ESSENTIALS FOR MEDICAL INTERPRETERS AND TRANSLATORS
Orlando González, MS, EMT-P
President, AccuLingua Communications & Consulting Services, LLC
Abstract: Medical interpreters must strive to continually further their knowledge and skills. The
ability to interpret accurately and completely is, to a large extent, dependent on how much
background knowledge the interpreter has of the content and the context of the communication.
In the field of health care interpreting, the areas of knowledge that are most salient include the
medical context (e.g., the basic parts and functioning of the body and common disease
syndromes and their respective treatments) and the socio-cultural context of the patient
populations for whom the interpreter interprets. The more background knowledge the interpreter
has, the more likely it is that the meaning of the messages will be fully understood and therefore,
the more likely it is that the conversion will be faithful to the original message.
Latino immigrants add a unique flavor to the language of medicine. Communication with the
patient and family members is essential to properly triage, assess, and diagnose medical
conditions. A clear contextual understanding of the patient’s cultural medical expressions by
national origin will complement the medical language. This bilingual workshop
(English/Spanish) will cover both the language of medicine at the provider’s level and the
colloquial level for different Latin American countries.
The ever developing medical profession coupled with the continuous influx of Ibero-American
immigrants into the United States adds an extraordinary challenge for medical interpreters and
translators. The vast field of medicine has a rich and specific language that is influenced by
etymological conventions, historical developments, eponyms (words based on the personal
names of people), polysemic renditions (words having several or multiple meanings), and even
political persuasions. Moreover, the diverse numbers of Spanish-speaking people in this country
represent 22 different countries in three continents plus several islands on both hemispheres, and
over 340 million people worldwide.1
Medical interpreters and translators must strive to continually further their knowledge and skills
in the basic health-related sciences and clinical practice. The ability to accurately and completely
convey the original message into the recipient language is, to a large extent, dependent on how
much background knowledge the interpreter or translator has of the content and the context of
the message. In the field of health care interpreting, the areas of knowledge that are most salient
include the medical context (e.g. the basic parts and functioning of the body and common disease
syndromes and their respective treatments) and the socio-cultural context of the patient
populations.
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Latino immigrants add a unique flavor to the language of medicine. Communication with the
patient and family members is essential to properly triage, assess, and diagnose medical
conditions as well as to effectively expose and elicit information from the patients and medical
professionals. A clear contextual understanding of the patient’s cultural medical expressions by
national origin will complement the medical language. Interpreters and translators must have a
working knowledge of Ibero-American colloquial idioms, semantic interpretations, and
idiosyncratic expressions such as euphemisms, pleonasms, and even incorrect usages of the
languages that may express a connotative idea quite different from its denotative intent. Most of
these linguistic applications stem from over 500 years of European, African, and indigenous
cultural influences.
Over the last several years, the Spanish-speaking population in the United States has grown 58%
to reach over 35 million, representing one in eight of all Americans. The potential language
barriers faced by this population are also significant. The Census 2000 Supplementary Survey
estimates that over 44 million Americans over the age of 5 speak a language other than English
at home. For 62% of those 44 million, that language spoken in the home is Spanish.
In addition to their high growth and relative need of language services, working with Spanishspeaking immigrants – because of the wide variety of their countries of origin – offers both
medical interpreters and translators a unique challenge and opportunity for insights into the
interplay of culture and language in the health care setting. By specifically addressing language
and cultural issues, it is hoped that everyone responsible for rendering oral and written
information accepts the task of learning more about what is needed for medical providers to
effectively ensure equal access to health services for Non-English Proficient and Limited English
Proficient populations. With this end in mind, the medical interpreter and translator must always
keep and apply the following three essential truths: (1) English and Spanish are two different
languages, (2) the nature of medicine demands urgency with impeccable conduct, (3) medicine is
a highly specialized field.
1.
ENGLISH AND SPANISH: TWO DIFFERENT LANGUAGES
Even though English and Spanish are classified as Indo-European languages, their structures and
evolutions make them part of two different subfamilies. English belongs to a subfamily of
languages known as Germanic.2 The Germanic languages are related in the sense that they can be
shown to be different historical developments of a single earlier parent language. Spanish,
conversely, belongs to the subfamily of Romance languages, which are variant developments of
Latin. They developed from the colloquial Latin of late Roman times.3
The professional interpreter and translator must constantly remind himself or herself that the
source and target languages are indeed two separate languages. It is then his or her job to keep
the target language from being contaminated or forced by the recipient language.4 To accomplish
this goal, the original idea must be adjusted into the second language in a linguistically and
culturally appropriate manner while preserving the intended message.
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Essentials for Medical Interpreters and Translators
Two essential principles to keep in mind are that, in order to express a faithful rendition of the
source language in the target language, the interpreter and translator must first comprehend the
original message and then express its meaning in the recipient language.5 Comprehension is the
key to effective interpretation and translation. Therefore, professional interpreters and translators
must be avid readers in both languages in order to ever expand their linguistic abilities and
subject matter expertise. An important goal is to keep from following the easier path during the
language conversion process and meaning adaptation. This is of utmost importance since there is
always a natural tendency to select words or phrases that are similar in their English and Spanish
morphology; but, after taking a closer look, they may reflect messages that are totally different.
Recognizing Anglicized words and false cognates requires comparative knowledge of both
languages and medical discernment of scientific usages between American and Latin American
clinical settings.6 A myriad of printed materials in the United States reflect improper adaptations
of the Spanish language into a merely invented dialect that results from a lack of knowledge of
the Spanish language by Spanish-speaking individuals. This impropriety is then reaffirmed by
the national Hispanic media and other self-proclaimed language experts. Even more, many
Spanish-speaking immigrants, whether it is from ignorance or insecurity, tend to conform to
these erroneous practices, thus perpetuating an ever changing and volatile adulteration of the
Spanish language.
The job of medical interpreters and translators becomes a serious mission bathed with discipline
and responsibility. It encompasses a professional and moral responsibility that ensures seamless
communication between two different languages for the benefit of two distinctive parties with a
common purpose. They are professional communicators who also happen to preserve two
different languages.
2.
NATURE OF MEDICINE: URGENCY WITH IMPECCABLE CONDUCT
While medicine is not an exact science, it requires urgency and impeccable conduct from every
member of the treatment cycle. This treatment cycle is made up not only by physicians, nurses,
and allied health personnel but also by those who convey information to providers, patients, and
care givers. Communication in the health care setting, whether oral or written, must be rendered
with a sense of expediency and flawless behavior.
The professional medical interpreter and translator must recognize that he or she has a legal,
ethical, and moral obligation to those who do not share a common language. He or she also
shares the same degree of liability borne by the other members of the treatment cycle. An
important factor to always consider is that the information being communicated could potentially
have a positive or negative impact on the welfare of the patient, family members, and other
members of the medical team. This is indeed a matter of life and death governed by the same
principles of human dignity and respect that characterize well-known medical precepts such as
“Primum non nocere” – Latin for "First, do no harm."
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Besides the duty to act on behalf of the patient and provider, interpreters and translators must not
be guilty of dereliction or breech of duty. Once a professional service has been advertised,
whether formally or informally, there exists an implied duty to be ready to respond without any
perceived or real discrimination. Moreover, after an assignment is accepted, the medical
professional, including interpreters and translators, must finish the job as agreed. Abandonment,
in the medico-legal sense, is a form of negligence. This practice, with even greater impact when
performed by interpreters, can take many forms. An interpreter, for instance, may leave a nonEnglish speaking patient in the Emergency Department before a provider has finished
questioning the patient. The liability focuses on the dual fact that the medical interpreter did not
provide the continuity of care that the patient required and the failure to provide continued
treatment caused the patient further injury.7 The probability of this scenario is greatly minimized
when all medical professionals abide by established standards of conduct.
Just like many other professions, the profession of medical interpretation and translation are
governed by a strict code of ethics and standards of practice. Health and social service agencies
have moral and legal obligations to follow a code of ethics that respects the rights of the patients.
These guidelines involve at least three areas. First, the policies and procedures of the contracting
organization form the basis of the institutional code of ethics and practices. Of utmost
importance here is the statute of confidentiality. Second, interpreters and translators must adhere
to a set of rules and regulations that make up the ethics of the profession. For example, the
professional language communicator must convey all information with fidelity and accuracy.
Finally, medical interpreters and translators must always adopt a professional conduct toward
their coworkers, clients, and colleagues. This is part of their personal code of ethics.
Interpreters and translators must continually safeguard the trust that has been bestowed upon
them. Trust is the common link that binds professional interpreters and translators with providers
and patients. If this bond of trust is violated or misrepresented, the interpreter will then lose
credibility; consequently, he or she will not be effective.
3.
MEDICINE: A HIGHLY SPECIALIZED FIELD
Professional medical interpreters and translators are not expected to know as much as the
physicians, nurses, or other members of the healthcare team; however, they are expected to have
a comparable level of intellectual ability. This level of cognitive reasoning gives the professional
communicator a degree of confidence and credibility to perform his or her daily tasks with
authority and efficiency. While interpreters and translators do not need to be as knowledgeable
as the speakers or authors, they must have sufficient knowledge of the ideas and concepts at
hand.8 It is this power of reasoning, not necessarily the command of facts, which gives
interpreters and translators the ability to twig, transform, and transmit the intended message.
A degree of subject matter expertise beyond that of an average person is a prerequisite for
effective interpretation and translation. This amount of knowledge serves as a precursor to
comprehension. Consequently, it behooves medical interpreters and translators to read and study
information that relates to various medical conditions and treatments both in English and
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Essentials for Medical Interpreters and Translators
Spanish. There must be an emphasis on vocabulary development by systematically preparing and
studying glossaries on various medical topics. Even in the absence of required specialized
continuing education in the field of medical interpretation and translation, the professional
communicator must seek to participate in annual workshops and training sessions to secure a
minimum of continuing medical education units just like any other member of the treatment
cycle.
Medicine is an ever growing and specialized field. Every year, new diseases are continually
being researched, new treatments are being tested, and new technological advances are being
implemented worldwide. Just in the United States, the Food and Drug Administration (FDA)
adds and deletes hundreds of prescribed and over-the-counter drugs every year.9 Moreover, every
Ibero-American country admits new medications through their drug regulatory agencies.
Hundreds of these medications make their way to the American market regardless of FDA
approval.
The current demographic explosion in the United States goes beyond an increase in the number
of Spanish-speaking populations. It has also attracted the development of a new market of
pharmaceutical products that are being sold in local ethnic stores and consumed by immigrants
and non-immigrants alike. Since many of these medications are not FDA approved, they do not
form part of the curriculum at most medical, pharmacy, and nursing schools in the U.S.
Furthermore, many of these drugs are not found in the American Physicians Desk Reference, a
commercially published compilation of manufacturers' prescribing information on prescription
drugs, updated annually, which is widely used by medical specialists. While the majority of these
imported medications could be classified under an over-the-counter category, many of them also
include prescribed drugs such as antibiotics and contraceptives that are readily available without
prescription. The potential for adverse interactions with prescription and even over-the-counter
medications makes these unapproved drugs dangerous to consumers. Professional medical
interpreters and translators with a basic understanding of this new market become a great asset to
the medical community as they exercise their role of language clarifiers and bring awareness to
the medical practitioners and educators. This fact even adds more weight to the seriousness and
accountability of the profession of medical interpreters and translators.
The distinctiveness of the two languages, the urgency of the profession, and the specialty of the
field are but three essential elements that must be considered by professional medical interpreters
and translators. They do not constitute, however, the only elements of effective communication
through a third party. The more background knowledge the interpreter and translator have, the
more likely it is that the meaning of the messages will be fully understood; therefore, the more
likely it is that the conversion will be faithful to the original message. This is part of the essential
foundational structure that demands development, updates, and adaptations. These elements have
even greater significance when dealing with the ever changing variables that connect language,
medicine, and human beings of sundry multiple backgrounds.
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Orlando González
NOTES
1
“Romance Languages: Spanish.” Verbix, July 7, 2007 < http://www.verbix.com/languages/spanish.shtml>.
2
“Germanic Languages: English.” Verbix, September 21, 2006 < http://www.verbix.com/languages/english.shtml>
3
“Languages: Romance.” Verbix, September 23, 2006 < http://www.verbix.com/languages/romance.asp>
4
Marina Orellana, La Traducción del Inglés al Castellano (Santiago de Chile: Universitaria, 1990) 26.
5
M. Eta Trabing, Introduction to Court Interpreting (Pensacola: Berkana, 2002) 11-12
6
Fernando A. Navarro, Diccionario crítico de dudas inglés–español de medicina, 2da Edición (Madrid: McGrawHill) XVII-XX
7
Arnold S. Goldstein, EMS and the Law (Bowie, MD: Prentice-Hall, 1983) 44-46
8
M. Eta Trabing, Introduction to Court Interpreting (Pensacola: Berkana, 2002) 13
9
“Center for Drug Evaluation and Research.” FDA. August 24, 2007 <http://www.fda.gov/cder/index.html>
REFERENCES
1. Verbix. 2004 <http://www.verbix.com/>
2. Orellana, Marina. La Traducción del Inglés al Castellano. Santiago de Chile: Universitaria,
1990.
3. Trabing, M. Eta. Introduction to Court Interpreting. Pensacola: Berkana, 2002.
4. Navarro, Fernando A. Diccionario crítico de dudas inglés-español de medicina. 2da Edición.
Madrid: McGraw-Hill, 2005.
5. Goldstein, Arnold S. EMS and the Law. Bowie, MD: Prentice-Hall, 1983.
6. “Center for Drug Evaluation and Research.” FDA. August 24, 2007
<http://www.fda.gov/cder/index.html>
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