceful to lay on a scare tactic by using translation mistakes to reach out to prospects.
While translations need to be accurate regardless of the subject – whether it concerns tips for “flower arrangement” or a “user manual for a dialysis machine” – medical content calls for extra diligence. For the simple reasons that it affects patients’ lives.

female nurse in operating theatre

To err is human
True! But, what makes us humans unique is the ability to learn from mistakes. We can develop measures to minimise them.
For that reason, I have compiled a list of tips on how to avoid mistakes when translating for medicine and healthcare.

Searching through some online databases, I have come across a variety of cases where translation errors have resulted in serious incidents. Above all, a translation mistake that happened in a hospital in Berlin. Due to a non-professional translation, 47 patients ended up with a wrong knee replacement.

However, Most other reported cases of translation errors which led to “Serious Incidents” have two things in common: ‘Patient Communication’ and ‘Emergency Situation’.
In fact, most of these case reports describe the failure of a healthcare provider to produce a professional interpreter (“at all” or “in time”).

In this article, however, I won’t cover interpretation errors and focus primarily on the translation of medical text/literature.

brown glas bottles used in Pharmacy

Why do Mistakes in Medical Translation happen?

Owing to the complexity and specialist terminology, literature with highly specialist content is probably the hardest to translate. As a result, it is most prone to inaccuracy and mistakes.

Not enough background knowledge:

The discussion on who is better at translating medical content:
The linguist who specialises in medicine or a Medic with translation skills? – has been going on for some time. Reaching no clear verdict.

Certainly, one thing is clear:
Not every bilingual Medic is able to produce a concise translation and not ever linguist can handle medical content.

Above all, Translators from the linguistic faculty tend to be more proficient at keeping the patient-focused information simple. Whereas the medically trained Translator tends to use more jargon. On the other hand, the medically trained Translator feels more at ease with specialist subjects – for obvious reasons.

glass skull with vasculature

Example:
During proofreading of a text about intrauterine fetal catheterisation (obstructive uropathy), I noted the following:
The linguist chose a German translation similar to “clogged up” when translating the term “obstructed”. Although linguistically a correct choice, this interpretation was wrong. A medically trained professional would inherently have known that the causes of fetal obstructions are either due to anatomical malformation or external compression (rather than lithiasis) and instinctively use more appropriate wording. Needless to say that a potential buyer of this catheter would pick up on that and regard the text – or even the manufacturer – as “Non Expert”.

How to avoid Errors in Medical Translations

  1. Get the feeling of the content
  2. Don’t assume
  3. Take timeouts
  4. Know your Acronyms
  5. Localise your Eponyms
  6. Do Research
  7. Readability rules!
  8. Avoid premature closure

1. First contact: How does the content of this text make you feel?

Now, before you call me an esoteric tree hugger, consider the following example:
You’re an Anti-vaxxer and in front of you is a patient information leaflet about the latest vaccine for measles – ready to be translated.
You can probably see where I’m coming from now.
Although translators in the scientific fields wish to think of themselves as objective and dispassionate, it is a known fact that emotional bias plays an important factor and can interfere with the quality of the final translation.
Tip: If you disagree with the content, say No and refuse the assignment. Alternatively, try to examine your reaction to the text consciously and acknowledge these feelings. This way, you might be able to reduce your bias and perform with greater objectivity.

2. Don’t assume

This error occurs when translators who are not 100% familiar with a subject matter draw from what is easily accessible in their minds, rather than what is actually meant in the source text. Cognitive short cuts such as “Tumour is another word for cancer”, can lead to a completely wrong approach when for example translating a text about space-occupying lesions in the brain.

I can recommend a fantastic read about heuristics and biases by Daniel Kahneman, it’s called: Thinking Fast and Slow.

3. Take Timeouts:

Now and then, interrupt the Translation process to check for accuracy.
This timeout will allow you to take a fresh look. Change the focus temporarily from the sentences (or paragraph) and review the content globally.
It is a bit like interim proofreading. However, this method is time-consuming and difficult to adapt when under pressure.
Your CAT tool may be of help and allow a rapid interim filter of significant parameters.
Tip: during this process, you might come across mistakes in medical translation that are worth checking again in the final quality assessment. Add them to the list of essential quality control points.

4. Know your Acronyms:

More often than not, acronyms are taken over from English – the lingua franca of science. Still, this is not always the case. If unsure, it needs to be researched. An example: Inflammatory bowel disease, IBD in English is more frequently known as CED (chronisch-entzündlichen Darmerkrankungen) in German.
Use this free online acronym checker from MediLexicon.

5. The localisation of eponyms:

The definition of Eponyms is as follows:
A name for a disease, procedure, organ, or body function that is derived from the name of a person who first identified the condition (or devised the object).
It comes as no surprise that different countries honour different persons and therefore, depending on the region, Eponyms can differ. The famous example being Graves’ disease which in German Literature is called Morbus Basedow.

6. Research:

Not only terminology research but also the broader field of the subject matter should be explored before attempting any translation in the clinical sector. If an invasive or surgical procedure is part of the content, familiarise yourself with the anatomy and terminology thereof. If a disease features in the text, refresh your mind regarding the pathology to reduce mistakes in medical translation.

7. Keep Patient information simple:

Not only mistranslation but Readability can have ramifications on patients’ wellbeing. So I have added this point to my list of tips.
It is a known fact that patients do not retain all the information given during a consultation with a doctor. For this reason, the trainee doctors are taught at medical school to repeat every critical piece of the information three times to the patient. If patients lack information, they will refer to written instructions (once back home and more relaxed).
As a study from 2012 by Nisbeth and Zethsen (1) revealed: Patients do not follow written treatment guidelines when lacking clarity.

Information or Instructions aimed at Patients need to be kept simple. If a jargon term cannot be expressed with simple words, it must be defined before using it. Words with different meanings should be avoided, to prevent confusion. In fact, once a medical “term” has been used, the same “term” should be repeated throughout the text, instead of replacing the “term” with synonyms.

8. Premature delivery of a translation:

Before delivering a medical translation containing mission-critical information, it has to be proofread by a second person and ideally quality assessed by a third one. I compare this process to the multidisciplinary approach used in clinical practice.
Example of a multidisciplinary approach:
The diagnosis and treatment plan of a life-threatening disease like cancer is never made by one person alone. When deciding diagnosis and treatment, every hospital in the UK has meetings where every case is reviewed by several specialists such as a radiologist, pathologist and others.

For the maximal safety net to detect mistakes in medical translation, such multi-person measures can and should be adopted in the translation process of critical clinical information.

male hand writing word Quality with a pen

To summarise:

Make sure you feel comfortable with the subject matter and up to speed with the terminology of the content in front of you. Take your time in reviewing the output throughout the translation process, even if you are under time pressure. Develop a quality assurance routine using your CAT-tool.
Together with the proofreader and quality assurer, you will be part of an optimal team – reducing mistakes in medical translation to an absolute minimum and delivering a great product to your customers.

References:
(1) Nisbeth Jensen, Matilde & Korning Zethsen, Karen. (2012). Translation of patient information leaflets: Trained translators and pharmacists-cum-translators – A comparison. Linguistica Antverpiensia. 11. 31-49.

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