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Medical translation

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Karwacka Wioleta (2015) ”Medical Translation”. In: Ł. Bogucki, S. Goźdź-Roszkowski, P. Stalmaszczyk (eds.) Ways to
Translation. Wydawnictwo Uniwersytetu Łódzkiego pp 271-298.

Medical translation

Wioleta Karwacka

University of Gdańsk

Abstract: Translation is a crucial factor in disseminating knowledge and new discover-

ies in the medical field. It can also be a critical factor in providing healthcare services to
foreigners or minorities. The translators of medical texts face a number of challenges,
some of which are the subject of research. Theyincludemedicalterminology, lexi-
calequivalence of medicaltexts, readability, qualityissues. This chapter offers a general
overview of the major issues in medical translation. It briefly presents the history of
medical translation and the development of medical language. It also discusses certain
characteristic features of medical language: terminology, including eponyms and multi-
word terms, acronyms and abbreviations, affixation, word compounding, the doublet
phenomenon, polysemy and synonymy. Translating for lay-readers and professional
audiences is the next issue presented in this chapter. Considerable attention is devoted to
problems in translating medical texts, and other issues, such as qualifications of medical
translators, verification and review.
Keywords: abbreviations, accuracy, acronyms, eponyms, translation error, medical
terminology, medical translation, quality, translation/translator competence, user-
friendliness

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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Wioleta Karwacka

1. Introduction

Medical translation concerns a number of subject areas, including pharmacolo-

gy, medical rescue system, surgery, obstetrics, paediatrics, psychiatry, internal
medicine, oncology, cardiology and other fields of specialty, as well as other
disciplines, such as law or administration. Translation is a crucial factor in dis-
seminating knowledge and new discoveries in the medical field globally. Medi-
cal translation does not concern a single genre or a homogenous discourse. The
translated texts include popularizations, such as textbooks for medical students,
popular science book on medicine, but also research papers, conference proceed-
ings, case studies, case histories, discharge summaries, reports and relatively
simple texts for patients: information leaflets, consent forms, brochures.
A number of texts are translated due to regulatory requirements concern-ing
new medical products and medical devices or new applications of pharmaco-
logical products. What also generates the demand for the translation of medical
texts is the need to conform to the formal requirements applicable to clinical trial
registration and conduct or marketing new drugs, which involves translating the
registration documents and other necessary materials to the local language. New
findings are published in English, which means that a number of research papers
are translated. The demand for medical translation is also the result of emigra-
tion. What is more, translators prepare medical files for patients who seek medi-
cal help outside their own country of residence. The translators of medical texts
face a number of challenges, some of which are the subject of research. They
include medical terminology, lexical equivalence of medical texts, readability,
quality issues. This chapter offers a general overview of the major issues in med-
ical translation.

2. Medical language

Medical discourse comprises a range of forms of communication. Gotti

(2008: 24) uses the term specialized discourse as ”the specialist use of language
in contexts which are typical of a specialized community stretching across the
academic, the professional, the technical and the occupational area of knowledge
and practice”. Three factors are of crucial importance: the user, the domain of
use and special application of language. Medical language is used in expert-
expert and expert-lay communication, with characteristic features varying from
genre to genre, depending on the communicative situation and its participants.

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Genres used in expert-expert communication such as discharge summaries, case

studies and case notes, imaging reports and research papers use numerous spe-
cialized terms whose semantic value is taken for granted; the only words or
phrases which are explained are those coined or redefined by the author of a
paper or a presentation (cf. Gotti 2008). Expert-lay communication covers pack-
age leaflets, informed consent documents, patient factsheets etc., which use (or
should use) less complex terminology, which is illustrated or explained when it
occurs for the first time (cf. Gotti 2008). The main characteristics of specialized
medical texts include terminology and syntactic features, such as nominalization,
heavy pre- and postmodification, long sentences, use of passives and third per-
son (Askehave & Zethsen 2000). The sections below present some of the most
prominent features of medical English with particular focus on medical termi-
nology and related translation problems and challenges.

2.1. Brief history of medical translation and the development of medical

language

The scientific world is predominantly English-speaking and major scientific

journals publish papers in English. The share of scientific papers written in Eng-
lish in the total number of papers published is 80% according to Montgomery
(2009) and 85% according to Kaplan (2001). But long before English became
the lingua franca of science, Latin was the dominant language of medicine as of
the 2nd century, while Greek remained the language of instruction for medical
students until the 3rd century (Fischbach 1998). In fact, Greek and Latin shaped
the conventions of scientific (not only medical) writing for over 2000 years
(McMorrow 1998: 14).
All the great civilizations kept records of medical findings (McMorrow
1998) and translation has for a long time supported the dissemination of medical
knowledge – Greek medical advances were imported to Rome thanks to physi-
cian translators, Asclepaides for instance (Fischbach 1998: 2). Physicians trans-
lated medical writings to other languages as well, which included Syriac, Arabic,
Farsi, and Hebrew (McMorrow 1998: 15). In the 7th century Baghdad had one of
the most prominent medical schools, which was also a school of
translators. The works of Persian and Arab physicians were translated into
Latin at Toledo School of Translators (Fischbach 1998). Jack Segura (1998:
37) observes that “Arab armies brought with them a treasure trove of
medical and scientific knowledge from Ancient India, Persia, Egypt, Greece
and Syria.” Arabs acted as intermediaries in disseminating medical knowledge,
including the Greek medical heritage. Two recognized translators:
Constantinus Africanus (1020-1087) and
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Wioleta Karwacka

Gerard of Cremona (1140-1187) lived on the Arab-Christian frontier, the former

worked at Salerno and the latter – in Toledo (Ackernecht 1982, McMorrow
1998). Despite the significant role in translation, the Arabic influence on the
language of medicine is relatively small (McMorrow 1998: 15), and mainly con-
cerns botanic names or names of herbs. The 13th century marked the beginning
of the second wave of translations of Greek manuscripts, which were now ren-
dered directly and more accurately.
According to McMorrow (1998: 16) “Latin had a life of about 800 years in
academic medicine (1000-1800)”. In the Middle Ages both Latin and Middle
English were acceptable in medical communication: Latin in academic instruc-
tion and Middle English as the vernacular language. Anglo-Saxon had some
basic medical terminology e.g. head, skull, brain, nose, blood, wound, sore etc.
The 19th century was when the reign of Latin in teaching and writing medi-
cine virtually ended. The effect of that reign, however, is visible to date in the
relative similarity, or “quasi-uniformity” (McMorrow 1998: 21) of medical
lan-guages in the Western world, especially in the Western languages.
The importance of the exact and precise description of anatomy and disease
has been emphasized since the very early stage of medicine
development. (McMorrow 1998; Soubrier 2014). What is observed, however,
is the heteroge-neous and dynamic character of medical language:

Changes in medical knowledge and language have overtaken changes in political

and social context during the past 200 years. A major change in medical terminolo-
gy is well under way, one that will not wipe out the classical heritage, but enfold it
with many layers of heterogeneous material
(McMorrow 1998: 14).

The modern language of medicine employs modern derivatives of Greek and

Latin words “with no concern for etymological purity” (McMorrow 1998: 21).
The corpus of Greek and Latin terminology is still the base of the contemporary
medical language, which also uses new eponyms, acronyms and trade names1.

2.2 Eponyms

Eponyms constitute a considerable portion of medical terminology; they include

names of anatomical parts, e.g. Fallopian tubes, Adam’s apple, names of diseas-

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

es Parkinson’s disease, Alzheimer’s disease, signs and symptoms e.g. Babinski

sign, fractures e.g. Jefferson Fracture, procedures e.g. Heller myotomy, medical
devices e.g. Bard-Parker scalpel (cf. Meals 2007). Eponyms are frequently de-
rived from the names of researchers, but may also be derived from the names of
celebrity patients, e.g. Lou Gehrig disease, a common name for amyotrophic
lateral sclerosis (cf. Walling, 1999), fictitious characters, e.g. Othello’s syn-
drome, or geographical places, e.g. Lyme disease.
Eponyms may be the source of translation problems - the correspondence
between eponymous terms and their equivalents does not necessarily mean that
both source and target terms will be eponymous, although it may be the case:

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

What may be a potential challenge for a translator is the correspondence in

which only one of the terms (only source or only target) is eponymous, while its
coun-terpart is a descriptive term or is formed based on a Greek or Latin root.

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 3. Doublets of eponymous and non-eponymous terms and their equivalents

English non-eponymous Polish eponym Non-eponymous term

eponym term
Giardia Giardia duodenalis Giardia lamblia ogoniastek jelitowy,
lamblia2 Giardia intestinalis Lamblia jelito- wielkouściec jelitowy
wa
Giardiosis Lamblioza Giardioza
Cowper’s bulbouretheral gruczoły opuszkowo-
glands glands cewkowe
Bartholin greater vestibular gruczoły przedsion-
glands glands kowe większe

2.3. Acronyms and abbreviations

One of the characteristic features of medical language is the presence of acro-

nyms, initialisms and clipped forms. With English having the status of the lingua
franca of medicine, English acronyms enter other languages and are used both
by the medical professionals and patients, especially if no native acronym is
commonly used in the local language e.g. MCV, TSH, INR, CRP, LDL, HDL
etc. As presented in the table below, the correspondence between terms and the
type of abbreviation may vary.

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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2.4 Word compounding, affixation and the doublet phenomenon

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.

Table 5. Example of syntactic shifts (phrase change)

Source
Urazy oczodołu stanowią trudny pro-
blem diagnostyczny i terapeutyczny a
ich liczba wciąż rośnie pomimo stoso-
wania wielu, różnorodnych sposobów
zabezpieczenia głowy.
Target
Orbital injuries represent a difficult
diagnostic and therapeutic problem
and their number is still growing de-
spite the use of a great variety of head
protection means.

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

Table 6. Examples of suffixes and prefixes in medical terminology3

Affix Meaning of Examples of use Concept Polish equiva-

affix (EN) lent
Prefix: insufficient hypothermia too low body hipotermia
hypo- temperature
hypoglyc(a)emia too low blood hipoglikemia
glucose
hypocalc(a)emia too low serum hipokalcemia
calcium
Suffix: inflammation bronchitis inflammation zapalenie
- itis in the lining of oskrzeli
the bronchi
dermatitis inflammation zapalenie skóry
of the skin
gastritis inflammation zapalenie błony
in the lining of śluzowej
the stomach żołądka
hepatitis inflammation zapalenie
of the liver wątroby

The differences in affixation between terms in various languages lead to the

differences in semantic distribution observed in pairs of corresponding terms,
with a multi-word term in one language:

Table 7. Multi-word terms

Polish term English term
zakrzepowe zapalenie żył thrombophebitis
zapalenie midałków tonsilitis
tyreotropina, TSH thyroid-stimulating hormone (TSH),
thyrotopin
mięsak prążkowanokomórkowy rhabdomyosarcoma (RMS)

Recognizing multi-word terms as single translation units is therefore one of the

crucial skills of medical translators.
The third feature of FME described by Salager Mayer (1983) is the doublet
phenomenon - terms (usually of Greek and Latin origin) which have their coun-
terparts (usually of Anglo-Saxon origin) in the general language: search – inves-

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.)

2.5 Polysemy and synonymy

The most desired feature in the terminology of any discipline is bi-univocity,

which means that one designation refers to one concept and that one concept
receives only one designation – thus, with this kind of control over terminology,
it would necessarily have two features: monosemy and mononymy (cf. Soubrier
2002, 2014). Desired as they may be, these features are not always present in
medical terminology, whose terms are, to a certain extent, polysemous, and –
sometimes – synonymous. The examples of polysemous terms include:
 inflammation: a physiological function, a clinical condtion, a diagnosis
(Soubrier 2014), all of which are expressed with Polish zapalenie

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Wioleta Karwacka

 arm: a structure, a region (PL: ramię) or a study group in a clinical trial

(PL: grupa badana),
 discharge: secretion (PL: wyciek) or release from hospital (PL: wypis)
 opuszka: fingertip (finger pulp) or (aortic) bulb
 badanie: a test, a trial or an examination
Several of synonymous terms are presented above in the section on eponyms,
but they do not by any means complete the list of synonymous medical terms,
which also includes e.g. Hashimoto’s thyroiditis or chronic lymphocytic thyroid-
itis, osteoarthritis also referred to as or degenerative joint disease or osteoarthro-
sis or degenerative arthritis.
This section is only a brief overview of certain features of medical lan-
guage, which is the focus of more detailed research papers published in Advanc-
es in Medical Discourse Analysis edited by Gotti and Salager-Meyer (2006) or
Vol. 4 No. 7 of JAHR (2013) devoted to medical language.

3. Translation of medical texts for lay readers

Expert-lay communication constitutes a large portion of medical discourse,

en-compassing documents prepared for patients by medical professionals, quite
often in order to comply with regulatory requirements. A frequently translated
doc-ument, which is the focus of a number of research papers (cf. Sand, Eik-Nes
and Lodge 2013) is the informed consent form (ICF) / informed consent
docu-ment (ICD) – a document explaining the nature of the procedures a
patient or a clinical trial participant is to undergo. In Poland, for instance,
approximately 450–480 clinical trials are started, with the total number of
participants reaching 30 thousand patients (Sikora 2010). Under the
Declaration of Helsinki every patient or every study participant has to be
informed on the treatment-related risks. An ICD provides a patient with the
necessary information – by signing it a patient declares that he or she
understands the nature of the procedure or the study. Consequently, a patient
needs to be provided with an ICD in his or her first language. The text needs
to be clear and easily understood. Readability and user-friendliness are of key
importance in the case of informed consent forms as ambiguity undermines the
“informed consent” concept and breaches the provi-sions of the Declaration of
Helsinki. The ICDs, however, are often written in a language which is too
complex for lay readers (Pilegaard 2014). Pilegaard (Ibid.) notices the absence
of research into the linguistic manifestation of ethics in ICDs and emphasizes
the need for a deeper understanding of lay-friendliness and

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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).

Table 9. Corresponding passages from PS and PPI.

Product summary (PS)
Acute overdose could lead initially to
hypoglycaemia and subsequently to
hyperglycaemia. Due to the prolonged-
release characteristics of this medicinal
product peak levels of growth hormone
can be expected approximately 15 hours
after injection, see section 5.2. Long
Package leaflet (PPI)
If you use more Somatropin Biopart-
ners than you should, you should con-
sult your doctor.
If you have used too much of this
medicine, initially your blood sugar
may decrease and become too low.
Subsequently, it may increase and

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Wioleta Karwacka

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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4. Problems in the translation of specialized medical texts

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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Wioleta Karwacka

Extract (g) is an example of transediting (cf. Chesterman 1997); a number

of shifts are observed in the translation of this text and their purpose seems to be
following target conventions and achieving better reader-friendliness. The topic
sentence is added. The strategies employed in this sentence include: emphasis
change najistotniejszą – important, the addition of female (explicitation - both
men and women can be diagnosed with androgenic alopecia), unit change (cf.
Chesterman 1997) and addition of newly developed techniques:

Współcześnie możliwości diagnostyczne poszerzyły się o fototrichogram, tricho-

skan, trichoskopię oraz refleksyjną mikroskopię konfokalną in vivo.
Newly developed techniques enlarge the spectrum of possibilities in diagnosing
hair loss. These include the phototrichogram, trichoscan, trichoscopy and in vivo
reflectance confocal microscopy.

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:

Opiera się na obserwacji, że włosy anagenowe rosną, natomiast włosy telogeno-

we są niezmienione, gdy obserwuje się kolejne makrofotografie tej samej okolicy
skóry owłosionej głowy.
The basis for the phototrichogram is the observation that growing hairs are in the
anagen phase and non-growing hairs are in the telogen phase. Subsequent mac-
rophotographs of a shaven scalp area allow the percentage of telogen hairs to be as-
sessed.

Information changes, explicitness changes and other pragmatic strategies

are also observed in the remaining part of the text, a transition is added
(another recently developed method), some unit-content manipulation is
observed – the information that it is not necessary to remove hair is
moved to the sentence which introduces the part about trichoscopy, and
the term trichoscopy is explained. Explicitness change is visible in the
segment łodygi włosów, lejków mieszków włosowych i skórę otaczającą
mieszek włosowy – hair thickness and structure, and the perifollicular
area. What is also observed in this segment is that the source elements are
richer images than those in the target version. Information on zoom val-
ues is omitted, and so is the penultimate source sentence, which is partly a

284
 Medical Translation

repetition of the information which is presented in preceding segments.

Although translators are frequently required to produce a target text
which is very close to the original, such shifts are not uncommon in trans-
lating research papers – pragmatic shifts may improve the readability of
the text, without misinforming the expert readers, who probably know the
implied information.

Table 10. Extracts from medical research papers translated into English5
Source
a) Ustalenie rozpoznania żylnej
choroby zakrzepowo-zatorowej
(VTE), na którą składają się za-
krzepica żył głębokich (DVT) i
zator tętnicy płucnej (PE), wyma-
ga zarówno oceny klinicznej, jak i
wykonania dodatkowych badań
obrazowych, a w wybranych sytu-
acjach klinicznych — także testów
laboratoryjnych.
b) Przeprowadzone w ostatnich latach
duże próby kliniczne dowodzą, że
terapia złożona nadciśnienia
tętniczego ma już ugruntowaną
pozycję.
c) W grupie kobiet z otyłością
stwierdzono istotne statystycznie
zależności pomiędzy ekspresją
złości a dążeniem do szczupłości
oraz symptomami depresyjnymi i
lękowymi.
Target
Making a diagnosis of venous
thromboembolism (VTE), mani-
festing as deep vein thrombosis
(DVT) and/or pulmonary embo-
lism (PE) requires clinical assess-
ment, as well as imaging and — in
selected clinical settings — labora-
tory tests.
Large clinical trials performed in
the last few years prove that com-
bined therapy of essential hyper-
tension has reached a secure posi-
tion lately.
In the clinical sample of women
with obesity revealed significant
statistical correlations between an-
ger expression and drive for thin-
ness, depressive and anxiety symp-
toms.

d) Do badania zakwalifikowano 152 Total number of randomly chosen

osoby.
e) Glikemia w grupie interwencyjnej
była znamiennie mniejsza niż w
grupie kontrolnej w 180., 330.,
420., 450. i 480. minucie.
f) Większość pacjentów chorujących
hospitalized patients engaged in
the study was 152.
The glycaemia in the investigated
group was significantly lower than
in the control group in 180, 330,
420, 450 and 480 minute.
Most patients with hypertension

5
See the ‘References’ section for details

285
Wioleta Karwacka
na nadciśnienie tętnicze wymaga
leczenia więcej niż jednym lekiem
hipotensyjnym. Dotyczy to szcze-
gólnie pacjentów z innymi współ-
istniejącymi chorobami. Z tego
względu terapia nadciśnienia tętni-
czego przy użyciu preparatów zło-
żonych jest konieczna do osiągnię-
cia właściwych wartości ciśnienia
tętniczego. W wielu przypadkach
terapia ta przyspiesza osiągnięcie
celów terapeutycznych przy po-
równywalnej lub lepszej tolerancji
niż w przypadku monoterapii
wyższymi dawkami leków hipo-
tensyjnych. Dodatkowymi kwe-
stiami mogą być korzyści ekono-
miczne takiej terapii oraz efektyw-
niejsza współpraca z pacjentem.
g) Współcześnie możliwości diagno-
styczne poszerzyły się o fototri-
chogram, trichoskan, trichosko-
pię oraz refleksyjną mikroskopię
konfokalną in vivo. Fototricho-
gram jest metodą rzadko stoso-
waną w praktyce. Opiera się na
obserwacji, że włosy anagenowe
rosną, natomiast włosy telogeno-
we są niezmienione, gdy obserwu-
je się kolejne makrofotografie tej
samej okolicy skóry owłosionej
głowy. Trichoskan to cyfrowy,
zautomatyzowany odpowiednik
fototrichogramu. Trichoskopia jest
cyfrową metodą diagnostyczną
opierającą się na technice wideo-
dermoskopii. Najczęściej stosowa-
nymi powiększeniami są powięk-
szenia 20-krotne i 70-krotne. W
trichoskopii ocenia się łodygi wło-
sów, lejki mieszków włosowych i
skórę otaczającą mieszek włosowy.
Metoda umożliwia ocenę struktur
włosa bez konieczności pobierania
286
require more than a single antihy-
pertensive agent, particularly if
they have comorbid conditions.
Combination therapy of hyperten-
sion with fixed-dose combination
pills is required by most patients
with hypertension to reach target
blood pressure. In many cases,
combination therapy improves
rates of blood pressure control
and requires less time to achieve
target blood pressure with equiva-
lent or better tolerability than high-
er-dose monotherapy. Additional
benefits may include cost savings
and better compliance.
Recent years have brought signif-
icant progress in hair diagnostic
techniques. Classic methods of hair
evaluation, other than clinical exam-
ination, include evaluation of daily
hair loss, hair weighing, pull test,
wash test and the trichogram. Histo-
pathological examination of the
scalp skin remains an important
method in differential diagnosis of
hair loss, in particular in differenti-
ating female androgenic alopecia
from chronic telogen effluvium and
in diagnosing alopecia areata or
cicatricial alopecia. Newly devel-
oped techniques enlarge the spec-
trum of possibilities in diagnosing
hair loss. These include the photo-
trichogram, trichoscan, tri-
choscopy and in vivo reflectance
confocal microscopy. The basis
for the phototrichogram is the
observation that growing hairs are
in the anagen phase and non-
growing hairs are in the telogen
 Medical Translation

włosów. Trichoskopia pozwala na phase. Subsequent macrophoto-

różnicowanie łysienia androgeno-
wego kobiet z przewlekłym łysie-
niem telogenowym oraz umożliwia
rozpoznanie włosów dystroficz-
nych, resztkowych i ułamanych.
Nowoczesną metodą wymagającą
dalszych badań jest nieinwazyjna
technika obrazowania włosów i
skóry owłosionej głowy metodą
refleksyjnej konfokalnej mikrosko-
pii skaningowej in vivo.
graphs of a shaven scalp area
allow the percentage of telogen
hairs to be assessed. A trichoscan
is a computerized form of this
technique. Another, recently devel-
oped method, trichoscopy (hair and
scalp dermoscopy), allows evalua-
tion of the whole scalp without the
need to remove hair. Trichoscopy
allows one to analyze hair thick-
ness and structure, and the peri-
follicular area. In a recently pub-
lished study, the usefulness of
reflectance confocal laser scanning
microscopy in diagnosing hair
shaft abnormalities was docu-
mented.

What seems to be a noticeable tendency is avoiding the excessively impersonal

tone of a paper:
a) wyniki badań wskazują
our findings show
b) Celem niniejszej pracy było ustalenie, jaki odsetek stanowią wśród
nich pacjenci, u których potwierdzono rozpoznanie…
The aim of our study was to determine the percentage of children
with confirmed diagnosis of osteoporosis…
c) W pracy terapeutycznej warto zwrócić uwagę na rolę, jaką odgrywa
negatywny obraz ciała oraz sposób wyrażania złości przez osoby z
otyłością.
We should take into account the large role that negative body image
and anger expression play in treating obesity.
d) Autorzy niniejszej pracy uważają, iż rekonstrukcja lewej żyły nerko-
wej jest stosunkowo prosta technicznie i jeżeli jest to tylko możliwe,
powinno się ją przeprowadzać w każdym przypadku.
We consider the reconstruction of the left renal vein to be technically
relatively easy and it should be performed in every possible case.
e) przedstawiono przypadek 16-letniego sportowca
we present a case of a 16-year old cyclist vs. w niniejszej pracy

287
Wioleta Karwacka

f) Podsumowano dotychczas prowadzone i trwające badania kliniczne

poświęcone terapiom komórkowym w udarze mózgu.
Finally, we report recent and on-going clinical trials on stem-cell
therapy in cerebral stroke.

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).

5. Qualifications of medical translators

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

288
 Medical Translation

for patients means avoiding unnecessary jargon, complicated syntax, or highly

specialized vocabulary. Translating documents which are written for medical
professionals, on the other hand, requires specific terminology and discourse
markers typical of similar texts produced in the target language. Therefore, a
translator’s linguistic competence involves general and specialized languages.
That is why medical training is not limited to acquiring medical knowledge (cf.
O'Neil 1998: 73).
Having said that, background knowledge of medicine is necessary to ensure
that a message is transferred without distortions, which is one of the critical is-
sues in interlingual and intercultural knowledge mediation (cf. Montalt and Shut-
tleworth 2012; Karwacka 2014). Medical translators do not only acquire medical
knowledge through medical studies and they are not always physician-
translators: “there will always be more medical translations than can be handled
by the relatively few physicians who translate (and) medical translation will
perforce be done by non-physicians” (O’Neil 1998:69).
Some information on the background of medically knowledgeable linguists
is provided by the results of a survey Marla O’Neil (1998) conducted among
translators who are not physicians, but specialize in medical translation. Her
study revealed that medical translators acquire background knowledge by study-
ing medicine, participating in medical courses, working in a position indirectly
related to healthcare or medicine or participating in medical translation courses.
Other factors included access to medical professionals, medical professional
relatives, and a medical condition which resulted in doing background research
and contact with medical professionals. Most respondents to O’Neil’s question-
naire admitted that their translation was hardly ever verified.
The reality of medical translation too frequently shows that translators must
assume sole responsibility for the quality and accuracy of medical translations,
which seems to be one of the factors behind the often poor or substandard quali-
ty of medical translation, rather than merely the question of medical versus lin-
guistic educational background of the translator (cf. Karwacka 2014), especially
if it is medical translators themselves that decide whether they are qualified
enough to perform a particular translation task that they are considering to take
on.

6. Verification and review in medical translation

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-

289
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).

290
 Medical Translation

Parallel translation can also be applied as a standalone quality assurance

method: two parallel translations are produced, then compared and adjusted, if
necessary. The outcome of the process is the final TT which is a compilation of
the two parallel translations. This method affects the budget of a translation pro-
ject, but: “in this case the additional cost has a much more direct and positive
effect on the quality of the final document than is the case with a back-
translation” (Andriesen 2006: 16).
Another quality assurance method is cognitive debriefing. It is used as an
assessment tool for instruments such as questionnaires or scales. It involves
gathering feedback from a sample group of patients to learn how they under-
stand the wording of a given question. The purpose is to verify if the wording is
lay-friendly and reflects the intended concept at the same time (cf. Ploughman,
Austin, Stefanelli & Godwin 2010; Karwacka 2014).

7. Summary

This chapter is a brief overview of medical translation-specific problems rather

than an exhaustive presentation of all the issues in detail. Medical translation is a
complex and interesting phenomenon in which linguistic, sociocultural, scien-
tific, economic and other factors are at play. That is probably why multidiscipli-
nary approach is so useful in approaching medical translation in research.

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