“Sometimes, interpreting the doctor’s medical jargon can feel like trying to understand the lyrics of the popular rapper, Lil Wayne.” I came across this statement while preparing to work on this article. If you think the sentence belongs to a patient or another interpreter, you are wrong. This sentiment was written by Richard C. Senelick, MD, after his experience of accompanying his wife to a doctor (if you are interested, the link to his blog is below). The US population has a very low “health literacy” and Dr. Senelick advices medical professionals to become ‘medically bilingual,’ that is, learn to speak both medical jargon and plain language”. Of course, until that happens, we have a lot of work to do plus, of course, convert the message into another language—low or high register— depending on providers’ speech.
In my piece I am going to outline two categories of medical terminology that present a plentitude of challenges for interpreter in medical settings.
I. American English* terminology that does not have exact equivalent in a target language. Its groups include (but are not limited to) the following.
Medical legal documents
The contemporary US legal system is as complex as its healthcare system and both of them are differ from the way things are done in other countries. There are certain terms that sound not only unfamiliar, but almost scary to the LEP patient, especially if he/she belongs to an older generation, are visiting or recently immigrated. Here are just a few examples:
advance directive – legal documents that describe a patient’s treatment preferences and designate a surrogate decision-maker in the event that the person should become unable to make medical decisions for him or herself. AD’s generally fall into two categories: those that designate surrogate decision makers (power of attorney for health care, healthcare proxy) and those that designate care instructions (living will, POLST, pre-hospital DNR)
power of attorney for health care – this is a document in which you designate someone to be your representative, or agent, in the event you are unable to make or communicate decisions about all aspects of your health care. In the most basic form, a health care power of attorney merely says, “I want this person to make decisions about my health care if I am unable to do so.”
health care proxy – a health care proxy (also known as a durable power of attorney for health care, medical power of attorney or appointment of a healthcare agent) is a document that lets you to appoint another person (a proxy or agent) to express your wishes and make health care decisions for you if you can not speak for yourself
living will – a written document that specifies what types of medical treatments are desired under specific circumstances. The most common statement in a living will is to the effect that: “If I suffer an incurable, irreversible illness, disease, or condition and my attending physician determines that my condition is terminal, I direct that life-sustaining measures that would serve only to prolong my dying be withheld or discontinued.”
POLST – Physicians Orders for Life-Sustaining Treatment. A legal form, filled out by a patient with his or her physician, that instructs healthcare personnel as to what degree of interventional treatment the patient wants toward the end of his or her life
pre-hospital DNR – a legal document, signed by a patient and his or her physician, whose purpose is to instruct Emergency Medical Services personnel NOT to resuscitate a patient if the patient’s heart stops
do not resuscitate order (DNR) – a doctor’s written instruction not to attempt cardiopulmonary resuscitation (CPR) on a specific patient in the event of cardiac or respiratory arrest
damages – harm to the patient resulting from a medical mistake, expressed in monetary terms
Medical insurance and billing terminology
Helping the LEP patient navigate conversations about medical coverage and billing is no less of a test then talking about legal matters. The majority of native speakers of English get confused when they read their health insurance policy. Making a phone call or visiting billing department can be intimidating and frustrating for an LEP patient. That’s why working with an interpreter who is familiar with key terms or is trained to clarify unknown words can be critical for providing quality care to all patients.
copay – a cost sharing mechanism in group insurance plans where the insured pays a specified dollar amount of incurred medical expenses and the insurer pays the remainder
deductible – the amount you owe for health care services your health insurance or plan covers before your health insurance or plan begins to pay
exemption – most people must have qualifying health insurance or pay a fee. But people who qualify for a health coverage exemption don’t have to pay the fee. Exemptions are granted based on certain hardships and life events, health coverage or financial status, membership in some groups, and other circumstances
high-risk pool plan (State) – for years many states have offered plans that provide coverage if you have been locked out of the individual insurance market because of a pre-existing condition. High-risk pool plans may also offer coverage if you’re HIPAA eligible or meet other requirements. High-risk pool plans offer health insurance coverage that is subsidized by a state government. Typically, your premium is up to twice as much as you would pay for individual coverage if you were healthy
cost sharing reduction (CSR) – a discount that lowers the amount you have to pay for deductibles, copayments, and coinsurance. In the Health Insurance Marketplace, cost-sharing reductions are often called “extra savings.” If you qualify, you must enroll in a plan in the Silver category to get the extra savings
guaranteed issue – a requirement that health plans must permit you to enroll regardless of health status, age, gender, or other factors that might predict the use of health services. Except in some states, guaranteed issue doesn’t limit how much you can be charged if you enroll
capitation – a fixed payment that a patient makes to a health insurance company or provider to recoup costs incurred from various healthcare services. A capitation is different from a deductible or co-pay
utilization limit – the limit per year for coverage under certain available healthcare services for Medicare enrollees. Once a patient passes the utilization limit for a service, Medicare may no longer cover them
Titles of medical professionals
The next group of medical vocabulary deserves a large article on its own. How many of us stumble after provider greets the patients and says something like “My name is Mary, I am an APN”? The first step of course it to know what APN stands for and the second one is to be able to interpret in in terms that would make sense to the LEP patient. In the best case scenario, your country has professional with exactly same level of education and job responsibilities. If not, you need to be prepared!
APRN – Advance Practice Registered Nurse – a nurse with post-graduate education in nursing. APRNs are prepared with advanced didactic and clinical education, knowledge, skills, and scope of practice in nursing
CNS – Clinical Nurse Specialist – an expert clinician who works in a specialized area of nursing practice. Specialty areas can be identified by: • population (e.g., adults, geriatrics, women, etc)
CCRN – Critical Care Registered Nurse
PA – A Physician Assistant is a licensed health professional who practices medicine under the supervision of a physician. A P.A. provides a broad range of health care services including diagnosis and treatment of illness
resident – A resident, or house officer, is a physician (one who holds the degree of M.D., D.O., or MBBS, MBChB, or BMed) who practices medicine (usually in a hospital or clinic) under the direct or indirect supervision of an attending physician.
fellow – a fellowship is the period of medical training in the United States and Canada that a physician or dentist may undertake after completing a specialty training program (residency). During this time (usually more than one year), the physician is known as a fellow. In general, a fellowship is the path to becoming a specialist of some sort. For example, cardiologist, nephrologist, gastroenterologist, etc.
hospitalist – physicians whose primary professional focus is the general medical care of hospitalized patients. Their activities include patient care, teaching, research, and leadership related to hospital medicine.
On the opposite spectrum of high register medical terminology is medical slang which uses acronyms and informal terminology to describe patients, other healthcare personnel and medical concepts. English has tendency of coining new words by turning nouns into verbs and visa versa. There are also a lot of shortening of long words and abbreviations in medical slang.
The patient coded, or just “code” – a life-threatening event occurred that required the attention of the hospital’s emergency response team
bagging – manually helping a patient breathe using a squeeze bag attached to a mask that covers the face
tox screen – toxology screen – testing the urine for the level and type of drugs in a patient’s system. Rarely, it can also be a test of blood that may give an idea of the dose the patient ingested.
frequent flyer – a frequent flyer is a patient who visits the ER often, usually because they have no other place to receive care
b.i.d. – bis in die (Latin) – twice daily. As in “taking a medicine twice daily”, often seen on prescriptions. In the same way, t.i.d means three times a day and q.i.d. means four times a day.
BP – blood pressure
CC – chief complaint
II. The Second category consists of LEP patient’s language terminology and concepts that do not have exact equivalent in American English language or American culture. Most likely you will need to act as clarifier to a provider or as a cultural broker between patient and provider. This kind of competency is based on profound knowledge of culture and familiarity with beliefs of its people. To illustrate my point I will use examples from Russian language and Soviet and post-Soviet culture that I know myself. Unfortunately I am not familiar on a deep level with similar concepts in other societies which definitely limits my article. If you would like to share examples from other cultures, it would be very much appreciated!
There are two very common Russian diagnoses that always raise the doctor’s eyebrows – сердечно-сосудистая дистония (ССД) and вегето-сосудистая дистония (ВСД). My Russian colleagues and I have continuing discussions on what would be the best way to interpret them. Both of those terms represent a collection of symptoms that vary from person to person and are not always measurable as they are related to the emotional state of a patient (fatigue, high or low blood pressure, heart and/or abdominal pain, apathy, shortness of breath, weakness, etc). The literal translations of the diagnoses sound like “cardio vascular dystonia” and “vegetative vascular dystonia” (I also found term “vasoneurosis” for the later) but they don’t say much to an American provider.
Remedies and treatments
Homeopathic folk remedies are present in all of the world cultures and it is not unusual to interpret for a patient who talks about remarkable benefits of drinking herbal teas, consuming plant roots or berries. All we need to do it is to be well prepared and come up with correct name of a plant in a target language. But how about remedies or treatments that are basically procedures and require more descriptive approach from us?
Not so long ago, the western word was amused by “cupping” practices of some athletes during 2016 Olympic games in Rio. That is actually a traditional way to deal with cold and flu symptoms in post-Soviet countries. Another customary way to treat those illnesses is to dip the feet or even the legs up to the knee into a bowl or bucket with hot water (you can add few table spoons of dry mustard if you want an extra kick) and hold them there as long as possible. As soon as you are done, put on warm socks (cotton or wool) and lay under the warm blanket. A direct rendition of “парить ноги” (“steam your feet”) will definitely puzzle an American provider, so an interpreter would need to take time to explain procedure and its purpose to the listener.
Did you hear about душ Шарко – “Sharko shower” (“Charcot’s douche”) for treatments of a gout? It was also used for weight loss, muscles relaxation, improvement of blood circulation and as a remedy for depression. Sharko shower was a popular hydro massage procedure. From 8.5-10 feet away patient was showered with two compact high pressure (1.5-3 atmospheres) jets at the same time, from top to toe. The contrast effect (one the jets was about 104 F and another one was 68 F) and the strength of the stream were believed to be the most beneficial. Because side effects included bruising it was not recommended before or during beach season.
Right next to this group is another one consisting from common believes that are traditional in LEP culture but sounds very foreign to an English speaker. Technically they are not medical terms but they are significant for understanding patient’s message to a provider and I would like to mention this group here. If LEP from post-Soviet republic tells doctor “my low back hurts, because I was sitting by the window last night, the door was open and there was a cold draft,” an English-speaking provider might wonder how the draft and the low back pain are connected. But the situation is very clear to a Russian interpreter: being exposed to a draft (especially in hot weather or after taking a shower) is the obvious reason for inflammation of joints, ovaries and or even the appendix in the LEP mind.
Sitting on a cold surface (brick, stone, metal bench during cold seasons) or drinking cold fluids are believed to be the cause of pain or inflammation as well. The sentences like “It was getting chilly outside but I was sitting on swing for too long. Now my uterine appendages are in pain” or “I drank milk straight from the refrigerator and had itchy throat the next day” will make sense to a provider if interpreter conveys the believe behind those phrases.
The goal of this article was to take a look at and invite discussion about two significant categories of medical terminology that are related not only to medicine and linguistics, but also to the legal systems, social and cultural contexts, and scientific developments.. Better classification and unification of terminology across the languages will improve our performance, provider and patient experiences working with interpreters and move us up as professionals.
* American English – just “English” further
List of sources is available by your request