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Foreign-Language Medical Records: When Every Detail Counts
By Ann Wiles, CCS

A medical record can be a minefield of details. A nurse has scribbled an illegible note in the margin. A page from another patient’s file has accidentally been slipped in. A handwritten medication dosage is unclear.

And when a medical record isn’t written in English, the situation gets worse. If you don’t speak the foreign language, how can you be sure your translation is accurate and complete? So let’s talk about what can go wrong with foreign-language medical records and what you can do about it.

What’s the Big Deal?
Medical terminology is basically the same from one language to another, right? So how hard can it be to read a medical record in another language? In reality, it can be difficult or impossible, even for medical experts.

A doctor once asked me to translate 20 pages of medical records on a patient who was coming from a French-speaking country to the United States for specialized care. I could tell exactly where the doctor had given up trying to read and translate the information from French to English—at the top of page 3, where her handwritten notes left off. After my translation, she said, “It reads just like a regular medical record,” and she was able to provide appropriate care to the patient.

What Can Go Wrong?
A poorly translated foreign-language medical record is useless at best, misleading at worst, and always a waste of money. The following are some problems that may arise during the translation:

• Missing information: It’s tedious to re-create everything that was in the original document, including a note scribbled in the margin, but the information is essential and might make a difference concerning a patient’s treatment.

• The wrong patient: The name stamp is not the same on all the pages of the medical record, but the translator simply copied and pasted and didn’t check carefully. This could be a page from the wrong person’s medical records.

• The wrong date: I’ve seen as many as three date formats in one medical record. Sometimes this means the date of service can’t be determined, and the translator should indicate this clearly.

• The wrong translator: The translation of your medical record says “illegible” or “illegible page” everywhere you look, usually referring to handwritten sections. Physician handwriting is notorious for illegibility. Some text will be completely illegible, but in my experience, the more “illegibles” there are, the less experienced the translator.

• The wrong abbreviation: Medical records use acronyms liberally, but they can be untranslated or mistranslated. Medical records in foreign languages use acronyms that are sometimes in the foreign language, sometimes already in English, and sometimes a mixture of both. Failing to translate them isn’t an option. In a French record, for example, PAC can translate to port-a-cath in French, which is used for chemotherapy administration, or CABG in English, which stands for coronary artery bypass graft, which are clearly not the same procedure.

• The wrong format: No distinction is made between typed and handwritten text or the translation doesn’t alert you to redacted text. This could be important if text was rewritten or left out. Or the formatting is poor, so you can’t follow the translation or compare it side by side with the original medical record if you need to check a detail.

You can’t afford inaccurate medical records, so what do you do? With apologies to the medical profession, doctors don’t always make the best translators. You need a specialist—an experienced professional translator.

Here’s what to look for in a professional translator:

• Language skills: Your translator should have high-level expertise in the foreign language and in English. Use a native English speaker if you are translating into English. It is rare for anyone to write like a native in a second language, and that’s obviously problematic when nuance counts. A translation from a nonnative English speaker can be awkward at best and incomprehensible at worst. But even the right language combination isn’t enough.

• Translation skills: The translator should have expertise in moving meaning from one language to another, a crucial skill that doesn’t automatically come with knowing two languages or from familiarity with the medical field. You’ll never have a guarantee of this skill, but a credentialed translator—American Translators Association (ATA) certified, for example—is a better bet. And as in any profession, more experience usually means better work. Medical translation experience is a start, but often it’s not enough for the challenges posed by medical records. Ideally, find someone with expertise in translating physician and/or nurse handwriting.

• Medical expertise: Don’t end up with an operative report stating that the surgeon “placed a keyboard under the skin” when, in fact, the surgeon implanted a port in the subclavian (true story). Formal medical or nursing training is a plus if the translator is also a qualified translator in the particular language.

Optimize Your Time and Money
Identify and hire the right translator early, so translation can start while you attend to other matters. A page of medical records can have one to 1,000 words. An experienced translator can give you a rough estimate of the total words and the time required. Medical records translation usually takes longer than other translations because of time-consuming formatting, the deciphering of handwriting, and the frequently poor quality of the document.

Quality translation does not come cheap, but as they say, “Pay peanuts and you’ll get monkeys.” If you don’t plan ahead, expect to pay rush fees. The formatting of the translation should generally match that of the foreign-language medical record, but you probably don’t need to spend extra time and money on desktop publishing-type quality.

Don’t know where to start? Visit the online directory of the ATA at www.atanet.org and use the free searchable online databases of ATA member translators and translation agencies. Tailor your search to the language pair and subject area you need, and be sure to search for certified translators. Read CVs and ask questions. If your translator will come from a translation agency, ask who will be translating the material, how many translators will work on your documents, and what their qualifications are. If the agency won’t give you this information, thank them and move on to the next candidate.

As anyone who has read them can attest, medical records are a different breed of document. They are packed with acronyms, technical jargon, on-the-fly abbreviations not found in any dictionary in any language, illegible handwriting, unpronounceable and unfamiliar drugs, and traps for the inexperienced. Therefore, a good translation is imperative.

— Ann Wiles, CCS, has been a full-time independent translator since 2001 and has been certified by the American Translators Association for French-to-English translation since 2002. She also has 26 years of full-time nontranslation work experience in several specialties, including medical, pharmaceutical, public health, and business.