The difficulties of medical translation
Medical translation involves unfamiliar terminology, unclear source text and documents that are difficult to read or reproduce. Patient language, changing usage and translated official terminology add difficulties that vocabulary knowledge alone cannot resolve.
Terminology and source text
In a survey of 332 medical translators published in 2016, source shortcomings or ambiguities were reported as a difficulty by 61%, non-standard abbreviations by 59% and identical acronyms with different meanings by 48%. Other difficulties were the vastness of the field (55%), extensive research (46%), technical complexity (41%), rapid developments in medicine and technology (22%) and collocations (15%). Examples of ambiguous acronyms included AHA for acquired or autoimmune haemolytic anaemia, IST for insulin shock therapy or insulin stress test, and AND for axillary node dissection or the ordinary conjunction.
Respondents also identified poor handwriting, complex or unclear writing by doctors and medical writers, difficult texts by non-native speakers, and errors arising from poor quality control. Language difficulties included anglicised Latin, false friends, new terms without target-language equivalents and choosing between learned and everyday terms such as coagulation and clotting or myopia and short-sightedness. Other problems included unfamiliar regulatory standards, inadequate documentation in some languages and a shortage of educational programmes.
A terminology search may produce too many alternatives, with subject knowledge and experience needed to choose between them. Research into an unfamiliar term requires knowing where to search, evaluating sources critically and selecting them precisely; resolving one term can take as long as translating perhaps 600 routine words. A new technology may have no term in the target language, leaving the translator to coin one or paraphrase it, with scientific understanding, communication with the client or agency and help from medical professionals.
Convoluted sentences can be difficult for both translator and reader, requiring writing skill and clarification from the client or author. Poor translation-memory or machine-translation output can also be difficult to recognise without subject knowledge and experience. Current terminology requires relevant reading, continuing professional development and professional contacts; in September 2024 the UK term junior doctor changed to resident doctor, a change circulated through the ITI medical and pharmaceutical network.
Some translators regard research as continuing professional development and value learning to find reliable information and understand a specialised subject quickly. They can decline work outside their competence, and some regard doing so as an ethical obligation. Survey respondents expressed an overriding preference for accepting only texts they were comfortable with and capable of completing successfully. They were less comfortable with regulatory documents and user manuals than with medical communications and scientific articles, possibly because regulatory restrictions and technical knowledge create additional demands.
Medical reports
Medical reports present three particular challenges: acronyms, handwritten or scanned text, and desktop publishing. Unlike journal articles, reports very seldom expand acronyms on first use, so identifying uncommon ones requires medical terminology in both languages and research and technological skills. A handwritten Romanian form mixed Romanian and English abbreviations; experience with handwriting and help from medical colleagues enabled their interpretation.
In a Spanish cardiology report being translated into English for UK follow-up, DI resisted searches in credible terminology resources, consultation with colleagues and a specialist forum because the proposed expansions did not fit cardiology. With the patient's permission, the translators contacted the issuing hospital and learned that DI was a typo for DL, dislipidemia, or dyslipidaemia.
Handwriting may require deciphering before translation can begin, while blurred scans and photographs or cropped margins can obscure or truncate text. Standard practice is to insert [illegible text] only after using available resources and background knowledge to decipher it, since too many insertions may make the translation incomprehensible. If the source is unsuitable, the translator should tell the client; a colleague may help decipher it, or a better copy may be obtained, such as photographs of individual sheets without flash.
Tables, images and graphs also need translation, with the source format reproduced as closely as possible so that readers can compare the documents side by side. Tables are the easiest to reproduce, although translated wording takes different space: English units has five characters and Spanish unidades eight. Overlaying text boxes on an image can work for a few terms, but many boxes may impair its appearance or intelligibility; a translated legend can then convey the information. Where exact reproduction is too difficult, the translator should retain the format as faithfully as possible and describe non-text information in square brackets or a translator's note. Desktop publishing can take longer than translation.
Patient language and the translation brief
Translating a consent form requires understanding how medical information is communicated in the target culture, including doctor–patient relationships, particularly when the document requests active, explicit consent. Expert language may leave the translator deciding whether to find lay alternatives, add explanations absent from the source or ask the client which changes are allowed; additional research can affect delivery times and rates. Ecchymosis and cephalalgia have everyday alternatives, bruise and headache, whereas screening, randomisation and interventional trial may lack lay equivalents.
Long sentences with nested or inconsistently ordered clauses require untangling, and nominalisations, passives, compound phrases and phrasal verbs can resist a lay rendering. Word-for-word or sentence-level calques can produce unnatural target text, while editing for readability may exceed the brief and change budgets and turnaround times. Repetition can confuse readers, making advice to the client about a lay audience part of the translator's work. A condition may never have been discussed in a language community, leaving no established term; patient education still requires both technical accuracy and basic understandability.
Errors in official terminology
Translated standardised terminologies may contain non-equivalent terms that subsequently enter translated medical texts, particularly German summaries of product characteristics using MedDRA. In the German MedDRA examples described in 2014, Schwangerschaft, Wochenbett und perinatale Erkrankungen made pregnancy and puerperium read as disorders, while Wochenbett also shifted the register of puerperium. Erkrankungen der Geschlechtsorgane und der Brustdrüse narrowed reproductive system to genitals and breast to mammary gland, omitting functional aspects and stromal components respectively; Fortpflanzungssystem and Reproduktionssystem were available equivalents for reproductive system. Übersensibilitätsreaktion drew on psychological sensitivity rather than physiological susceptibility; Überempfindlichkeitsreaktion was the suggested rendering of hypersensitivity reaction.
The following preferred terms illustrate further German translation problems identified in 2014.
| English term | Official German rendering | Problem | Suggested rendering |
|---|---|---|---|
| Swelling face | Schwellendes Gesicht | Unidiomatic and not a standard medical term; suggests a face in the process of swelling | Gesichtsschwellung |
| Feeling abnormal | Gefühl anomal | Unidiomatic and not a medical term | Fehlempfinden / Gefühlsstörung |
| Gravitational oedema | Ödem der Gravitation folgend | An unusual phrase despite an adequate German term | Gravitationsödem |
| White blood cell count decreased | Leukozytenzahl erniedrigt | Inadequate collocation; erniedrigt primarily means debased or humiliated | Verminderte Leukozytenzahl |
Clarification and working pressures
Translators should flag unclear content rather than assume its meaning and ask clients or colleagues for help; translator communities can assist with terminology and other problems. A private individual commissioning a medical-record translation is generally unable to help with terminology, whereas an article's author may be very open to clarifying wording because their name appears on the work. Some agencies pass on queries they cannot answer internally, while others or their project managers may be reluctant.
Strict deadlines and long client response times may prevent a query raised on delivery day from being resolved in time. Leaving a comment allows a subsequent proofreader to answer where possible or a project manager to forward a crucial point to the client; clients may respond within hours or never, so a quick reply cannot be assumed.
Deadlines require time management, and translating a serious diagnosis or grim prognosis can be emotionally difficult, especially for a young patient or one close to the translator's age. Coping strategies can help, but no solution fits everyone. Maintaining a work–life balance can also help.