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Towards Understanding Medical Translation and Interpreting

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 Table of Contents

Introduction (Wioleta Karwacka) · 7

Božena Džuganová
Various Aspects of Medical English Terminology · 9
Barbara Librowska, Małgorzata Greber,
Paulina Szydłowska-Pawlak, Dorota Kilańska
Terminology Mapping:
CSIOZ Recommendation, ICNP® and SNOMED CT · 35
Arkadiusz Badziński
Collocations, Equivalence and Untranslatability
as Selected Critical Aspects in Medical Translation · 67
Barbara Walkiewicz
Translation of Medical Texts from Discourse Perspective · 85
Goretti Faya-Ornia
Relevance of Formal and Cultural Variations in Text Genres
for Medical Translation: Medical Brochures, Web Pages of
Hospitals, Patient Information Leaflets and Informed Consents · 109
Ewa Kościałkowska-Okońska
Translating Patient Information Leaflets:
Expectations of Users and the Reality · 137
Arkadiusz Badziński
Teaching Medical Simultaneous Interpreting: From Theory to Practice · 161
Wioleta Karwacka
Medical Translation Training:
From a Translation Student to a Medical Translation Professional · 177
Abstracts · 191
 Introduction

Medical translation is receiving increasingly more attention from lin-

guists, healthcare providers and translation researchers, who uncover the
complexity and significance of this field. It is inseparably connected with
considerable responsibility and ethical gravity. In translation research, at-
tention is paid to medical language with its terminology, characteristics of
particular genres in medical writing, medical translator’s role and status,
medical translation errors and quality assurance. This volume addresses
three major issues within the area of medical translation: problems spe-
cific to discourse and genres within the medical translation field, charac-
teristics of medical language, including medical terminology, and medical
translator training.
One of the distinctive features of medical discourse is the use of spe-
cialised terminology, which can prove problematic in translation and
interpreting. The first part of the volume is devoted to terminology and
LSP-specific problems in medical translation. The chapter by Božena
Džuganová focuses on English medical terminology. She provides an
overview of English medical terminology with particular attention to
historical, etymological, semantic, morphological and didactic aspects.
Arkadiusz Badziński presents problems and practical remarks related to
the use of collocations, terms and jargon in medical communication. An-
other aspect mentioned by the author is the inconsistency of terms despite
relative consistency of concepts in various countries and cultures, which
can be observed, for instance, in medicolegal nomenclature. Barbara Li-
browska, Paulina Szydłowska-Pawlak, Małgorzata Greber and Dorota
Kilańska analyse yet another dimension of medical terminology. Their
8 Introduction

chapter focuses on controlled terminology used in nursing practice and

the results of mapping between terminology systems.
The focus of the second part of the volume is the discursive specific-
ity and generic diversity of communication in the healthcare community.
Barbara Walkiewicz examines key discourse aspects of discharge summary
translation, which can, in fact, be observed in other medical genres as well.
Her study shows the importance of discourse competence and the aware-
ness of discourse features among translators who work for the medical
community. Goretti Faya-Ornia discusses the relevance of culture in medi-
cal text genres. She analyses culture-specific problems, including cultural
conventions and economic restrictions relevant to the translation of medi-
cal brochures, web pages, PILs (Patient Information Leaflets) and informed
consent forms in Spanish, English and German. The recipients of these
texts are laypersons, who are more likely to respond well to a document
which is adapted to target conventions. This theme is continued by Ewa
Kościałkowska-Okońska, who focuses on PILs in Polish and English, es-
pecially their readability, simplicity of expressions, accuracy and precision.
The results of her analysis indicate that there is still room for improvement
as far as the readability or lay-friendliness of Polish PILs is concerned, as
they tend to be too formal, impersonal and lexically inaccessible.
The last two chapters offer insights into medical translator and inter-
preting training process. Arkadiusz Badziński proposes a course dedicated
to training medical interpreters, which includes both interpreting-specific
modules and medical language tasks. The author also stresses the impor-
tance of background knowledge in medical interpreting, which is also true in
the case of medical translation training. Finally, Wioleta Karwacka presents
a revised genre-based and skill-based medical translation training course.
This volume is addressed to translators, translation researchers and
students who wish to learn medical translation fundamentals and explore
research directions in the field. Medical translation is an important and
diverse area, which will hopefully be explored more as new translation
studies trends emerge.
Wioleta Karwacka
 Božena Džuganová
Comenius University, Bratislava, Slovakia

Various Aspects of
Medical English Terminology

Introduction

‘There is no recognised discipline called medical linguistics, but perhaps

there ought to be one. The language of medicine offers intriguing chal-
lenges both to medical historians and to linguists’ (Wulff 2004: 187), as
well as to medical translators (Karwacka 2015).
The roots of written medical language can be traced back to the 5th cen-
tury BC (Dirckx 2005); the spoken language of medicine has naturally ex-
isted ever since the establishment of the medical profession itself. However,
medical English or English for Medical Purposes (EMP) as a university
course and an academic field of research can only be traced back to very
recent times (Grego 2014: 18). The first attempts to codify English for Spe-
cific Purposes (ESP) started in the 1970s*,

when lexicon, as the specialized languages’ most evident distinguishing

feature, had been the main focus of research, and it remained so until the
advent of genre and discourse analysis widened linguistic perspective to
include syntactical, textually and eventually discursive patterns as objec-
tive descriptors of specialized languages. In 1980s ESP began to be con-
sciously researched as a linguistic area per se and a consistent bibliography
on the subject began to appear, the establishment of dedicated and regular
academic teaching, training courses for professionals, journals and con-
ferences worldwide followed shortly afterwards. (Grego 2014: 18)

* Grego (2014) claims that the 1970s and 1980s saw the beginning of ESP codifica-
tion, whereas Mićić (2013) dates it back to the 1960s.
10 Božena Džuganová

English for Medical Purposes is one of the main branches of ESP, i.e., of
English for Academic Purposes (EAP) as well as of English for Occupa-
tional Purposes (EOP) (Sinadinović 2013: 273) or English for Profession-
al Purposes (Mićić 2013: 218)*, because it refers mainly to the academic
needs of students and future professionals who will seek a career in the
academic environment and to the actual needs of professionals at work
(Ypsilandis and Kantaridou 2007: 69 qtd. in: Mićić 2013: 218). EAP and
ESP are now referred to as International Scientific English (ISE) (Mićić
2013: 218). The common feature of members of this discourse community
is the effective use of English in writing science, their primary goal being
research, not language. Medical English belongs to ISE and involves many
different areas and fields of scientific interest and research. It is designed
to serve a large range of users starting with physicians of all specialties,
postgraduate and undergraduate students of medicine, linguists, transla-
tors, interpreters specialising in medical issues, etc.
Although EMP shares many common traits with other ESP varieties, it
has its own specific features created by the given professional community for
communicative purposes within its specific field of work (Grego 2014: 18).
And due to these specific features, it is usually recommended for adult learn-
ers at the upper-intermediate or advanced levels. Further division or sub-cate-
gorisation of EMP, with overlapping in certain areas, is also possible and often
occurs: English for Nurses, English for Paramedics, English for Dentists, etc.
Every profession uses its own terminology, i.e., a technical or special-
ised language that allows its members to communicate efficiently. EMP is
applied by its learners or users mainly in:
–– communication between patients and physicians or among physicians;
–– everyday discourse about illnesses and diseases which has devel-
oped into an extensive body of literature that penetrates slowly into
medical education and medical practice (Fleischman 2008: 470);

* Hutchinson and Waters (1987: 16) do note that there is no clear-cut distinction
between EAP and EOP: ‘People can work and study simultaneously; it is also likely
that in many cases the language learnt for immediate use in a study environment will
be used later when the student takes up, or returns to, a job’.
Various Aspects of Medical English Terminology 11

–– reading professional literature;

–– running medical research and sharing the results with other scien-
tists, i.e., writing articles in English (scientific research is conveyed
mainly through on- and off-line medical journals);
–– taking part in conferences and congresses and presenting and un-
derstanding papers presented there;
–– surfing the web to find suitable information or exchanging opin-
ions, posing questions and giving answers in medicine-dedicated
fora (Mićić 2009: 88 qtd. in: Sinadinović 2013: 275; Vicentini and
Radicchi 2014: 220).
Thanks to the fact that all the greatest medical discoveries have been
published in English (95% of medical papers come from English-speak-
ing countries; Pilegaard 2000: 7), English has become the lingua franca of
medicine and science and is expected to remain so in the future. Native
anglophone professionals who have received training in English-speaking
countries frequently practice, run research and communicate internation-
ally. It is not surprising then that the didactic purpose has the leading role
in EMP studies* (Grego 2014: 19).
On the other hand, two seemingly opposed trends may be observed
in English today – it is no longer the exclusive preserve of the original
English-speaking countries, but has become a global possession. In other
words, there are only a few English-speaking countries within an increas-
ingly English-speaking world (Canziani, Grego and Iamartino 2014: 11).
Today, all the most influential medical journals are written in English,
and English has become the language of international conferences and con-
gresses. We have entered the era of medical English, which resembles the era
of medical Latin when physicians used a single language for international
communication. Whereas in former times new medical terms were derived
from classical Greek or Latin roots, now they are often, partly or wholly,

* According to the QS University Ranking (2017), among the world’s top ‘Life Sci-
ences and Medicine Faculties’, the first 19 positions (except position no 7, taken by the
Swedish Karolinska Institutet) are firmly held by educational institutions of English-
speaking countries.
12 Božena Džuganová

composed of words borrowed from ordinary English – e.g. bypass, clear-

ance, screening, scanning – and doctors from non-English-speaking coun-
tries now have the choice between borrowing these English terms directly
and translating them into their own language (Wulff 2004: 188). Hence the
huge impact of medical English on national medical terminologies.
In our paper we will try to analyse English medical terms with regard to
their historical, etymological, semantic, morphological, and didactic aspects.

1. The Immense Progress of Medicine

Requires New Terms

In the past century, epochal discoveries were made in natural sciences,

particularly in medicine. Discovery of blood groups made transfusions
possible. Thanks to new drugs (such as penicillin or tetracycline) and vac-
cination, many diseases could be successfully treated or even eradicated.
Clinical medicine developed into many new branches. Internal medicine,
for example, split up into endocrinology, gastroenterology, haematology,
nephrology, oncology, pulmonology, rheumatology, etc. All this could hap-
pen thanks to the great development of science and technology. New diag-
nostic devices and methods were invented, e.g. computed tomography, so-
nography, mammography, laparoscope, endoscope, colonoscopy or magnetic
resonance imaging (MRI). New diseases appeared, such as AIDS, BSE (Bo-
vine spongiform encephalopathy or so-called mad cow disease), avian flu
(H5N1 virus), swine flu (H1N1 virus) or ebola (Džuganová 2013). All these
new things and phenomena had to be named, documented and propa-
gated among scientists as well as common people. New words – medical
terms – had to be formed.
According to Goumovskaya (2007), 98% of all English medical terms
have Latin or Greek roots. For instance, in 1951, the terms sonograph and
sonography were formed from the Latin sonus (‘sound’) and the Greek
graphō (‘to write’). Adequately to these terms, other related terms were
coined. In 1956, it was the term sonogram (sono + G./L. gramma), in 1960
Various Aspects of Medical English Terminology 13

ultrasonograph (ultra + sonograph) and ultrasonography (ultrasonic +

graphy), etc. (OED). Although it seems that the number of new terms is
enormous, Jammal (1988 qtd. in: Fleischman 2008: 473) comments on
Julien Green’s observation on pace disproportion between thought and
words with the statement ‘while science flies, its terminology walks – typi-
cally at a pace that lags far behind scientific advances’.

2. Medical Terminology

The most conspicuous differences between ESP and General English are
related to vocabulary. Medical English vocabulary for Academic Purpos-
es is usually considered to be more difficult to learn and use in practice
(Sinadinović 2013: 275). In order to be able to function in any of the ar-
eas which are covered by EMP, students need to gain knowledge of specific
technical and non-technical words (Harding 2007 qtd. in: Sinadinović 2013:
275), to store them in their long-term memory and use them productively.
Terminology, as a specific feature of ESP, is a linguistic discipline which
studies, analyses and describes a specialised area of the lexicon, i.e., terms.
The aim of terminological studies is standardisation of terms so that they
are used uniformly.
The unique position of terminology among other linguistic studies is
connected with the fact that it is based on the knowledge of linguistics,
lexicology, lexicography and morphology. The linguist who deals with
a concrete area of terminology needs to understand its structure and
meaning from the linguistic point of view and to have at least basic back-
ground knowledge of the studied discipline (Dávidová 2011: 9).
Formation of new terms in each field of medicine deserves appropriate
attention as these terms subsequently become part of general language.
There is a very close relationship between general (codified) language
and the language of science. The language of science forms about three
quarters of all written and printed materials of the general language in
each nation. While general language serves all of its users, the language of
14 Božena Džuganová

science requires a certain level of scientific education, because the terms

as names of certain concepts merely indicate their meaning. Only experts
know their exact meaning (Poštolková, Roudný and Tejnor 1983: 11).
In medical terminology, two completely different phenomena can be
observed: (1) a very precisely worked-out, internationally standardised
anatomical terminology and (2) a quickly developing clinical terminology
of all medical branches, characterised by a certain terminological chaos.
The main cause of this phenomenon is rapid development of scientific
knowledge and a need to quickly name new devices, diseases, symptoms,
etc. (Džuganová 2002: 56).
Attempts to unify clinical medical terminology on an international
level have mostly been unsuccessful. According to Šimon (1989), the first
attempt to create a unified international classification of diseases was made
in the 19th century. This classification had no united rules and similarly as
the modern International Statistical Classification of Diseases and Related
Health Problems (WHO 2010) it is only a technical tool used for statistical
purposes. Lack of unified medical terminology is especially visible today,
as computers have entered into medicine and faultless international com-
munication is required (Šimon 1989: 52).
English medical terms (anatomical and clinical) have a restricted, spe-
cific meaning, are mostly of Greek or Latin origin and can be studied from
various perspectives, e.g. etymological, morphological, semantic or lexical
(in both diachronic and synchronic ways).

2.1. Main Features of Medical Terms

The term as a basic unit of terminology names a concept which exists in

the system of concepts of a scientific or technical discipline (Poštolková,
Roudný and Tejnor 1983: 26). There are some typical features of the term
which distinguish it from the non-term. They include unambiguousness,
exactness, stability, word-formation potential and lack of emotionality
(Hauser 1980: 34–35; Peprník 2006: 73). As Hauser (1980: 34) observes,
these features of the term are perceived as ideal since not all of them are
Various Aspects of Medical English Terminology 15

always present in all terms. Overlapping in features and meanings between

terms leads to various relationships among them, e.g. synonymy, polysemy,
hypernyms or hyponymy, the former two of which will be discussed later.
As the main function of the term is to name the concept objectively, the
presence of emotionality would be redundant and undesirable. Therefore,
the term should be deprived of any emotional expressivity and subjective
evaluation. This is why diminutives are not suitable for the formation of
terms. Regardless of this fact, there exist some diminutives in English and
Latin medical terminology, i.a., L./E. cerebellum (small brain), L. bronchi-
olus, E. bronchiole (small bronchus), L. clavicular or E. clavicle (small key).
These words are still used in medical terminology as they have a long tra-
dition, and because their original expressive feature is no longer perceived
(Hauser 1980: 35).

2.2. The Main Sources of Medical Terminology

Although medical terms have been drawn from many languages, the great
majority are from Greek and Latin. Terms of Greek origin occur mainly
in clinical terminology, e.g. cardiology, nephropathy, gastritis, Latin terms
make up most anatomical terminology (nomina anatomica), e.g. cor, ren
or ventriculus.
The fall of the Roman Empire did not mean the end of Roman-Greek
culture. In the 7th century the expansion of Arabs started, resulting in the
formation of a large Arabic empire extending from Spain to Asia Minor.
The Arabic language was used in this region, competing with Latin in the
west. Arab physicians studied Greek medicine and enriched it. The great-
est Arab physician was Ibn Sīnā, or Avicenna (10th–11th century), as he was
called in Latin. His most famous work is The Canon of Medicine, a medical
encyclopaedia which became a standard medical text at many medieval
universities and remained in use as late as 1650 (Flannery; Bujalková and
Jurečková 2013: 6). The Arabic influence on English medical terminol-
ogy (EMT) can be traced in expressions such as alcohol, alchemy, alkali
or nitrate, which entered English through Latin and French. Similarly, the
16 Božena Džuganová

terms dura mater and pia mater are calques (translations) from Arabic
into Latin (Andrews 1947).
In EMT there are, however, also terms of other origins, e.g. taken from
French, such as jaundice, ague, cannula, poison, faint, grand mal, petit mal,
massage, passage, plaque or pipette, or from Italian, e.g. belladonna, influ-
enza and varicella. French played a far more important role as a medium
for penetration of Latin words into English. These are, for example, words
such as superior, inferior, male, female, face, gout, migraine, odour, oint-
ment, pain and venom (Andrews 1947).
Current medical terminology may be divided into two main parts:
anatomical (based on Latin) and clinical (based on Greek). EMT is so de-
pendent on the Greek-Latin that a good acquisition of EMT requires at
least a basic knowledge of Greek-Latin terminology (Dávidová 2011: 9).

2.2.1. Greek in Medical Terminology

It is estimated that about three-quarters of medical terminology is of Greek

origin. The main reason for this is that the Greeks were the founders of
rational medicine in the golden age of Greek civilisation in the 5th century
BC. The Hippocratic School and, later on, Galen of Pergamum (a Greek
from Asia Minor who lived in Rome in the 2nd century AD) formulated the
theories which dominated medicine up to the beginning of the 18th century.
Hippocrates and his disciples were the first to describe diseases based on
observation, and the names given by them to many conditions are still used
today, such as arthritis, catarrh, diarrhoea, dyspnoea, nephritis or pleuritis
(pleurisy) (Répás 2013: 5; Wulff 2004: 187).
At the beginning of the 1st century AD, when Greek was still the lan-
guage of medicine in the Roman world, an important development took
place. At that time, Aulus Cornelius Celsus wrote De Medicina, which was
an encyclopaedic overview of medical knowledge based on Greek sources.
Celsus faced the problem that most Greek terms had no Latin equivalents.
He therefore either imported Greek terms directly into Latin, e.g. pyloros
(now pylorus), even preserving their Greek grammatical endings, or he
Various Aspects of Medical English Terminology 17

Latinised Greek words, writing them with Latin letters and replacing Greek
endings by Latin ones, e.g. stomachus and brachium (Wulff 2004: 187).
A third reason for the large number of Greek medical terms is that the
Greek language is suitable for the building of compound words. When
new terms were needed with the rapid expansion of medical science dur-
ing the last few centuries, Greek words or Greek words with Latin endings
were used to name new conditions, diseases, instruments or devices. The
new words follow the older models so closely that it is impossible to dis-
tinguish the two by their forms. Such words do not appear different from
the classical terms, e.g. streptococcus was coined by Viennese surgeon Al-
bert Theodor Billroth in 1877 from strepto- (‘twisted’) and Modern Latin
coccus (‘spherical bacterium’, from Greek kokkos, ‘berry’). Similarly, ap-
pendicitis was coined in 1886 from the Latin stem of appendix, in the
medical sense, and -itis (‘inflammation’). The term cystoscopy, ‘examina-
tion of the bladder with a cystoscope’ (1889), was coined in 1910 from
Latinised combining form of Greek kystis (‘bladder’) and -scope (OED).
A lot of simple Greek root words are used in everyday English without
our realising their origin. To quote just a few: acne, basis, chaos, character,
criterion, dogma, horizon, stigma, thema, etc. (Répás 2013: 5).
Actually, about one-half of our medical terminology is less than a cen-
tury old. A fourth reason for using the classical roots is that they form an
international language (Répás 2013: 5).
Although there are few Greek terms that have preserved their ‘pure’
Greek form, e.g. asthma or trauma, most Greek medical terms came into
English in a Latinised form, i.e., with a Latin ending or spelling, e.g.:

bacterium from Gr. bakterion bronchus from Gr. bronchos

carcinoma from Gr. karkinōma coma from Gr. koma
embolus from Gr. embolus pericardium from Gr. pericardion
spasmus from Gr. spasmos thrombus from Gr. thrombos

Many Greek terms resisted assimilation for a very long time and were An-
glicised only partially, either as adjectives or names of diseases (never as
18 Božena Džuganová

a denomination of a part of the human body). At the beginning, the pro-

cess of Anglicisation was very slow or in a very changed form, e.g.:

Gr. diafragma → Engl. diaphragm Gr. opthalmos → Engl. ophthalmia

Gr. paralysis → Engl. palsy Gr. pleuritis → Engl. pleurisy
Gr. rhachitis → Engl. rickets Gr. therapia → Engl. therapy

Here are several examples of Greek adjectives and names of diseases refer-
ring to organs or parts of the body commonly used in colloquial language,
such as arm, skin, liver, heart, kidney, bone, head, hip, mouth or wrist –
body parts which have kept their original English denominations:

Organ in Greek Organ in English Adjective/disease

brachion arm brachial/-
derma skin dermal/dermatitis
hepar liver hepatic/hepatitis
kardia heart cardiac/carditis
nephros kidney nephric/nephrosis
osteon bone osteal/osteoma

After the decline of the Roman Empire, Greek as a scientific language dis-
appeared completely. The rebirth of Greek as a tool suitable for scientific
purpose did not occur until the period of Humanism.

2.2.2. Latin in Medical Terminology

Romans took over the medical knowledge of the Greeks, translating and
re-writing the Greek medical books. The greatest Roman medical writer,
Celsus, was considered to be the founder of Latin medical terminology. The
Latin language lacked names for many medical concepts, especially terms
for pathological conditions, and that is why Celsus and others had to bor-
row the Greek terms into Latin. This was the way Latin medical terminology
based on two languages – Latin and Greek – was founded.
Various Aspects of Medical English Terminology 19

There is a historical paradox that Latin, as the second major source of

medical vocabulary, had to vanish as a living language before it became
a means of doctors’ communication for long centuries during the Middle
Ages. Latin terms penetrated into English terminology in various forms:
–– terms preserved in original Latin form: from a number of pre-
served English medical terms of Latin origin, we have chosen the
following ones: abdomen, appendix, nucleus, tonsillitis, virus, etc.
These terms have preserved their original Latin form up to now
with some modification of their pronunciation according to the
phonetic rules of English;
–– Latin terms assimilated into English: another similarly numerous
group is of anglicised Latin terms. Terms such as mandible, muscle,
oil, pulp, pulse, vein, nerve, pulse, puncture, ventricle and crown are
obvious to everybody and do not need any definition. Similarly, as
is the case with Greek terms, some Latin terms assimilated only as
specialised denominations of organs or diseases, the organs being
commonly named by English words, e.g.:

Organ in Latin Organ in English Adjective

pulmo lungs pulmonary
os (oris) mouth oral
cutis skin cutaneous
ren kidney renal
umbilicus navel umbilical
cor heart cordial*
dens (dentis) tooth dental

–– terms that experienced a multiple assimilation: a few medical terms

experienced a multiple assimilation – from Greek into Latin, from
Latin into Old French, from Old French into English. Compare:

* A sense now obsolete or rare, replaced by cardiac.

20 Božena Džuganová

Greek Latin French English

diaita diaeta diete diet
rheumatikos rheumaticus reumatique rheumatic
spasmos spasmus spasme spasm
chirurgos chirurgus chirurgien surgeon

–– neologisms formed from Latin elements: in the 16th century many

neologisms from Latin elements entered the language for a scien-
tific purpose, e.g. delirium, cadaver, cornea, vertigo, albumen, sinus,
appendix, abdomen, digit, ligament, saliva.
Humanism created not only humanistic Latin but also conditions for
its successive replacement by living languages. Since the time of Human-
ism and the Renaissance, the history of international medical terminology
has overlapped with the history of national terminologies. They influence
each other and cannot be separated (Šimon 1989).
Latin had a tendency to replace Greek nouns describing the parts of
the human body and their relative adjectives with its own terms and used
Greek stems for the formation of compound words suitable for denomina-
tion of pathological changes. A similar process can be observed in English,
which also prefers its own terms for the denomination of organs while all
other terms are taken from Latin together with the tendency mentioned
above. See:

Organ (Engl.) Organ (Lat.) Disease (Gr.) Adjective (Lat./Gr.)

breast mamma mastitis mammary
kidney ren nephritis renal
marrow medulla myelitis medullary
skin cutis dermatitis cutaneous
eye oculus ophthalmia ocular / optic

‘Latin and Greek remained languages of medicine up to the 19th century

when national medical languages started to gain in importance’ (Dobrić
2013: 496).
Various Aspects of Medical English Terminology 21

2.2.3. Remnants of Classical Grammar

Certain grammatical patterns and rules characteristic of the classical lan-

guages are retained and observed with classical words and phrases that
have been adopted into medical English. Greek and Latin are more highly
inflected languages than English. That is, they make more extensive and
more varied use of changes in the endings of words to signal shifts of
meaning and to show syntactic relations among the words of a phrase or
sentence. (Dirckx 2005: APP 9)

The most preserved remnants of classical grammar can be observed in cas-

es of irregular plural and grammatical concord. Terms that retain their Latin
form are usually, but not always, pluralised as in their original language.
Whereas English forms the plural of a noun by adding -s or -es (with a few
exceptions such as foot x feet, woman x women and sheep x sheep), the plu-
ral of a Latin noun may be formed in various ways depending on the class
or declension to which the noun belongs; thus, arteria x arteriae, bacillus
x bacilli, diverticulum x diverticula, ductus x ductus, femur x femora, nucleus
x nuclei, species x species. Greek words that have not been fully Latinised
form their plurals according to Greek patterns: ankylosis x ankyloses, ar-
thritis x arthritides, condyloma x condylomata, sarcoma x sarcomata, crite-
rion x criteria (Dorland 1996; Dirckx 2005: APP 9).
According to Longman English Grammar (Alexander 1988: 48), ‘there
is a natural tendency to make all nouns conform to the regular rules for
the pronunciation and spelling of English plurals. The more commonly
a noun is used, the more likely this is to happen. Some native English
speakers avoid foreign plurals in everyday speech and use them only in
scientific and technical contexts’.
Commonly we can find foreign as well as assimilated plurals of these
foreign words: apex – apices/apexes, apparatus – apparatus/apparatuses,
enema – enemata/enemas, focus – foci/focuses, fungus – fungi/funguses,
hernia – hernia/hernias, larva – larvae/larvas, sarcoma – sarcomata/sarco-
mas, vertebra – vertebrae/vertebras.
22 Božena Džuganová

In Latin, any adjectives modifying a noun must ‘agree’ with it in num-

ber, gender and case (grammatical concord). For example, in the com-
pound nouns linea alba (‘white line’), aqua destillata (‘distilled water’)
or vertebra thoracica (‘thoracic vertebra’), both noun and adjective are
feminine singular, whereas in spiritus dilutus (‘diluted alcohol’) and dens
caninus (‘canine tooth’), both noun and adjective are masculine singular.
In nervi thoracici (‘thoracic nerves’), both words are masculine plural.
Sometimes, as in these examples, grammatical concord results in a pho-
netic match or rhyme, but this is mere coincidence. In many Latin noun-
adjective phrases no such rhyming occurs: asthma bronchiale, foramen
magnum, labium majus, lichen planus, lobus renalis, processus muscularis,
etc. (Dirckx 2005: APP 9; Bujalková and Jurečková 2013).

3. Structure of Medical Terms

Morphologically medical terms can be basically divided into one-word

and multiple-word or descriptive terms. One-word terms can be simple
(underived) words, derived words, compounds or combinations of de-
rived and compound words. Drozd and Seibicke (1973) consider deriva-
tion and compounding to be the basic word-forming processes.
Generally vocabulary spreads in three possible ways: (1) forming new
names, (2) forming new meanings and (3) borrowing words from other lan-
guages (Peprník 1992: 7). Other linguists divide forming of new terms ac-
cording to their ways of formation: (1) morphological, by means of deriva-
tion/affixation, compounding and abbreviation, (2) syntactic, by forming
collocations and multi-word phrases, (3) semantic, by narrowing (specify-
ing) the meaning of common words and by metaphoric and metonymic
transfer of the previous meaning, and (4) borrowing words from other lan-
guages (Poštolková, Roudný and Tejnor 1983: 34).
Various Aspects of Medical English Terminology 23

3.1. Derivation

Words which consist of a root and an affix (or several affixes) are called
derived words or derivatives and are produced by the process of word-
building known as affixation or derivation. Derived medical terms can
consist of a prefix, one or two word roots, and a suffix in various combina-
tions, as witnessed in the following examples:

myocardium = myo- (prefix) + card(ium) (root)

endocarditis = endo- (prefix) + card (root) + -itis (suffix)
adenoma = aden(o) (root) + -oma (suffix)

There are numerous derived words whose meanings can be easily deduced
from the meanings of their constituent parts. For example, the Greek pre-
fix di- and the Latin prefix bi- convey the meaning ‘two’, ‘twice’ or ‘double’
in such words as the adjectives diploid, dicentric, diphasic, bilateral and
bipolar, as well as in the nouns diplopia and diglossia. The identification of
the components and the basic block terms from which the words are de-
rived allows associations, which are easily recognisable and in many cases
eliminate the need for medical students and doctors for root memorisa-
tion (Goumovskaya 2007).
Yet, such cases represent only the simplest stage of semantic readjust-
ment within derived words. The constituent morphemes within deriva-
tives do not always preserve their current meanings and are open to subtle
and complicated semantic shifts, e.g. moral x unmoral x amoral x non-
moral x immoral or social x asocial x unsocial x antisocial.
Derivational affixes are used to create new words and they change the
grammatical class of the root word to which they are attached, e.g. haema-
tology (noun), haematologist (noun) and haematologic(al) (adjective).
From the etymological point of view, affixes are classified into the same
two large groups as words: native and borrowed.
24 Božena Džuganová

3.2. Compounds

The second most productive type of word-formation is compounding. A com-

pound word is a fixed expression made up of more than one word, e.g. human
being, blood donor, hay fever or Black Death. While in German compound
words are easily recognisable because they are always written together, in Eng-
lish writing of compound words varies. Compound words may be written:
–– as two/three words: blood pressure, blood group, heart attack, cen-
tral nervous system;
–– with a hyphen: life-span, collar-bone, birth-control;
–– as one word: gallstone, haemophilia, leucocytopenia, pseudopoly-
cytemia.
There are no strict rules for writing the compound word. Occasionally
some terms are written with a hyphen, occasionally as two separate words or
one word, e.g. life span – life-span or gall bladder – gallbladder (Peprník 1992:
13). There is a visible tendency in modern American English to omit hyphens
(often recommended by academic medical journals) (Kujawska-Lis 2018).
Composition seems to be older than derivation from a diachronic
viewpoint because word-forming affixes developed from independent
words. A similar process can be seen nowadays in the development of
prefixoids (pseudoprefixes) and sufixoids (pseudosuffixes) (Poštolková,
Roudný and Tejnor 1983: 42), e.g. myo-, arthro-, haemo-/haemato-, adi-
po-, hepato-, onco-, patho-, -aemia, -itis, -logy, -tomy, -pathy, -cyte, -algia,
-ectomy or -scope. Each of these pseudoaffixes hides a certain meaning,
e.g. myo- means ‘muscle’, arthro- – ‘joint’, haemo-/haemato- – ‘blood’, -ae-
mia – ‘blood’, -itis – ‘inflammation’ and -logy – ‘science’, but they are not
used as independent words. They have been developed artificially from
Greek and Latin word roots for scientific purposes.

3.3. Descriptive Terms

Both mentioned types are also classed as morphological because they

undergo certain morphological processes. While derivation and com-
Various Aspects of Medical English Terminology 25

pounding prevailed in the past and preferred Latin and Greek roots and
affixes, nowadays a syntactic approach prevails: witness the forming of
descriptive terms such as Acquired Immune Deficiency Syndrome, Bovine
Spongiform Encephalopathy, Severe Acute Respiratory Syndrome or Irrita-
ble Bowel Syndrome, which subsequently undergo the process of abbrevia-
tion because their full names are too long and uneconomical. Many Eng-
lish abbreviations have become internationally so well-known that many
laymen may not know their English full-forms (AIDS, HIV, BSE, SARS,
IBS) (Karwacka 2015).

3.4. Abbreviations

An abbreviation is a shortened form of a word or phrase. There are many

ways of forming abbreviations. Usually, but not always, they consist of a let-
ter or group of letters taken from a word or phrase. Abbreviations occur in
written language and their spoken varieties may be only graphic (g – gram,
h – hour), both graphic and phonetic (G.P. – general practitioner) or acro-
nymic ([eits] – AIDS, which developed from its initialisation). According to
Crystal (1995), acronyms are initialisms pronounced as single words, like
SARS (Severe Acute Respiratory Syndrome). Sometimes an acronym can be
formed from parts of words, as in Ameslan (American Sign Language). Nor-
mally acronyms and initialisms are regarded as subgroups of abbreviations:
‘Some linguists do not recognise a sharp distinction between acronyms and
initialisms, but use the former term for both’ (Crystal 1995: 120).

3.5. Initialisms

Initialisms are very popular in written medical English to shorten long

descriptive terms. For instance, terms from biochemistry such as: deoxy-
ribonucleic acid → DNA, ribonucleic acid → RNA or Adenosine Triphos-
phate → ATP; and from clinical medicine: Acute Lymphocytic Leukaemia
→ ALL, Chronic Lymphocytic Leukaemia → CLL, Autoimmune Thrombo-
cytopenia → AITP or Idiopathic Thrombocytopenia → ITP.
26 Božena Džuganová

Usage of initialisms is so frequent that in each text it is necessary to

introduce the full phrase first and then its abbreviation in brackets to
avoid misunderstanding; for instance, the initialism CML can mean either
Chronic Myeloid Leukaemia or Chronic Monocyte Leukaemia. Similarly,
IHD can mean either Ischemic Heart Disease or Intermittent Haemodialy-
sis. Kujawska-Lis (2018) makes us aware of the abbreviation HD, which
can have several meanings: Hansen’s disease, haemodialysis, hip dysplasia,
Hirschsprung’s disease, Hodgkin’s disease, hormone disruptor, Huntington’s
disease or hyperactivity disorder.

4. Polysemy and Synonymy of Medical Terms

Despite the fact that lexical variability manifested by numerous synony-

mous words and expressions is an important character of cultivated, refined
language, synonymy is often disadvantageous for terminology because it
makes precise communication more complicated (Horecký 1962 qtd. in:
Polackova 2001: 174). Too many synonymic terms for one concept are an
unwanted phenomenon in scientific language that contributes to misunder-
standing and complicates efforts to systemise medical terminology.
Polysemy, homonymy and synonymy are unwanted phenomena in
medical terminology; however, their occurrence is relatively abundant
and no branch of medicine can avoid them. While synonyms quantitative-
ly enlarge the vocabulary, homonyms are rather rare within one branch of
medicine.

4.1. Polysemy

Polysemy is the process in linguistics according to which one word can

have two or more meanings. In fact, the application of already existing
terms in order to express another meaning is a much more popular prac-
tice than creating complex and sophisticated names for each separate
meaning which needs to be expressed. This phenomenon is in practice in
Various Aspects of Medical English Terminology 27

specialised terminologies as well, and the sphere of medical care is not an

exception.
Since medical terminology requires being specific in order to avoid se-
rious mistakes, there is a grave necessity to make sure that medical terms
are used in their appropriate meaning; for instance, suture can mean:
–– a type of fibrous joint in which the opposed surfaces are closely
united, as in the skull;
–– material used in closing a surgical or traumatic wound with stitches;
–– a stitch or series of stitches made to secure apposition of the edges
of a surgical or accidental wound (used also as a verb to indicate the
application of such stitches);
–– the act or process of uniting a wound by stitches.
The medical term surgery can mean:
–– the branch of medicine which treats diseases, injuries and deformi-
ties by manual or operative methods;
–– the place in a hospital or doctor’s or dentist’s office where surgery
is performed;
–– in Great Britain, a room or office where a doctor sees and treats
patients;
–– the work performed by a surgeon (Dorland 1996: 1612, 1614).
Usually in medical English the context allows the recipient to under-
stand which meaning is activated in a particular utterance (Kujawska-
Lis 2018).

4.2. Synonymy

Synonyms are defined as words with similar or very close meanings. Syn-
onymy is very closely connected with calques and borrowings (loanwords)
(Džuganová 2013).
The emergence of synonyms in medical lexicon is stimulated by vari-
ous reasons, e.g. ethical ones. The blunt words cancer and tumour have of-
ten been considered by physicians to be too unbearable to be pronounced
in front of their patients. There are compassionate reasons for employing
28 Božena Džuganová

euphemisms in the practice of medicine. Years ago, a doctor could have

used the word carcinoma and been reasonably sure most patients would
not have known this synonym for cancer. That is not true today, when
public awareness of the major disease and the vocabulary used to describe
it has grown. And medical language provides a long list of euphemistic
alternatives. Doctors can and do refer to cancer as a neoplasm, a growth or
a neoplastic figure (Goumovskaya 2007).
Synonymy can appear in several levels:
–– along with an international Greek/Latin term, another synonym
formed from foreign (Greek/Latin) elements has developed at the
same time, e.g. erythrocyte x normocyte or haematopoiesis x san-
guinification. Such synonyms arise due to the different motivation
of word-formation of individual terms. For example in the term
erythrocyte, the red colour is emphasised. In its synonymic term
normocyte the normal development of the cell is emphasised;
–– an international Greek/Latin term has been translated into Eng-
lish, e.g. cranium x skull, femur x thighbone, cerebrum x brain, ster-
num x breastbone, erythrocyte x red blood cell (RBC), leukocyte
x white blood cell (WBC), thrombocyte x blood platelet or coagula-
tion x blood clotting. Calques of Greek/Latin terms into English
have different stylistic value and validity. While the international
terms erythrocytes, leukocytes, thrombocytes and coagulation serve
for specialists, their English equivalents red blood cells, white blood
cells, blood platelets and blood clotting are used in articles or speech
determined for the common reader or listener;
–– sometimes, along with a borrowed term, several variants of a transla-
tion occur and enter mutually into synonymic relations, e.g. erythro-
cyte – red (blood) cell x red (blood) corpuscle, phagocyte – phagocytic
cell x defensive cell or the colloquial expression scavenger cell.
Since the 18th century, there has been a call for systematic order and
a certain regularity in the English language that has still not been com-
pletely fulfilled. For instance, besides terms with Greek-Latin spelling,
there are also:
Various Aspects of Medical English Terminology 29

–– terms with English spelling: haemostasia x haemostasis, polyglobu-

lia x polyglobulism, thrombopathia x thrombopathy, thrombopenia
x thrombopeny;
–– different affixes are used in words with the same meaning; for in-
stance, we have found in English texts the following terms used as
synonyms: embolia x embolus x embolism and coagulum x coagulate
x coagulant.

5. Didactic Aspects

An important goal of teaching medical vocabulary is to teach the tools

of word analysis that will enable understanding of complex terminology.
‘Medical terms are very much like individual jigsaw puzzles. They are con-
structed of small pieces that make each word unique, but the pieces can be
used in different combinations in other words as well’ (Chabner 1996: 1).
Mastering basic medical terminology in English is one of the first steps
towards achieving access to the very latest information. To make the study
of English medical terminology easier and more effective, it is important
to become familiar with some basic rules of word analysis and to master
the meaning of individual prefixes and suffixes instead of memorising in-
dividual items from the whole medical dictionary. The teaching and learn-
ing of new terms can be accelerated by arranging them into logical groups,
e.g. terms describing body substances or body fluids or denoting colours.

Body substances Body fluids Colours

adip(o)/lip(o) – fat chol(e) – bile erythr(o) – red
calc(i) – calcium haem(a/o) – blood leuk(o) – white
glyc(o) – sugar hydr(o) – water alb(o)/albin(o) – white
lith(o) – stone hidr(o) – sweat chlor(o) – green
thromb(o) – clot py(o) – pus cyan(o) – blue
30 Božena Džuganová

Another useful method is applying various visual stimuli such as flash-

cards during the teaching and learning process (Barnau 2014/2015; Bar-
nau 2015).

6. Advantages of Latin and Greek

It is important to remember that Latin and Classical Greek are used in

medical English not merely because of tradition. Those so-called ‘dead’
languages form the basis for scientific and technical terms for the follow-
ing reasons:
–– there is no ambiguity in them because Latin and classical Greek
as ‘dead’ languages do not undergo any changes. The meaning of
a word does not change but is consistent. In a living language, words
acquire new meanings. For example, acid originated from Latin
acidus which meant a chemical such as the acetic acid in vinegar.
In modern English, there are thousands of named acids, among the
more familiar being amino acids, binary, carboxylic, fatty, folic, ni-
tric, organic, sulfuric, ternary, tannic and ribonucleic acids (Dorland
1996: 15). Nowadays it has acquired another meaning and is used
in English slang for LSD (lysergic acid diethylamide), a dangerous
hallucinogenic drug (Goumovskaya 2007);
–– the precise meaning and precise use of words is of crucial impor-
tance in all forms of medical communication. The essential prop-
erty of precision in the words of ‘dead’ languages helps to make new
medical terms from Latin and Greek roots whose meanings do not
alter over time (Goumovskaya 2007);
–– another reason Latin and Greek roots are used to form medical
words is that they result in terms that are shorter and more con-
venient than long descriptions in English. They provide a method
of shorthand for the description of complex objects and proce-
dures in medicine. Knowledge of the simple Greek roots can help
in spelling a word more easily. Consider the English definition of
Various Aspects of Medical English Terminology 31

mononucleosis (monos, meaning ‘one’, + nucleus, meaning ‘centre

of a cell’, + osis, meaning ‘diseased condition’): an acute infectious
disease triggered by the Epstein-Barr virus. Hematic symptoms in-
clude excess of monocytes with one nucleus (Goumovskaya 2007);
–– Greek-Latin terminology is primarily used by a relatively small cir-
cle of people – specialists – and is used as a peripheral part of the
lexical system of Modern English even today (Vachek 1974);
–– it provides continuity between the past and the present as well
as the continuity in space – Latin terminology is used predomi-
nantly in Western (so-called scientific) medicine (Bujalková and
Džuganová 2015);
–– it served as a secret language among doctors. Their patients did not
understand it and were thus not forced to immediately confront
the full nature of their diagnosis. Nowadays such a paternalistic
model of doctor–patient communication should not be used any-
more (Kujawska-Lis 2016).

Conclusions

Anatomical terminology contains, according to the latest edition of Termi-

nologia Anatomica: International Anatomical Terminology (FIPAT 1998),
about 5,800 Latin terms (80% of all terms are Latin, 20% are Greek). Clini-
cal terminology copes with statistical classifications of diseases. The names
of diseases have been formed empirically in various times and places, that
is why clinical terminology is not so uniform. Besides, clinical branches
of medicine are developing continuously and knowledge of them must be
constantly revised and updated.
English is a language historically and culturally linked with Latin. Em-
phasis of differences can serve to evoke interest in medical students and
enable them to remember things better. Medical terms derived from classi-
cal languages present another ‘foreign’ language (specifically its vocabulary
and grammar rules, as syntax is not addressed in terminology studies). In
32 Božena Džuganová

medical language, a high number of English terms are equivalents of Latin

ones in terms of their semantic, historical and morphological aspects.
In our paper, we have briefly discussed the position of EMP within
ESP and ISE, paying attention to the huge progress in medical research
and the need to coin new terms for new concepts. We have mentioned the
disproportion between anatomical and clinical terminology and analysed
the main sources of English terminology, structure of medical terms and
relationships between terms from the viewpoint of polysemy, homonymy
and synonymy. We have also emphasised several advantages of the medi-
cal terms originating from Greek and Latin terminologies.

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 Barbara Librowska
Medical University of Łódź, Łódź, Poland
Małgorzata Greber
Medical University of Łódź, Łódź, Poland
Paulina Szydłowska-Pawlak
Medical University of Łódź, Łódź, Poland
Dorota Kilańska
Medical University of Łódź, Łódź, Poland
Council for eHealth in Nursing at the National Centre
for Healthcare Information Systems

Terminology Mapping: CSIOZ

Recommendation, ICNP® and SNOMED CT*

Introduction

The nursing history card included in the Recommendation of the Pol-

ish Council for eHealth in Nursing at the National Centre for Healthcare
Information Systems (Centrum Systemów Informacyjnych Ochrony Zd-
rowia, CSIOZ) dated 11 September 2013 is compliant with the Polish Na-
tional Implementation of HL7 Clinical Document Architecture (CDA)
standard. An analysis of the Recommendation led to the conclusion that

* We would like to thank the Council for eHealth in Nursing at the National Centre
for Healthcare Information Systems for consultations and the Chancellor, Dr Jacek
Grabowski from the Medical University of Łódź, for providing funds for the project.
We also thank our Colleagues from the Social Nursing and Nursing Management De-
partment for valuable tips. The aim of the project was to map the nursing history card
(Pol. karta wywiadu pielęgniarskiego) included in the Recommendation of the Council
for e-Health in Nursing at the Centre for Healthcare Information Systems on Interna-
tional Classification of Nursing Practice ICNP® reference terminology. Our aim was to
implement the ICNP® version as the standard of electronic health records (EHR).
36 B. Librowska, M. Greber, P. Szydłowska-Pawlak, D. Kilańska

the terminology in the Recommendation needed to undergo validation,

which was especially important due to the development of an IT tool dedi-
cated specifically to the nursing process. Integrating the Recommendation
with reference dictionaries such as ICNP® and SNOMED CT involved
finding terms in these dictionaries which could be assigned to terms from
the Recommendation. Mapping natural terminology (i.e., terminology
used naturally by professionals) on the controlled classifications can sup-
port the interoperability of the Recommendation and contribute to ex-
tending the technical interoperability of the HL7 CDA standard (Polska
Implementacja Krajowa, PIK – Polish National Implementation) prepared
at the National Centre for Healthcare Information Systems.
In mapping, one system’s resources are assigned to the resources of
a corresponding system (including files or network resources). Terminol-
ogy mapping involves interpreting terminology, its context and descrip-
tion while comparing systems or classifications. The process can be au-
tomated, semi-automated or performed manually. By ensuring semantic
interoperability, mapping contributes to increasing the system’s speed,
comfort and functionality (cf. Kim, Hardiker and Coenen 2014; Gianan-
gelo and Fenton 2005; Imel and Campbel 2003).
The ICNP® dictionary was created in 1989 as an initiative of the par-
ticipants of the Congress of the International Council of Nurses (ICN) in
Seoul. It is the first international standard whose aim is to facilitate the de-
scription and comparison of nursing practice locally, in regions and coun-
tries, as well as globally. The International Council of Nurses systemati-
cally updates and develops the Classification. ICNP® is constantly working
on ensuring the compatibility of the terminology with other classifications
(being in the WHO Classification family). Currently, ICNP® contains over
700 diagnoses and over 800 nursing interventions (ICN 2015a; 2015b).
SNOMED CT is a multinational and multilingual system that can be
translated into different languages and dialects. It is a clinical terminology
system designed to describe phenomena that accompany patient care for
clinical purposes. It is maintained and updated by IHTSDO – Internation-
al Health Terminology Standards Development Organisation (CSIOZ).
Terminology Mapping: CSIOZ Recommendation, ICNP® and SNOMED CT 37

1. Material and Methods

The project involved mapping the nursing history card and the health status
card onto ICNP®. For this purpose, an equivalence table was prepared, in
which natural terms from the Recommendation were entered in the first col-
umn. In the second column we entered an adequate corresponding term from
the ICNP®, i.e., from a referential terminology set which contains keywords
for ensuring consistency and univocity of terms used in the Classification.
ICNP® focus axis keywords were used in searches. In the absence of an ad-
equate term, the location, means, action, judgment and time axes were used.
The focus axis terms were assigned to diagnoses and presented in the table in
the third column. There were 60 terms in the Recommendation which were
not found in ICNP®. Consequently, in the second stage of the project, the
SNOMED CT dictionary was also applied in the mapping process. For this
purpose, the fourth column was added to the table, for a SNOMED CT term
whenever an ICNP® term was missing. It is important to note that the ICNP
terminology is translated into Polish in compliance with ICN guidelines and
consulted with a panel of experts for ICNP translation. The translated ver-
sion is assessed every two years by the nursing community.
In the next stage, the eHealth Council was consulted and terms which
did not reflect the natural terminology contained in the Recommendation
were either confirmed or eliminated, as presented in this paper. For the pur-
poses of the mapping process, an Excel spreadsheet with the Polish version
of the classification was made available by the ICN-Accredited Centre for
ICNP® Research & Development at the Medical University of Łódź. We also
used the ICNP Browser for mapping. Subsequently, the online SNOMED
CT Browser was used for the SNOMED CT dictionary mapping.
The project was carried out as part of the research activities of the Medical
University of Łódź and financed from the funds of the Medical University of
Łódź. The mapping process started in August 2017 and ended in March 2018.
The results of the work are presented in Table 1 below. Empty spaces in
the SNOMED CT column reflect the fact that SNOMED CT terms were
selected only for the terminology from the Recommendation which was
not found in ICNP®.
 Table 1. The terms of the Recommendation mapped to ICNP and SNOMED CT
38

History card term ICNP term ICNP diagnosis SNOMED CT

cukrzyca cukrzyca – diabetes [10005876] (F)
nadciśnienie tętnicze hipertensja – hypertension [10009394] (F)
choroby sercowo- status kardiologiczny – cardiac status [10003927] (F)
naczyniowe
nowotwór no corresponding term neoplastic disease
[55342001]
padaczka no corresponding term epilepsy [84757009]
gruźlica no corresponding term tuberculosis
[56717001]
układ oddechowy status oddychania – respiratory status [10016962] (F)
choroby nerek no corresponding term kidney disease
[90708001]
choroby reumatyczne no corresponding term rheumatic joint disease
[14175009]
udar mózgu no corresponding term cerebellar stroke
[230690007]
choroba zakrzepowo- no corresponding term thromboembolic
zatorowa disease [371039008]
tętno tętno – pulse rate [10016134] (F)

tętno na tętnicy promieniowej – radial pulse rate

[10016255] (F)

tętno na tętnicy grzbietowej stopy – pedal pulse rate

[10014215] (F)
tętno miarowe normalne – normal [10013295] (J)
tętno niemiarowe nieprawidłowe – abnormal [10013269] (J)
tętno nitkowate no corresponding term thready pulse
[64661000]
B. Librowska, M. Greber, P. Szydłowska-Pawlak, D. Kilańska
 History card term ICNP term ICNP diagnosis SNOMED CT
alergie alergia – allergy [10041119] (F) alergia – allergy [10029697] (DC)
alergia na lek alergia na lek – medication allergy [10011878] (F)
alergia na pokarm alergia pokarmowa – food allergy [10008091] (F)
alergia na środek alergia na lateks – latex allergy [10011185] (F) alergia na lateks – latex allergy [10000790] (DC)
chemiczny
alergia na roztocze no corresponding term allergy to house dust
mite [232350006]
alergia na sierść no corresponding term allergy to animal hair
zwierząt [300911008]
alergia na pyłki traw/ no corresponding term allergy to tree pollen
drzew [419263009]
aktywność fizyczna ćwiczenie – exercising [10007315] (F)
tytoń bez nadużywania tytoniu – no tobacco abuse bez nadużywania tytoniu – no tobacco abuse
[10029152] (F) [10029147] (DC)

nadużywanie tytoniu – tobacco abuse [10019766] (F) nadużywanie tytoniu – tobacco abuse [10022247]
(DC)

rzucenie palenia – smoking cessation [10038756] (F) używanie tytoniu w przeszłości – previous tobacco use
[10038858] (DC)
inne używki nadużywanie substancji – substance abuse [10018992] nadużywanie substancji – substance abuse [10022268]
(F) (DC)

bez nadużywania substancji – no substance abuse bez nadużywania substancji – no substance abuse
[10029134] (F) [10029123] (DC)
Terminology Mapping: CSIOZ Recommendation, ICNP® and SNOMED CT

bez nadużywania alkoholu – no alcohol abuse bez nadużywania alkoholu – no alcohol abuse
[10028777] (F) [10028765] (DC)

nadużywanie alkoholu – alcohol abuse [10002137] (F) nadużywanie alkoholu – alcohol abuse [10022234] (DC)
39
 History card term ICNP term ICNP diagnosis SNOMED CT
40

uzależnienie od alkoholu – alcohol dependence uzależnienie od alkoholu – alcohol dependence

[10041375] (F) [10041347] (DC)

bez nadużywania specyfików – no drug abuse bez nadużywania specyfików – no drug abuse
[10028875] (F) [10028868] (DC)

nadużywanie specyfiku – drug abuse [10006346] (F) nadużywanie specyfiku – drug abuse [10022425] (DC)

uzależnienie od specyfików – drug dependence uzależnienie od specyfików – drug dependence

[10041811] (F) [10041381] (DC)
przyjmowane leki administrowanie – administering [10001773] (A) administrowanie lekiem – administering medication
[10025444] (I)

administrowanie antybiotykiem – administering

antibiotic [10030383] (I)

administrowanie insuliną – administering insulin

[10030417] (I)

administrowanie leczeniem profilaktycznym –

administering prophylactic treatment [10001827] (I)

administrowanie lekiem przeciwbólowym –

administering pain medication [10023084] (I)

administrowanie lekiem przeciwgorączkowym –

administering antipyretic [10037248] (I)

administrowanie suplementem diety – administering

nutritional supplement [10037037] (I)

administrowanie szczepionką – administering vaccine

[10030429] (I)
B. Librowska, M. Greber, P. Szydłowska-Pawlak, D. Kilańska
 History card term ICNP term ICNP diagnosis SNOMED CT
administrowanie witaminą – administering vitamin
[10037044] (I)

administrowanie witaminą B12 – administering

vitamin B12 [10030438] (I)

administrowanie lekiem wziewnym – administering

inhalant medication [10046579] (I)
urządzenia urządzenie – device [10005869] (M)
urządzenie korekcyjne – corrective device [10005231]
(M)

urządzenie ortotyczne – orthotic device [10013834]

(M)

aparat ortodontyczny – tooth brace [10019848] (M)

aparat słuchowy – hearing aid [10008805] (M)

but korekcyjny – correction shoe [10005220] (M)

okulary – glasses [10008460] (M)

szkło kontaktowe – contact lens [10005040] (M)

urządzenie protetyczne – prosthetic device [10015855]

(M)
Terminology Mapping: CSIOZ Recommendation, ICNP® and SNOMED CT

peruka – wig [10021081] (M)

proteza dentystyczna – denture [10005750] (M)

proteza kończyny – artificial limb [10002602] (M)

41

szklane oko – glass eye [10008473] (M)

 History card term ICNP term ICNP diagnosis SNOMED CT
42

urządzenie uruchamiające – mobilising device

[10012131] (M)

laska inwalidzka – walking stick [10020893] (M)

aparatura podnosząca – lifting apparatus [10011349]

(M)

pojazd – vehicle [10020654] (M)

wózek inwalidzki – wheelchair [10021052] (M)

poręcz – hand rail [10008657] (M)

dostępy naczyniowe droga do ciała – body route [10003467] (L)
wkłucie obwodowe droga dożylna – intravenous route [10010798] (L)

kaniula – venous cannula [10020677] (M)

wkłucie centralne droga centralna – central line [10004115] (M)

kaniula dożylna – venous cannula [10020677] (M)

inne dostępy droga do jamy ciała – intracavitary route [10010617]
(L)

droga do miejsca występowania zmiany –

intracavitary route [10010686] (L)

droga do szyjki macicy – intracervical route

[10010629] (L)

droga do światła przewodu – intraluminal route

[10010693] (L)

droga docewkowa – urethral route [10020341] (L)

B. Librowska, M. Greber, P. Szydłowska-Pawlak, D. Kilańska
History card term ICNP term ICNP diagnosis SNOMED CT
droga dodziąsłowa – gingival route [10008439] (L)

droga dogałkowa – ocular route [10013615] (L)

droga domięśniowa – intramuscular route [10010705]

(L)

droga donosowa – nasal route [10012430] (L)

droga doodbytnicza – rectal route [10016553] (L)

droga dooponowa – intrathecal route [10010767] (L)

droga doowodniowa – intraamnional route

[10010561] (L)

droga dopochwowa – vaginal route [10020581] (L)

droga dopęcherzykowa – intravesical route

[10010812] (L)

droga dosercowa – intracardiac route [10010601] (L)

droga dostawowa – intraarticular route [10010588]

(L)

droga dotętnicza – intraarticular route [10010574] (L)

droga doustna – oral route [10013749] (L)

Terminology Mapping: CSIOZ Recommendation, ICNP® and SNOMED CT

droga douszna – auricular route [10003008] (L)

droga dożylna – intravenous route [10010798] (L)

droga ileostomijna – ileostomy route [10009743] (L)

43
History card term ICNP term ICNP diagnosis SNOMED CT
44

droga inhalacji – inhalation route [10031585] (L)

droga kolostomijna – colostomy route [10004617] (L)

droga nadtwardówkowa – epidural route [10007021]

(L)

droga oddechowa – airway route [10002100] (L)

droga okołonerwowa – perineural route [10014355]

(L)

droga okołostawowa – periarticular route [10014329]

(L)

droga podania – topical route [10033157] (L)

droga podjęzykowa – sublingual route [10018985] (L)

droga podskórna – subcutaneous route [10018963] (L)

droga pokarmowa – gastrointestinal route [10008321]

(L)

droga pozagałkowa – retrobulbar route [10017206] (L)

droga pozajelitowa – parenteral route [10014047] (L)

droga pozaowodniowa – extraamnional route

[10007434] (L)

droga przez szyjkę macicy – endocervical route

[10006847] (L)
B. Librowska, M. Greber, P. Szydłowska-Pawlak, D. Kilańska
 History card term ICNP term ICNP diagnosis SNOMED CT
droga przezmostkowa – intrasternal route [10010751]
(L)

droga skórna (powierzchowna) – cutaneous route

[10005489] (L)

droga tracheostomijna – tracheostomy route

[10019946] (L)

droga transdermalna – transdermal route [10020011]

(L)

droga urostomijna – urostomy route [10020510] (L)

droga wewnątrzgałkowa – intraocular route

[10010714] (L)

droga wewnątrzkanałowa – intraductal route

[10010672] (L)

droga wewnątrzmaciczna – intrauterine route

[10010779] (L)

droga wewnątrztrzustkowa – intrabuccal route

[10010590] (L)

droga wieńcowa – intracoronary route [10010638] (L)

droga zatokowa – endosinusial route [10006852] (L)

Terminology Mapping: CSIOZ Recommendation, ICNP® and SNOMED CT

droga śródskórna – intracutaneous route [10010664]

(L)
status społeczny status społeczny – social status [10018410] (F)
45
 History card term ICNP term ICNP diagnosis SNOMED CT
46

mieszka z rodziną/ no corresponding term lives with family

opiekunem [22413007]
mieszka samotnie no corresponding term lives alone [105529008]
bezdomny no corresponding term homeless [32911000]
status ekonomiczny no corresponding term economic status
[73831000]
pracuje no corresponding term working [261041009]
renta no corresponding term invalidity pension
[160981007]
emerytura no corresponding term retirement pension
[160995005]
zasiłek no corresponding term benefit status
[224192004]
skóra zaburzenia na skórze – impaired skin [10012917] (F)
świerzb no corresponding term infestation caused by
Sarcoptes scabiei var.
hominis
[128869009]
wszawica no corresponding term pediculosiscapitis
[81000006]
pediculosiscorporis
[25188002]
wybroczyny no corresponding term petechiae of skin
[423716004]
skóra sucha sucha skóra – dry skin [10006367] (F)
skóra wilgotna wilgotna skóra – moist skin [10012149] (F)
uszkodzenia pęknięcie – fissure [10007963] (F)
powierzchowne
maceracja – maceration [10011493] (F)

egzema – eczema [10031172] (F)

B. Librowska, M. Greber, P. Szydłowska-Pawlak, D. Kilańska
 History card term ICNP term ICNP diagnosis SNOMED CT
trądzik – acne [10029553] (F)

tkanka bliznowata – scar tissue [10017500] (F)

rany przewlekłe rana skóry – skin wound [10018256] (F)

rana – wound [10021178] (F)

maceracja – maceration [10011493] (F)

pęknięcie – fissure [10007963] (F)

samookaleczenia samookaleczenie – self-mutilation [10017795] (F) samookaleczenie – self-mutilation [10001623] (DC)
inne zaburzenia rana nowotworowa – malignant wound [10031688] rana złośliwa (niegojąca) – malignant wound
(F) [10030019] (DC)

rana oparzeniowa – burn wound [10030866] (F) rana oparzeniowa – burn wound [10029737] (DC)

rana otwarta – open wound [10046408] (F)

rana zamknięta – closed wound [10044928] (F)

wrzód – ulcer [10020237] (F)

rana urazowa – traumatic wound [10020122] (F) rana urazowa – traumatic wound [10030088] (DC)

rana kłuta – puncture wound [10016147] (F)

rana postrzałowa – gunshot wound [10008619] (F)

rana szarpana – laceration [10011090] (F)

Terminology Mapping: CSIOZ Recommendation, ICNP® and SNOMED CT

martwica – necrosis [10012482] (F)

odmrożenie – frost bite [10008247] (F)

oparzenie – burn [10003763] (F)

47
 History card term ICNP term ICNP diagnosis SNOMED CT
48

otarcie naskórka – excoriation [10007287] (F)

stłuczenie – contusion [10005161] (F)

zacięcie – cut [10005462] (F)

owrzodzenie cukrzycowe – diabetic ulcer owrzodzenie cukrzycowe – diabetic ulcer

[10031101] (F) [10042181] (DC)

owrzodzenie stopy cukrzycowej – diabetic foot ulcer

[10042650] (F)

owrzodzenie żylne – venous ulcer [10020683] (F) owrzodzenie żylne – venous ulcer [10030100] (DC)
rana pooperacyjna rana chirurgiczna – surgical wound [10019265] (F) rana chirurgiczna – surgical wound [10023148] (DC)
odleżyny odleżyna – pressure ulcer [10015612] (F) odleżyna – pressure ulcer [10025798] (F)

bez odleżyny – no pressure ulcer [10029077] (F) bez odleżyny – no pressure ulcer [10029065] (DC)
wzrok wzrok – sight [10018124] (F)
wzrok prawidłowy, zdolność widzenia – ability to see [10023468] (F)
pozytywny
niedowidzenie no corresponding term zaburzone widzenie – impaired vision [10022748] amblyopia [387742006]
(DC)
ślepota no corresponding term zaburzone widzenie – impaired vision [10022748] day blindness
(DC) [399323001]
słuch słuch – hearing [10008814] (F)
słuch efektywny zdolność słyszenia – ability to hear [10023434] (F)
węch powonienie – smell [10018327] (F)
węch efektywny zdolność odczuwania zapachów – ability to smell efektywny zmysł powonienia – effective sense of smell
[10023475] (F) [10027344] (DC)
węch zaburzony no corresponding term zaburzone odczuwanie zapachów – impaired sense of disorder of smell
smell [10022528] (DC) [275462005]
B. Librowska, M. Greber, P. Szydłowska-Pawlak, D. Kilańska
 History card term ICNP term ICNP diagnosis SNOMED CT
niedosłuch no corresponding term zaburzona zdolność słyszenia – impaired hearing tone deafness
[10022544] (DC) [55647004]
głuchota no corresponding term zaburzona zdolność słyszenia – impaired hearing hearing loss [15188001]
[10022544] (DC)
smak smak – taste
[10019458] (F)
smak efektywny zdolność odczuwania smaku – ability to taste efektywny zmysł smaku – effective sense of taste
[10023481] (F) [10028538] (DC)
smak zaburzony zaburzone odczuwanie smaku – impaired sense of disorder of taste
taste [10022814] (DC) [399993004]
układ nerwowy status neurologiczny – neurological status [10013141]
(F)
pełna świadomość świadomość – awareness [10003083] (F)
nastrój wyrównany równowaga nastroju – mood equilibrium [10035785] równowaga nastroju – mood equilibrium [10035792]
(F) (DC)
komunikacja słowno komunikowanie – communication [10004705] (F)
logiczna
zachowanie interaktywne – interactive behaviour efektywne zachowanie interaktywne – effective
[10010463] (F) interactive behaviour [10028063] (DC)
rytm snu i czuwania adekwatny sen – adequate sleep [10014939] (F) adekwatny sen – adequate sleep [10024930] (DC)
zachowany
nudności nudności – nausea [10012453] (F) nudności – nausea [10000859] (DC)

bez nudności – no nausea [10028997] (F) bez nudności – no nausea [10028984] (DC)
zaburzenia splątanie – confusion [10004947] (F) splątanie – confusion [10023633] (DC)
świadomości
Terminology Mapping: CSIOZ Recommendation, ICNP® and SNOMED CT

splątanie chroniczne – chronic confusion [10000522]

(DC)

splątanie ostre – acute confusion [10000449] (DC)

nastrój podwyższony, no corresponding term nastrój labilny – labile moods [10045652] (DC) mood swings
49

obniżony [18963009]
 History card term ICNP term ICNP diagnosis SNOMED CT
50

zawroty głowy zawroty głowy – dizziness [10006160] (F)

omdlenia no corresponding term fainting [271594007]
zaburzenia równowaga – balance [100031100] (F) zaburzona równowaga – impaired balance [10047170]
równowagi (DC)
utrata przytomności no corresponding term loss of consciousness
[419045004]
napady padaczkowe no corresponding term epileptic seizure –
myoclonic [192992007]
rytm snu i czuwania zaburzony sen – impaired sleep [10012929] (F) zaburzony sen – impaired sleep [10027226] (DC)
zaburzony
bezsenność – insomnia [10010330] (F)

hipersomnia – hypersomnia [10009387] (F)

lunatykowanie – sleep walking [10018294] (F)

niedowłady niedowład – paresis [10014075] (F)
porażenia porażenie – paralysis [10014006] (F)
komunikacja zdolność komunikowania werbalnego – ability to zdolna/y do komunikowania werbalnego – able to
werbalna communicate by talking [10025039] (F) communicate verbally [10028230] (DC)
komunikacja apraxia apraxia
ograniczona, [10047039] (F) [10047041] (DC)
wymuszona
zaburzenia mowy dysfazja – dysphasia [10006457] (F) zaburzone komunikowanie werbalne – impaired
verbal communication [10025104] (DC)
niewyraźna mowa – slurred speech [10018304] (F)

jąkanie się – stuttering [10018944] (F)

zachowanie i reakcje zachowanie – behaviour [10003217] (F)
emocjonalne
zachowanie bez pozytywne zachowanie – positive behaviour
zaburzeń [10014816] (F)
B. Librowska, M. Greber, P. Szydłowska-Pawlak, D. Kilańska
 History card term ICNP term ICNP diagnosis SNOMED CT
zachowanie zachowanie zorganizowane – organised behaviour
adekwatne do sytuacji [10013777] (F)
pełna świadomość bez agresywnego zachowania – no aggressive bez agresywnego zachowania – no aggressive
co do miejsca, czasu behaviour [10035632] (F) behaviour [10035645] (DC)
i osoby
bez przemocy – no violence [10029175] (F) bez przemocy – no violence [10029168] (DC)

zachowanie asertywne – assertive behaviour

[10002660] (F)
zaburzenia problem z zachowaniem – behaviour problem problem z zachowaniem – behaviour problem
zachowania [10012545] (F) [10029716] (DC)
niepokój zachowania kompulsywne – compulsive behaviour
psychoruchowy [10004883] (F)
pobudzenie zachowanie autodestrukcyjne – self-destructive zachowanie autodestrukcyjne – self destructive
psychoruchowe behaviour [10017707] (F) behaviour [10027424] (DC)

zachowanie zdezorganizowane – disorganised

behaviour [10006059] (F)

zachowanie wycofane – withdrawn behaviour zachowanie wycofane – withdrawn behaviour

[10040754] (F) [10040765] (DC)
lęk niepokój – anxiety [10002429] (F) niepokój – anxiety [10000477] (DC)

starch – fear [10007738] (F) strach – fear [10000703] (DC)

agresja zachowanie agresywne – aggressive behaviour
[10002026] (F)
rozpacz rozpacz – despair [10005811] (F) rozpacz – despair [10047056] (DC)
Terminology Mapping: CSIOZ Recommendation, ICNP® and SNOMED CT

smutek smutek – sadness [10017418] (F) smutek – sadness [10040662] (DC)

obojętność no corresponding term indifference [20602000]
inne bezradność – helplessness [10008920] (F) bezradność – helplessness [10039952] (DC)
bezsilność – powerlessness [10015394] (F) bezsilność – powerlessness [10001578] (DC)
51

brak nadziei – hopelessness [10009105] (F) brak nadziei – hopelessness [10000742] (DC)
 History card term ICNP term ICNP diagnosis SNOMED CT
52

cierpienie – suffering [10019055] (F) cierpienie – suffering [10025588] (DC)

dystres – distress [10006118] (F)
frustracja – frustration [10008252] (F)
gniew – anger [10002320] (F) gniew – anger [10045578] (DC)
nastrój depresyjny – depressed mood [10005784] (F) nastrój depresyjny – depressed mood [10022402] (DC)
negative euphoria – negative euphoria [10047382] (F) negative euphoria [10047400] (DC)
nerwowość – nervousness [10013071] (F)
samotność – loneliness [10011417] (F)
wstyd – shame [10017996] (F) wstyd – shame [10046761] (DC)
zagrożenie – insecurity [10010311] (F)
zawiść – envy [10007013] (F)
zazdrość – jealousy [10010952] (F)
zmęczenie – fatigue [10007717] (F) zmęczenie – fatigue [10000695] (DC)

wyczerpanie [10007327] (DC)

układ sercowo- status sercowo-naczyniowy – cardiovascular status
naczyniowy [10033946] (F)
zaburzenia zaburzony – impaired [10012938] (J) zaburzony układ sercowo-naczyniowy – impaired
cardiovascular system [10022949] (DC)
obrzęki obrzęk – oedema [10041951] (F)

obrzęk limfatyczny – lymphatic oedema obrzęk limfatyczny – lymphatic oedema

[10031661] (F) [10030003] (DC)

obrzęk obwodowy – peripheral oedema obrzęk obwodowy – peripheral oedema

[10027476] (F) [10027482] (DC)
B. Librowska, M. Greber, P. Szydłowska-Pawlak, D. Kilańska
 History card term ICNP term ICNP diagnosis SNOMED CT
obrzęk wysiękowy – weeping oedema [10033310] (F) obrzęk wysiękowy – weeping oedema [10030116]
(DC)

bez obrzęków obwodowych – no peripheral oedema bez obrzęków obwodowych – no peripheral oedema
[10029031] (F) [10029020] (DC)
wodobrzusze wodobrzusze – ascites [10041946] (F)
sinica no corresponding term cyanosis [3415004]
duszność duszność – dyspnoea [10006461] (F) duszność – dyspnoea [10029433] (DC) dyspnea [267036007]

bez duszności – no dyspnoea [10029255] (F) bez duszności – no dyspnoea [10029264] (DC)
duszność wysiłkowa duszność funkcjonalna (wysiłkowa) – functional duszność funkcjonalna (wysiłkowa) – functional
dyspnoea [10008268] (F) dyspnoea [10029414] (DC)
duszność duszność spoczynkowa – resting dyspnoea [10017117] duszność spoczynkowa – resting dyspnoea [10029422]
spoczynkowa (F) (DC)

duszność w pozycji leżącej – orthopnoea [10013823]

(F)
żylaki kończyn zaburzony proces układu naczyniowego – impaired
dolnych, choroba vascular process [10012993] (F)
żylna zakrzepowo-
zatorowa zakrzepica żył głębokich – deep vein thrombosis
[10027495] (F)

bez zakrzepicy żył głębokich – no deep vein bez zakrzepicy żył głębokich – no deep vein
thrombosis [10036391] (F) thrombosis [10036406] (DC)

pozytywny proces układu naczyniowego – positive efektywna funkcja naczyń obwodowych – effective
Terminology Mapping: CSIOZ Recommendation, ICNP® and SNOMED CT

vascular process [10028118] (F) peripheral vascular function [10028139] (DC)

układ oddechowy status oddychania – respiratory status [10016962] (F)
53
 History card term ICNP term ICNP diagnosis SNOMED CT
54

bez zaburzeń, oddech pozytywny proces układu oddechowego – positive efektywna funkcja układu oddechowego – effective
efektywny respiratory system process [10028156] (F) respiratory system function [10028160] (DC)

efektywna wymiana gazowa –

effective gas exchange [10027993] (DC)

efektywne oddychanie – effective breathing

[10041334] (DC)
zaburzenia układu zaburzony proces układu oddechowego – impaired zaburzona funkcja układu oddechowego – impaired
oddechowego respiratory system process [10012891] (F) respiratory system process [10023362] (DC)
oddech nieregularny no corresponding term irregular breathing
[248585001]
oddech zwolniony no corresponding term slow respiration
[86684002]
oddech przyspieszony no corresponding term tachypnea
[271823003]
oddech świszczący świszczenie – wheeze [10033334] (F) świszczenie – wheeze [10030128] (DC)
stany bezdechu bezdech – apnoea [10035012] (F) bezdech – apnoea [10035020] (DC)
duszność duszność – dyspnoea [10006461] (F) duszność – dyspnoea [10029433] (DC)

duszenie się – suffocation [10019064] (F)

hipoksja – hypoxia [10009608] (F)
kwasica oddechowa – respiratory acidosis [10032653]
(F)
aceton no corresponding term ketotic breath
[23034007]
fetor no corresponding term breath smells
unpleasant [79879001]
kwaśny kwasica oddechowa – respiratory acidosis [10032653]
(F)
kaszel kaszel – cough [10005249] (F) kaszel – cough [10047143] (DC)
B. Librowska, M. Greber, P. Szydłowska-Pawlak, D. Kilańska
 History card term ICNP term ICNP diagnosis SNOMED CT
suchy kaszel no corresponding term dry cough [11833005]
wilgotny kaszel no corresponding term productive cough
[28743005]
kaszel napadowy no corresponding term paroxysmal cough
[43025008]
chroniczny kaszel no corresponding term chronic cough
[68154008]
pokasływanie no corresponding term coughing [263731006]
chrypka no corresponding term hoarseness [50219008]
zaleganie w drzewie zaburzony proces układu oddechowego – negative zaburzona funkcja układu oddechowego – actual
oskrzelowym respiratory system process [10012891] (F) negative respiratory system process [10023362] (DC)
odkrztuszanie odkrztuszanie – expectoration [10007362] (F)
odsysanie no corresponding term exhaustion [60119000]
plwocina plwocina – sputum [10018717] (F)
kolor plwociny no corresponding term gray sputum
[277900008]
rusty sputum
[24816000]
green sputum
[277908001]
white sputum
[427931002]
brown sputum
[277910004]
yellow sputum
[277907006]
Terminology Mapping: CSIOZ Recommendation, ICNP® and SNOMED CT

clear sputum
[248604008]
dirty sputum
[248605009]
sinica no corresponding term cyanosis [3415004]
55
 History card term ICNP term ICNP diagnosis SNOMED CT
56

sinica obwodowa no corresponding term peripheral cyanosis

[95442007]
drożność dróg udrożnienie dróg oddechowych – airway clearance zaburzona drożność dróg oddechowych – impaired
oddechowych [10002090] (F) airway clearance [10001051] (DC)

efektywna drożność dróg oddechowych – effective

airway clearance [10027964] (DC)
rurka intubacyjna rurka intubacyjna – endo tracheal tube [10006868]
(M)
rurka tracheotomijna tracheotomia – tracheotomy [10019951] (M)
tlenoterapia tlenoterapia – oxygen therapy [10013921] (F) terapia tlenem – real oxygen therapy [10039369] (I)
cewnik cewnik – catheter [10004087] (M)
maska maska tlenowa – oxygen mask [10013909] (M)
układ pokarmowy status układu pokarmowego – gastrointestinal status
[10034122] (F)
bez zaburzeń efektywna masa ciała – effective weight [10027385] (F) waga w granicach normy – weight within normal
limits [10027392] (DC)
niedowaga niedowaga – underweight [10020263] (F) niedowaga – underweight [10027316] (DC)

zaburzona masa ciała – impaired weight [10013016] problem z masą ciała – body weight problem
(F) [10027290] (DC)
nadwaga nadwaga – overweight [10013899] (F) nadwaga – overweight [10027300] (DC)

zaburzona masa ciała – impaired weight [10013016] problem z masą ciała – body weight problem
(F) [10027290] (DC)
otyłość otyłość – obese [10013457] (F)
niedożywienie – malnutrition [10042077] (F)

kacheksja – cachexia [10003802] (F)

kwashiorkor – kwashiorkor [10011057] (F)

B. Librowska, M. Greber, P. Szydłowska-Pawlak, D. Kilańska
 History card term ICNP term ICNP diagnosis SNOMED CT
wyniszczenie – marasmus [10011734] (F)
cofanie się pokarmu (refluks) – regurgitation
[10016632] (F)
jama ustna status jamy ustnej – oral status [10044225] (F)
błona śluzowa błona śluzowa jamy ustnej – oral mucous membrane
[10013731] (L)
pleśniawki pleśniawka/afta – thrush [10019713] (F)
owrzodzenia wrzód – ulcer [10020237] (F)
dysfagia zdolność przełykania – ability to swallow [10000236] zaburzone połykanie – impaired swallowing
(F) [10001033] (DC)
zgaga zgaga – heartburn [10043280] (F) zgaga – heartburn [10043298] (DC)
odbijanie odbijanie – burping [10003785] (F)

negatywne odbijanie – negative burping [10012584]

(F)
wymioty wymioty – vomiting [10020864] (F)

niepowściągliwe wymioty ciężarnych – hyperemesis niepowściągliwe wymioty ciężarnych – hyperemesis

[10046742] (F) [10046757] (DC)

bez wymiotów – no vomiting [10029199] (F) bez wymiotów – no vomiting [10029181] (DC)
łaknienie łaknienie – craving [10005334] (F) nadmierne przyjmowanie pokarmów – excess food
intake [10000682] (DC)
pica (łaknienie spaczone) – pica [10014580] (F)
deficyt w przyjmowaniu pokarmów – deficient food
przyjmowanie pokarmów – food intake [10008101] intake [10000607] (DC)
Terminology Mapping: CSIOZ Recommendation, ICNP® and SNOMED CT

(F)
pragnienie pragnienie – thirst [10019671] (F) pragnienie – thirst [10037847] (DC)

przyjmowanie płynów – fluid intake [10008015] (F) zaburzone przyjmowanie płynów – impaired fluid
intake [10029873] (DC)
57
 History card term ICNP term ICNP diagnosis SNOMED CT
58

odżywianie enteralne no corresponding term enteral feeding

[229912004]
PEG no corresponding term gastrostomy present
[302109006]
odżywianie no corresponding term intravenous feeding
parenteralne [25156005]
nietolerancja no corresponding term food intolerance
pokarmów [235719002]
nietolerancja napojów no corresponding term milk intolerance
[700094005]
alcohol intolerance
[102612005]
perystaltyka jelit perystaltyka jelit – bowel motility [10037207] (F)

status jelit – bowel status [10027681] (F)

wydalanie defekacja – defaecation [10005628] (F)

rutyna wypróżnień – bowel routine [10041637] (F)

efektywna defekacja – effective defaecation efektywna defekacja – effective defaecation

[10028398] (F) [10028403] (DC)

bez biegunki – no diarrhoea [10040059] (F) bez biegunki – no diarrhoea [10040063] (DC)
wzdęcia wzdęcia – flatulence [10007985] (F)

negatywne wydalanie gazów – negative flatulence

[10012725] (F)
zaparcia zaparcie – constipation [10004999] (F) zaparcie – constipation [10000567] (DC)

zaklinowanie – faecal impaction [10009817] (F) zaklinowanie masami kałowymi – faecal impaction
[10021885] (DC)
B. Librowska, M. Greber, P. Szydłowska-Pawlak, D. Kilańska
 History card term ICNP term ICNP diagnosis SNOMED CT
biegunka biegunka – diarrhoea [10005933] (F) biegunka – diarrhoea [10000630] (DC)

zaburzona defekacja – impaired defaecation zaburzona defekacja – impaired defaecation

[10012652] (F) [10022062] (DC)
stolec zabarwiony krew – blood [10003319] (F)
krwią
smolisty stolec no corresponding term tarry stool [269899009]
trzymanie stolca – bowel continence [10027699] (F) trzymanie stolca – bowel continence [10027741] (DC)

nietrzymanie stolca – bowel incontinence nietrzymanie stolca – bowel incontinence

[10027702] (F) [10027718] (DC)

nieretencyjne trzymanie stolca – encopresis

[10027725] (F)
przetoka stomia – stoma [10018857] (L)

ileostomia – ileostomy [10009727] (L)

kolostomia – colostomy [10004590] (L)

układ moczowo- status układu moczowego-płciowego – genitourinary
płciowy status [10034133] (F)
bez zaburzeń, diureza pozytywne oddawanie moczu – positive urination
prawidłowa [10014987] (F)

kontynencja moczu – urinary continence kontynencja moczu – urinary continence

[10026663] (F) [10027836] (DC)
zaburzenia układu zaburzone oddawanie moczu – impaired urination zaburzone oddawanie moczu – impaired urination
Terminology Mapping: CSIOZ Recommendation, ICNP® and SNOMED CT

moczowo-płciowego [10012986] (F) [10021790] (DC)

dysuria ból przy oddawaniu moczu – pain during urination
[10013966] (F)
wielomocz, częste oddawanie moczu – urinary frequency częste oddawanie moczu – urinary frequency
częstomocz [10046682] (F) [10046695] (DC)
59
 History card term ICNP term ICNP diagnosis SNOMED CT
60

skąpomocz, bezmocz zatrzymanie moczu – urinary retention [10034631] zatrzymanie moczu – urinary retention [10034654]
(F) (DC)
mocz zagęszczony no corresponding term turbid urine
[167238004]
krwiomocz no corresponding term blood in urine
[34436003]
nykturia moczenie mimowolne – enuresis [10026824] (F)
inkontynencja no corresponding term incontinence
[48340000]
urostomia urostomia – urostomy [10020506] (L)
inne zaburzenia białkomocz – proteinuria [10043976] (F) białkomocz – proteinuria [10043982] (DC)
inkontynencja moczu – urinary incontinence inkontynencja moczu – urinary incontinence
[10026895] (F) [10025686] (DC)

całkowita inkontynencja moczu – total urinary całkowita inkontynencja moczu – total urinary
incontinence [10026876] (F) incontinence [10026807] (DC)

funkcjonalna inkontynencja moczu – actual negative

funkcjonalna inkontynencja – functional incontinence functional incontinence [10026778] (DC)
[10026830] (F)
odruch inkontynencji moczu – reflex incontinence
[10026784] (DC)
odruch inkontynencji moczu – reflex incontinence
[10026853] (F) inkontynencja stresowa moczu – stress incontinence of
urine [10026797] (DC)
wysiłkowa inkontynencja moczu – stress incontinence
[10026869] (F) nagła inkontynencja moczu – urge incontinence of
urine [10026811] (DC)
cewnik Foley’a cewnik urologiczny – urinary catheter [10020373]
(M)
pieluchomajtki pielucha – diaper [10005914] (M)
inne urządzenia cewnik zewnętrzny – urinary condom [10020387] (M)
B. Librowska, M. Greber, P. Szydłowska-Pawlak, D. Kilańska
 History card term ICNP term ICNP diagnosis SNOMED CT
cykl miesiączkowy menstruacja – menstruation [10011976] (F)
regularny no corresponding term normal period
[282027006]
nieregularny no corresponding term irregular periods
[80182007]
menopauza menopauza – menopause [10011930] (T)
obfita menstruacja krwotok menstruacyjny – menorrhagia [10011948]
(F)
bolesna menstruacja no corresponding term painful menstruation
[289900009]
krwawienia krwotok menstruacyjny – menorrhagia [10011948]
międzymenstruacyjne (F)
ciąże ciąża – pregnancy [10015421] (F)
poród poród – child delivery [10004311] (T)

cesarskie cięcie – cesarean section [10004143] (M)

poronienie aborcja samoistna – spontaneous abortion [10018646]
(F)
wydzielina z cewki upławy – vaginal discharge [10043320] (F)
moczowej
układ kostno- status układu mięśniowo-szkieletowego –
stawowy musculoskeletal status [10034292] (F)
poruszanie status układu mięśniowo-szkieletowego – efektywny status układu mięśniowo-szkieletowego –
samodzielne, musculoskeletal status [10034292] (F) effective musculoskeletal status [10033807] (DC)
nie wymaga
Terminology Mapping: CSIOZ Recommendation, ICNP® and SNOMED CT

usprawniania,
postawa i budowa
ciała prawidłowe,
napięcie mięśniowe
prawidłowe,
ruchomość w stawach
61

pełna
 History card term ICNP term ICNP diagnosis SNOMED CT
62

napięcie mięśniowe skurcz mięśni – muscle cramp [10046703] (F) skurcz mięśni nóg – leg cramps [10046719] (DC)
obniżone, wzmożone,
przykurcze proces skręcenia mięśnia – muscle twisting process
mięśniowe, [10012328] (F)
zakres ruchów
zaburzony, siła przykurcz stawu – joint contracture [10010975] (F)
mięśniowa zaburzona
drżenia mięśniowe drżenie – tremor [10020146] (F) drżenie – tremor [10022846] (DC)

drżenie starcze – senile tremor [10017851] (F) słaba sprawność rąk – actual negative ability to
perform fine motor function [10043042] (DC)
mobilność zdolność poruszania – ability to mobilise zaburzona mobilność – impaired mobility
ograniczona [10012108] (F) [10001219] (DC)

zdolny/a do poruszania – able to mobilise

[10028461] (DC)

mobilność na wózku inwalidzkim – wheelchair zaburzona mobilność na wózku inwalidzkim –

mobility [10021068] (F) impaired wheelchair mobility [10001363] (DC)

mobilność w łóżku – mobility in bed [10003181] (F) zaburzona mobilność w łóżku – impaired mobility in
bed [10001067] (DC)

zdolny/a do mobilności w łóżku – able to move in bed

[10029240] (DC)

zdolność chodzenia – ability to walk [10000258] (F) zaburzone chodzenie – impaired walking [10001046]
(DC)

zdolny/a do chodzenia – able to walk [10028333]

(DC)

chodzenie z użyciem urządzenia – walking using

device [10020903] (F)
B. Librowska, M. Greber, P. Szydłowska-Pawlak, D. Kilańska
 History card term ICNP term ICNP diagnosis SNOMED CT
wady wrodzone no corresponding term birth defect
[276720006]
złamania złamanie – fracture [10008210] (F)
zwichnięcia zwichnięcie – sprain [10018698] (F)
inne zaburzenia ból mięśniowo-szkieletowy – musculoskeletal pain
[10012337] (F)

ból mięśni – muscle pain [10012316] (F)

ból kości – bone pain [10003569] (F)

ból artretyczny – arthritis pain [10002570] (F) ból artretyczny – arthritis pain [10047104] (DC)

ból spowodowany złamaniem – fracture pain ból spowodowany złamaniem – fracture pain
[10008223] (F) [10047127] (DC)
stan po mastektomii amputacja – amputation [10002246] (M)
Terminology Mapping: CSIOZ Recommendation, ICNP® and SNOMED CT
63
64 B. Librowska, M. Greber, P. Szydłowska-Pawlak, D. Kilańska

2. Summary of the Results

We mapped a total of 203 natural terms, 143 terms from ICNP® and 60
terms from SNOMED CT. We noticed certain inconsistencies in nausea
assessment in the Recommendation. The term ‘nausea’ was included in
the scope of food
​​ history, while the definition in the Classification indi-
cates that the term should in fact be transferred to the neurological status.
The Recommendation also included the term ‘administrowanie lekiem’,
which could not be mapped within the focus axis, but it was reflected in
the action axis and more specifically in the interventions folder. As a result,
2 terms were mapped onto the aforementioned reference terminology.
It is quite apparent that ICNP® allows for assigning more terms to
a natural term. The table presents ICNP® terminology for natural terms
from the Recommendation such as ‘inne używki’, ‘urządzenia’, ‘inne dostę-
py’, ‘uszkodzenia powierzchowne’, ‘rany przewlekłe’, ‘inne zaburzenia skó-
ry’, ‘rytm snu i czuwania’, ‘pobudzenie psychoruchowe’, ‘inne zaburzenia
zachowania’, ‘obrzęki’, ‘duszność’, ‘inne zaburzenia układu pokarmowego’
or ‘inne zaburzenia układu moczowego’. ICNP® terminology is more pre-
cise and thus provides more solid support for the nursing process.
Some natural terms in the history card could not be mapped with the
ICNP® terminology due to terminological lacunae. They could, howev-
er, be mapped with diagnoses: ‘węch zaburzony’, ‘niedosłuch’, ‘głuchota’,
‘smak zaburzony’, ‘nastrój podwyższony, obniżony’.
The Classification seems to have an insufficient number of terms de-
scribing some social situations. There was one natural term, ‘social sta-
tus’, which was mapped onto the ICNP® terminology. The dictionary lacks
the equivalents of such terms as ‘live with a family/guardian’, ‘live alone’,
‘homeless’, ‘economic status’, ‘work’, ‘pension’ and ‘benefit’. What is also
worth mentioning, specialised terminologies may sometimes use borrow-
ings or calques from their original language versions.
As a result of the mapping process, 451 terms from the nursing history
card were identified in the ICNP® dictionary; this was presented in the
following way: focus axis – 235 terms, action – 1 term, means – 31 terms,
Terminology Mapping: CSIOZ Recommendation, ICNP® and SNOMED CT 65

judgment – 3 terms, location – 54 terms and time axis – 2 terms. ICNP

Diagnosis and Interventions folders were mapped with 130 terms and 13
terms, respectively.
The use of ICNP® for mapping natural language terms from Recom-
mendation No. 1/2013 of the Council for e-Health in Nursing of 11 Sep-
tember 2013 demonstrated a possible way to build semantic interoper-
ability for nursing care. This type of interoperability is necessary for the
development of electronic health records (EHR). The documents of the
nursing history card and the health status card have become international,
univocal and precise standards. They allow for continuation, coordination
and integration of care, as recommended in Directive 24/2011/EU on pa-
tient rights in cross-border healthcare.

Conclusions

Due to the lack of equivalents of some of the terms used in mapping, it

would be advisable to revise the discussed Polish Recommendation and
include terms which would be similar in meaning and available in the
above-mentioned classifications. Our analysis confirmed that the ICNP®
dictionary is a robust tool for mapping nursing terminology because it can
help broaden the description of the patient’s health status more precisely
than the Recommendation.

References

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Available at: https://www.csioz.gov.pl/interoperacyjnosc/klasyfikacje/ (accessed
10 March 2018).
Gianangelo, K. and Fenton, S. (2005). Mapping: Creating the Terminology and
Classification Connection. WHO – Family of International Classifications Net-
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icnpr/ (accessed 30 October 2016).
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(accessed 15 August 2018).
Kisilowska, M. (2014). Katalogi ICNP®. Istota założenia, wymagania, rozwój,
znaczenie. In: Międzynarodowa Klasyfikacja Praktyki Pielęgniarskiej. ICNP
w praktyce pielęgniarskiej, ed. D. Kilańska. Warszawa: Wydawnictwo Lekar-
skie PZWL, pp. 42–45.
SNOMED CT. (n.d.). SNOMED CT Browser. Available at: http://browser.ihtsdo-
tools.org/? (accessed 10 October 2018).
 Arkadiusz Badziński
University of Silesia, Katowice, Poland

Collocations, Equivalence
and Untranslatability
as Selected Critical Aspects
in Medical Translation

The best translation does not sound like a translation.

(Nida 1964: 12)

Introduction

Medical translation obviously requires more than familiarity with medi-

cal language and a thorough knowledge of the source and target texts,
which are the initial and basic prerequisites. Other critical aspects are also
involved in this process. The analysis of research on translation shows
that the definition of the translation process is still the subject of studies
conducted by many specialists, both from theoretical and practical points
of view. Defining translation has been discussed by a number of transla-
tion scholars (Jakobson 1959; Nida 1982; Dzierżanowska 1988; Newmark
1988; Bassnett-McQuire 1991; Grucza 1991; Wilss 1999; Lipiński 2000;
Kierzkowska 2002; Grucza 2009; Radziszewska 2012; Krzywda 2014). The
increasing development of this research dates back mainly to the post-
war era. For the purpose of this paper, the definition of translation by
Nida (1982: 83) was adopted, according to whom ‘translation consists of
reproducing in the receptor language the closest natural equivalent of the
source language message, first in terms of meaning and secondly in terms
68 Arkadiusz Badziński

of style’. The constantly growing demand for medical translation in Po-

land proves that the analysis of crucial issues related to translation, such as
collocations, equivalence and untranslatability, is still essential, and may
contribute to the solution of some problems in translation of (highly spe-
cialised) medical texts.

1. Problems Related to the Translation of

Collocations: Practical Remarks

In the language of medicine special attention should be paid to the trans-

lation of collocations as they constitute one of the key issues in medi-
cal texts. Newmark (1981: 180) observes that ‘the translator (…) will be
“caught” every time, not by grammar, which is probably suspiciously “bet-
ter” than that of educated native’s, not by his vocabulary, which may well
be richer, but by his unacceptable or improbable collocations’.
The term was initially introduced by Firth in the 1950s and was de-
rived from Latin (Takač and Miščin 2013: 237). Collocations, known as
conventional syntagms, are the semantico-syntagmatic structures with
some extent of combinability (Leśniewska 2006; cf. Białek 2009). A typical
collocation is made up of a base and a collocate and is easier to compre-
hend than to produce.
Research on collocations started about 2,300 years ago in Greece
(Robins 1967) and since that time studies have been extensively done
by a number of researchers, e.g. Palmer (1933), Mitchell (1971), Cowie
(1998), Gledhill (2000), Sinclair (2004), Białek (2009) or Miščin (2013), to
name the most outstanding ones. The focus on teaching and learning col-
locations was particularly analysed (Ellis 1996; Lewis and Conzett 2000;
Nesselhauf 2004; Duan and Qin 2012).
Definitions of the term and the criteria for assessing the extent of col-
locability and their strength vary (cf. Leśniewska 2006; Badziński 2011;
Baker 2011). Most researches, however, view them as multi-word phrases
in a given language, including fixed expressions (Gledhill 2000: 1). Differ-
Collocations, Equivalence and Untranslatability as Selected Critical Aspects… 69

ent collocation levels are distinguished in a given language based on the

‘unpredictability’, which is particularly visible in the case of a comparative
analysis of two languages.
One of the most reliable and comprehensive studies on collocations
was conducted by Gledhill (2000: 1), who distinguished 3 perspectives:
(1) statistical/textual collocations (syntagmatic association of lexemes
which prefer the company of another item rather than its synonyms due to
usage-related constraints), (2) semantic/syntactic collocations (related to
a more abstract relationship that exists between words with reference to the
frequency of occurrence; grammatical collocation in which grammatical
items are mixed with lexical ones) and finally (3) discoursal/rhetorical col-
locations, analysed from the perspective of performance with the focus on
rhetorical effect with no special attention paid to lexical units or grammar.
For the purpose of this paper the adopted definition of the term col-
locations includes the phenomena larger than words, which are fixed com-
binations of lexical items.
The problem of medical translation may be partly related to the fact
that for many translators medical terminology itself and medical colloca-
tions in particular are highly specialised even in the source language. It
should also be borne in mind that unlike single-word terms, collocations
are characterised by greater precision because they reflect the content of
a given concept or notion more comprehensively with the narrowing of its
meaning (Krzywda 2014).
In the analysis of the translation of collocations, the frequency of
nouns and adjectives is high in most studies (Cowie 1998; Gledhill 2000;
Nesselhauf 2004). Additionally, the formation of abbreviations is of great
significance in this respect. It should be stressed that currently in the Pol-
ish language of medicine there is a tendency to adopt English acronyms or
initialisms in the formal register rather than to use their Polish equivalents
either abbreviated or non-abbreviated (‘CRP’ is more often used in Polish
than ‘białko ostrej fazy’ and ‘MR’ is more often used than its Polish equiva-
lent ‘rezonans magnetyczny’). Some of the abbreviations, in particular ini-
tialisms and acronyms, have currently become part of the Polish language
70 Arkadiusz Badziński

of medicine and are used exclusively in their abbreviated form (AIDS,

MCV, MCH). In some cases, the choice may be determined and dictated
either by specialty (‘transaminazy’ in internal medicine vs ‘aminotrasfera-
zy’, typically used in laboratory diagnostics) or by the absence of a proper
Polish equivalent as in the case of watch-and-wait strategy, the collocation
used in oncology settings. This inevitable trend related to abbreviations,
mostly represented in medical language by acronyms and initialisms, is
constantly on the increase in various specialties such as surgery, cardiac
surgery, neurosurgery or radiology (e.g. CPK, CKMB, fMRI).
Even with such basic examinations as complete blood count or bio-
chemical analyses, collocations in the form of abbreviations also appear in
the medical records in laboratory diagnostics (‘white blood cells’ – WBC,
‘red blood cells’ – RBC, ‘platelets’ – PLT). This phenomenon is certainly
positive due to the fact that the lexical resources of one language are en-
riched with other elements. Of note, collocations in the form of abbrevia-
tions are also frequently used in cases when a rapid implementation of
medical procedures is required (emergency medicine or neurosurgery).
Due to the fact that some abbreviations can mean different disease entities,
this fact can cause confusion and difficulty in the process of translation.
To illustrate, RS may mean Rett syndrome in neurology, Reye syndrome
in hepatology, Raynaud syndrome in rheumatology and Rumination syn-
drome in gastroenterology.
Among the issues related to the translation of collocations, attention
should also be paid to semantic and syntactic transformations. Transpo-
sition as the replacement of one word from one class with another word
with the simultaneous preservation of meaning is of common occurrence
(Vinay and Darbelnet 1995). In other words, one grammatical category is
replaced with another (‘zaciskający pierścień’ – contriction ring, ‘rozdęcie
brzucha’ – abdominal distension).
The use of a descriptive equivalent is a procedure based on the exten-
sion of translation by placing further information in the target text for
more accurate and precise understanding (Radziszewska 2012). A large
number of collocations are translated into Polish with the use of descrip-
Collocations, Equivalence and Untranslatability as Selected Critical Aspects… 71

tive equivalents (blood group antigens – ‘antygeny głównych grup krwi

ABO’, dental anaeasthesia – ‘znieczulenie do zabiegów stomatologicznych’,
coronary care unit – ‘oddział intensywnego nadzoru kardiologicznego’,
retain urinary continence – ‘zachować zdolność do utrzymania moczu’,
dead on arrival – ‘martwy w chwili przywiezienia do szpitala’, corneal de-
bridement – ‘usunięcie patologicznego nabłonka rogówki’). There is no
explicit or prescribed rule in the selection of parts of speech that are incor-
porated into such collocations. Each time the decision to expand a multi-
word group must be made individually based on the language typical of
a given field and such a decision is connected with situation-dependent
circumstances. Extending the target collocations is sometimes crucial so
that the target text could sound not only correct but also natural to a na-
tive specialist in the particular medical field.
Furthermore, another frequently observed phenomenon in medical
translation is related to collocations consisting of two or more elements
often made up of a specialised term and an element (or elements) that are
not a medical term, which are taken from general language (interpupillary
distance, continuous infusion, papillary layer).
In the translation of collocations the temptation to use calque may oc-
cur. Vinay and Darbelnet (1995) have discussed the notion of calque. This
phenomenon is defined as ‘the borrowing[s] taken from other languages
by literal word-for-word or root-for-root translation’ (Džuganová 2013:
62). Calques may sound particularly odd to specialists in a given field,
especially when they themselves use a different equivalent. This procedure
is risky when different prefixes are used in both languages or when they
occur in a different order (‘podobarometr’ in Polish vs baropodometer
in English). Newmark observes that transparent collocations that ‘sound
convincing but have not been previously seen are among the translator’s
biggest pitfalls’ (1979: 1406).
The authors of manuscripts (i.e., clinicians themselves) frequently ap-
ply imprecise and/or inconsistent terms due to the use of professional jar-
gon taken from everyday (spoken) clinical practice. Pilegaard (1997: 175)
states that ‘health-care professionals often write about their specialty in
72 Arkadiusz Badziński

a language which is filled with their own specialised terminology and do

not always realise that it is, in fact, jargon’, which may be even incorrect
when written, even though it is acceptable when used in spoken language.
To illustrate, the phrase ‘oznaczyć leukocytozę’ (literally ‘to determine
leukocytosis’) used in Polish is incorrect as ‘leukocytoza’ (leukocytosis)
is already a pathological condition; this phrase is therefore technically er-
roneous in the source text, which may result in the wrong translation in
the target text if the translator does not possess medical knowledge. The
correct term that should be used in Polish is obviously ‘oznaczyć liczbę
leukocytów’, i.e., ‘to determine WBC’.
The phenomenon of collocations may also be analysed from the per-
spective of the terminological density of the text. Although Radziszewska
(2012) observed that vocabulary related to general science and specialised
vocabulary in German remains at the level of <30%, and this result is even
lower in English, this observation in the language of medicine seems to
be too far-reaching. For the sake of comparison, 5 randomly selected pa-
pers from the field of gastroenterology (Lancet, British Medical Journal,
New England Journal of Medicine, Epidemiological Review, JAMA) were
used to analyse their density by the author of this paper. The manuscripts
selected for the analysis were related to pseudomembranous colitis. Gen-
erally, lexical density was calculated according to the following formula:
percentage of specialised terminology out of the total number of words.
The percentage of specialised vocabulary varied with the following results:
18.4%, 24.1%, 32.7%, 14.2% and 31.4%, respectively. Although this was
only a tentative analysis, it shows an enormous percentage differences re-
lated to lexical density. The number of medical collocations in a given text
can indirectly influence text density thus increasing or decreasing difficul-
ties related to the process of translation. However, any generalisation in
this respect is impossible and therefore further studies are warranted.
A very interesting study that needs to be mentioned was conducted
by Gayle (2016). Based on the Oxford English Corpus (OEC) of nearly
2.5 billion words, Gayle used computational linguistics to extract collo-
cations most likely to occur in medical English writing and assessed the
Collocations, Equivalence and Untranslatability as Selected Critical Aspects… 73

proportion of different parts of speech. The frequency of every collocation

from the medical subcorpus was compared to respective frequencies in
the OEC corpus and these collocations were ranked depending on the
score. As a result, a ranked list was formed of the collocations which were
most likely to occur in the medical subcorpus. After elimination of du-
plicate terms, 5,436 entries of 10,000 collocations were then categorised,
depending on the grammatical relationship. In total, ‘constructions com-
prised of preposition-dependent nouns, verbs and adjectives were the
most prevalent (38%), followed by prepositional phrases (33%)’. ‘Preposi-
tion-independent noun and verb-based constructions were far less preva-
lent overall (18% and 5%, respectively)’ (Gayle 2016: 2). The study dem-
onstrated that terms of Greek and Latin origin are, in fact, considerably
less prevalent than it is generally thought, showing a high prevalence of
dependent prepositions in medical English.
Last but not least, culture-related issues may also be involved in the
process of translation and the proper use of collocations. As a result of
the increasing migration among different nations, a translator should be
particularly aware of the culture-specific domain in which collocations
may also play a part and pose some problems (Montalt Resurrecció and
González Davies 2007; Baker 2011), particularly during translation and in-
terpreting at hospital settings (e.g. emergency cases related to blood trans-
fusion, refusal of certain blood-derived products, faith-related avoidance
of certain medical procedures). It may also occur in the case of Chinese
medicine and its approaches to treatment when confronted with Western
medicine and its mode of treatment. Problems may arise at the level of
active substances or even certain procedures. Obviously, it is extremely
difficult to provide correct translation of some medico-philosophical
concepts (particularly frequent in Chinese medicine) as they are isolated
from the environment into which they are placed (Western world) and are
introduced into an entirely different language with a completely differ-
ent system of metaphors and set of values (Unschuld 1989; cf. Lakoff and
Johnson 1980). The ethnolinguistic sphere, however, must also be borne
in mind in medical translations since the broadly understood phenomena
74 Arkadiusz Badziński

related to historical background and geographical domains next to the so-

cio-cultural domain are also involved in the translation process. Religious
dietary restrictions must also be considered and further explained (if need
be) in the case of, e.g., kosher products. In the multicultural society in the
UK, it is vital for prescribers and patients to engage in an open dialogue
and to consider religious dietary restrictions to optimise treatment. Medi-
cal translators should be familiar with all these culture-related issues and
frequently use the strategy of adaptation when cultural differences occur
between the source language and the target language.

2. Equivalence and Untranslatability

Equivalence, another crucial concept related to collocations, is widely dis-

cussed not only in reference to scientific texts or discourse. Pieńkos (1999)
understands the equivalence between source and target texts as a key issue
that linguistics of the translation is involved in and translation theorists
themselves wonder whether the translation process should be closer to the
sender or the recipient of the text. In view of the large number of interpre-
tations, previous attempts to define the phenomenon have not resulted in
the development of any universally adopted definition.
In the process of translation, the choice of the proper equivalent
should be of utmost importance. Such an equivalent should be selected
as the most optimal of many that are available, which is directly related to
the phenomenon of equivalence proposed by Jakobson (1959) where the
aim in the original language should be identical to the aim in the target
language. The main problems are related to the multiplicity of medical
terminology where some nomenclature typical of anatomical concepts is
based on Latin and Greek, mainly in terms of prefixation and suffixation.
It would seem that since science and medicine in particular has developed
its own hermetic terminology, establishing the equivalent forms should
not be problematic. This is a common misconception because the phe-
nomena known as synonymy and polysemy are so prevalent in the lan-
Collocations, Equivalence and Untranslatability as Selected Critical Aspects… 75

guage of medicine (housewife’s eczema – ‘wyprysk ze zużycia’ or ‘wyprysk

gospodyń domowych’; fever of unknown origin – ‘gorączka o nieznanej
przyczynie’, ‘gorączka o nieustalonej etiologii’ or ‘gorączka nieznanego po-
chodzenia’). Furthermore, for the Polish term ‘choroba wieńcowa’ there
are as many as 4 different equivalent terms (coronary heart disease, coro-
nary arterial disease, coronary artery disease, ischaemic heart disease); for
Polish ‘droga’ at least 6 terms can be applied in medicine, depending on
the collocation and the context (way, pathway, tract, passage, path, route).
To illustrate, sensory pathway, alimentary tract, upper airways or admin-
istration route are just a few examples that show the above phenomenon.
Most medical dictionaries, however, offer context-free words, which
does not solve the problem and may even escalate it when an inappropri-
ate term is selected. Therefore the ideal 1 : 1 correspondence in which one
term could correspond to one equivalent is often impossible even at the
level of single words (the principle of 1 : 1 equivalence). Pilegaard (1997:
175) states that ‘it should be borne in mind that shades of meaning are
not necessarily expressed in the same way in the source language and the
target language’.
In the 1960s, Nida (1964: 159) formulated two types of equivalence:
formal and dynamic. The first one ‘focuses attention on the message itself,
in both form and content’ bearing in mind that ‘the message in the recep-
tor language should match as closely as possible the different elements in
the source language’. The latter one is based on Nida’s ‘principle of equiva-
lent effect’ in which the relationship between receptor and message ought
to ‘be substantially the same as that which existed between the original
receptors and the message’. Based on the above, in the case of medical
collocations dynamic equivalence is the prevailing relationship between
source and target units.
According to Dzierżanowska (1988), equivalence of the text as a whole
is more important than the equivalence in terms of word(s). According to
that researcher, the translation of a phrase consists in finding the equiva-
lent of the main element, which is most often the noun, forming the basis
for a collocation, and then its collocates.
76 Arkadiusz Badziński

Radziszewska (2012) is of the opinion that translation of specialised

terminology is characterised by certain features that distinguish it from
other forms of translation. In the process of translation one should bear
in mind the fact that the existence of equivalents, which remain in the
absolute 1 : 1 relationship, is not a rule even in the case of such highly
specialised texts as medical ones. The most significant aspect is to convey
the meaning of the original and not to provide complete grammatical or
lexical identity. Vinay and Darbelnet (1995: 342) perceive equivalence-
oriented translation as a procedure that ‘replicates the same situation as
in the original, whilst using completely different wording’. Despite the fact
that they mainly analyse equivalence in relation to idioms and proverbs, it
can also be applied in the case of collocations.
One of the most thorough analyses of equivalence was proposed by
Baker (2011), who discussed the phenomenon of equivalence at various
levels, including above the word level, i.e., at the level of collocations. Bak-
er mentioned the lack of understanding of collocations in the source text
as a serious problem. She also emphasised the occurrence of marked col-
locations in the source text, i.e., new collocations, denoting new concepts
and phenomena, which in the language of medicine could correspond to
collocations that come into use in new fields, such as nanomedicine or
oncology (e.g. watch-and-wait strategy).
For Pisarska and Tomaszkiewicz (1996), good translation is based on
the equivalence of the global target text compared to the source text. Ac-
cording to them, even if equivalence exists, it is almost always approxi-
mate and, in fact, almost never absolute. However, for Newmark (1988),
the most important phenomenon is the so-called equivalent effect and
in order to achieve it, the function of the source text must be identical to
the function of the target text, which is of prime importance in the case
of medical translation, where precision is a factor that may decide about
human life.
Baker (2011), in turn, discussing the lack of equivalence, postulates
that among the procedures to overcome it the following ones should be
used: superordinates (i.e., hypernyms – words with a broader and more
Collocations, Equivalence and Untranslatability as Selected Critical Aspects… 77

general meaning), borrowing with further explanation, translation by

means of a paraphrase or translation by omission. The above procedures
applied in the case of medical translation will obviously depend on the
text itself, the receiver of the text and its purpose.
Interestingly, the phenomenon of equivalence in terms of eponymy is
not always observed. According to Newmark (1981: 198), an eponym is
defined as ‘any word that is identical with or derived from a proper name
which gives it a related sense’. Newmark also distinguished three catego-
ries of eponyms, i.e., those derived from persons (inventors, discoverers),
objects and places. Physicians have disagreed over the appropriateness of
eponymous terms with respect to both written and spoken medical dis-
course. For some, they honour the inventors, whereas for others they give
no information other than historical. Despite these controversies, medi-
cal language is still replete with eponyms in the number of over 13,000
(Perlińska and Krzyżowski 2009). The translation practice shows that
equivalence at the level of eponyms is not always present either. The Eng-
lish equivalent of ‘odczyn Biernackiego’ (OB) is erythrocyte sedimenta-
tion rate, and the contribution of the Polish scientist to the phenomenon
in question is currently not marked in the English language. Similarly,
‘choroba Leśniowskiego–Crohna’ consists of two surnames of scientists
(Leśniowski and Crohn), whereas in the Anglo-Saxon terminology the
term Crohn(’s) disease is used. Lee-Jahnke (1998), after Van Hoof (1993),
uses the following typology of eponyms:
–– identical eponyms in both source and target texts;
–– different eponyms in source and target texts;
–– the absence of an eponym in one language.
Taking the above into account, one should consider the fact that equiv-
alence can be obtained at different levels. The concept of equivalence can
be seen as a gradual phenomenon, which means that the correspond-
ence may be higher or lower, and the decision lies between the complete
equivalence and its absence, and these two points are the extremes of the
concept of equivalence (Kizińska 2015). This concept is consistent with
the approach of the Leipzig School and illustrates the types of equivalence
78 Arkadiusz Badziński

where the complete equivalence is a 1 : 1 correspondence, facultative

equivalence is the existence of more equivalents in the target text for one
concept from the source language and finally zero equivalence shows no
equivalent at all.
Discussing the phenomenon of equivalence, it is essential to mention
the notion of untranslatability defined as the impossibility to translate the
entire phrase (or its fragments) or the inability to express or convey cer-
tain concepts in the target language that can be expressed in the original
language (Wojtasiewicz 2005).
According to Wojtasiewicz (2005), scientific texts occupy the third
position after trade-related and technical texts as those with the highest
percentage of translatability, and if medical discourse is treated as part of
scientific texts, it is clear that the problem of untranslatability is minimal.
In rare situations, when no direct equivalent is available, the translator
should attempt to find a substitute for the term (concept) or maintain the
term from the source text (collocation watch-and-wait in oncology). The
translator may also use a footnote with further explanation.
The situation, however, is not always so obvious. The concept of un-
translatability frequently observed at the word-formation level (diminu-
tives, allusions) also occurs in legal and economic discourse and is con-
nected with the broadly understood culture of the sender and the recipient,
as well as the source and the target language. In the language of medicine,
where most expressions are derived from Latin in the domain of physiog-
nomy and anatomy, the phenomenon of untranslatability should be rather
marginal and practically non-existent. However, according to Pilegaard
(1997: 162), the lack of physical correspondence between concepts occurs
because ‘French and German have no terms for knuckle, French none for
shin, and in Russian there is no distinction between hand and arm’.
Furthermore, in the medico-pharmaceutical areas, untranslatability
can also be observed. In the case of pharmacy, understood here as a field
of medicine, the Pharmaceutical Law Act is of interest since some of the
issues in this Act may include legal terminology or concepts. These may
pose a challenge due to the lack of equivalence or different understand-
Collocations, Equivalence and Untranslatability as Selected Critical Aspects… 79

ing of legal conditions related to the pharmaceutical law depending on

the country (e.g. written patient consent, living will, differences in terms
of admission of medicinal products and dietary supplements for phar-
maceutical turnover) (cf. Mela 2012). To illustrate, the Polish collocation
punkt apteczny is nowhere to be found in the Anglo-Saxon domain. Econ-
omy-related issues (costs of stay, drug reimbursement, finances related to
patient healthcare) are also found in medical texts. They may, however, be
differently understood, depending on the country (different social condi-
tions and terms and conditions of healthcare premiums paid by patients
in Australia vs in Poland), which may directly result in the phenomenon
of partial untranslatability.
The notion of untranslatability was clearly observed in one Turkish
study. Their authors stressed the significance of errors resulting from
mistranslations of the Bath Ankylosing Spondylitis Disease Activity In-
dex (BASDAI), which is a self-report questionnaire. Discrepancies due
to the real and the comprehended meaning of ‘untranslatable terms in
self-reports [resulted in] statistically meaningful changes in the total BAS-
DAI score which affect[ed] the whole treatment approach in these pa-
tients’ (Atagunduz et al. 2015). Therefore, the authors of the study argued
that the type of terms used should not have been translated into single-
sentence questions in self-reports and further visual or verbal explana-
tions ought to be attempted for better understanding by patients to avoid
such mistakes in the future. As a result, untranslatability observed in the
language of medicine may be associated with the cases of medico-legal
and economic terminology and nomenclature, which can be interpreted
as exceptions to the general principle of translatability (see Wojtasiewicz
2005). However, caution should be taken regarding texts where legal and
economic issues are involved. As Catford (1965: 93) writes, ‘source lan-
guage texts and items are more or less translatable rather than absolutely
translatable or untranslatable’.
Also Lipiński (2000: 171) seems to adopt a very balanced opinion when
he postulates that most ‘untranslatable cases are relative’ due to the fact
that not all parts of the message are equally important, and ‘introducing
80 Arkadiusz Badziński

a hierarchy among these features allows for necessary changes so that the
“losses” are the least tangible’ [translation mine – A.B.]. As Lipiński further
demonstrates, these ‘losses’ are, in fact, not always losses. Furthermore, for
Lipiński it is not the difference between the source text and the target text
that matters. What is important is to what extent these differences may in-
fluence ‘the similarity in the reception of the source text and the target text’.

Conclusions

Proper translation of medical texts obviously requires a thorough knowl-

edge of both languages. Translation may, however, still be a real challenge
due to the complexity of terminology and poor familiarity with the sub-
ject matter. Apart from medical knowledge, the issues of medical col-
locations, equivalence and untranslatability directly affect the quality of
the translation process of (highly specialised) medical texts. It should be
borne in mind that aside from methodological mistakes in medical man-
uscripts, poor translation of papers also results in the rejection of such
manuscripts, which may be due to inadequate equivalent forms or misuse
of collocations. All these factors may lead to erroneous translation, which
not only prevents further dissemination of medical knowledge but may
also discredit authors of papers in the eyes of other scientists.
What direction will be adopted in translation of medical texts remains
an open question that currently cannot be clearly answered due to a pleth-
ora of components, among which equivalence and collocations occupy
the key positions. Hopefully, near future will determine the direction of
translation studies in the field of medicine, which will (fully) allow us to
understand to what extent theoretical issues affect the practical approach
and vice versa, thereby contributing to the solution of some translation-
related problems.
Translators should always remember that lexical and grammatical
precision should be the priority in specialised medical translation. Con-
sequences of lexical errors, however insignificant they may seem, are, in
Collocations, Equivalence and Untranslatability as Selected Critical Aspects… 81

fact, of paramount importance. A poor non-specialist translation dis-

credits a translator and results in dissatisfaction of recipients at its worst,
whereas incorrect medical translation can result in life-threatening condi-
tions, particularly in the case of translation errors in the fields of pharma-
cology or emergency medicine. For that reason, no other field deserves
more attention and higher precision. The discussed phenomena, i.e., col-
locations, equivalence and untranslatability, can be obviously understood
separately. However, in medical translation they are closely related to one
another and therefore have been discussed together in the present paper.

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 Barbara Walkiewicz
Adam Mickiewicz University, Poznań, Poland

Translation of Medical Texts

from Discourse Perspective

Introduction

A medical text is a precise algorithm of meanings coded by special-

ists for the purpose of communicating medically important informa-
tion to the recipient. This algorithm is founded on terminological and
editorial normalisation, the aim of which is to optimise communication
by eliminating any undesirable interpretation. The normalised way of
verbalising the object of a text depends on the subject-situational re-
lationship within which it appears, which means that the awareness of
this relationship has an important impact on the reception of the text.
Translation re-encoding is based on a similar mechanism: what matters
is not only the appropriate translation of the content of the source text,
but also a skilful rendering of the verbally coded context of the original
discourse, which should also be understandable to the prospective re-
cipient of the target text. The sender of the original text is an element of
that context as well.
Because of the dual function of any translation – representative and
communicative (connected with the illocutionary potential of the origi-
nal) – the translator is obliged to skilfully render discourse elements
unique to the source medical environment, transferring the discourse
context to the target culture adequately to the expectation horizon of the
target recipient. This requires flexibility in choosing translation strategies,
which, in turn, calls for a well-developed discourse competence. The aim
86 Barbara Walkiewicz

of this article is to show key discourse aspects of medical text translation

as exemplified by the hospital discharge summary.

1. Translation as Discourse

When discussing translation, one needs to begin at the point of departure,

i.e., the source text. Every text, whether written or spoken, conforms to
codified norms of verbal behaviour, sanctioned within a particular social
context. These norms are expressed through genre, and they encompass
not only the verbal aspect of the utterances which actualise it, but also
the subject-situational context which they represent. As observed by Cha-
raudeau (1995: 103–104), every act of communication is discourse, i.e., an
inseparable whole occurring at two levels: verbal (internal circuit – circuit
interne) and non-verbal (external circuit – circuit externe), determining
the physical framework of communication (Grzmil-Tylutki 2007: 26).
There are four subjects participating in discourse: the communicating
subject (sujet communiquant – the actual sender of the message), the in-
terpreting subject (sujet interprétant – the actual recipient of the message),
as well as the speaker (énonciateur) and the addressee (destinataire).

Figure 1. Discourse according to Charaudeau

The first two subjects are partners in discourse, effectuating their dis-
course roles on the strength of the so-called contract. The contract is es-
Translation of Medical Texts from Discourse Perspective 87

sentially a social agreement thanks to which discourse partners are aware

of what roles they play within the framework of a given communication
situation and are able to verbalise the aims specified in the contract ac-
cording to their expectations. In other words, discourse is the linguis-
tic realisation of a particular intention (le faire), expressed according to
a socially established scenario through the strategies it provides (le dire),
which are appropriate for the discourse roles (Charaudeau and Maingue-
neau 2002: 138–141; Grzmil-Tylutki 2007: 32).
Translation as a form of text transformation does not only involve its
inclusion into another discourse (Labocha 2008: 79), but also, in itself,
a form of second-level discourse – one discourse representing another
(Hermans 2009: 307). Under this assumption, the translator is a commu-
nicating subject of the second level, authorised to broaden the contract
binding the partners of the first-level discourse (the speaker and the ad-
dressee) to the interpreting subject of the second-level, by rendering first-
level internal circuit in the language of the second-level recipient.

Figure 2. Translation as second-level discourse (Walkiewicz 2013: 36)

What is directly translated is the first-level internal circuit. The transla-

tor should not forget, however, that the level of the internal circuit holds
information referring to the strictly defined subject-situational context.
This is why every translation is an act of negotiation between two cul-
tural paradigms – source and target – based on two basic functions of
88 Barbara Walkiewicz

translation, independent of functions of the original. The first is that of

representing the first-level discourse (‘representation’), the second – the
communicative function, inscribing the original discourse into another
polysystem and the expectation horizon of the second-level addressee
(‘similarity’; Hermans 2009: 307).
This negotiating suspension between the first-level speaker and the
second-level addressee makes the translator’s choice less obvious. On the
one hand, they are aware that the translation will fulfil its role, i.e., realise
the illocutionary potential intended by the speaker of the original in the
target culture, only when it reaches the appropriate degree of acceptability
at the level of the target internal circuit; in other words, it achieves the sat-
isfying level of resemblance to the target standards of communication. On
the other hand, the translator’s duty is to preserve the full identity of the
first-level communicating subject, who, on the force of translation, incurs
a ‘contractual’ discourse obligation towards the second-level interpreting
subject, representative of a different culture. This means that a good trans-
lation should make it possible for the target recipient to find themselves
in the role of the second-level interpreting subject, tied by the first-level
contract to a ‘discourse location’, as well as to recognise the status and role
of the actual first-level communicating subject.

2. Discourse Implications of
Medical Text Translation

Medical texts embrace a wide spectrum of genres within the realm of

health and medicine, which reflects the complexity of the field and its
subject-situational diversity. There is, however, a common denomina-
tor linking all medical texts regardless of their genre: one of the partners
in discourse – communicating subject (speaker) or interpreting subject
(addressee) – is a healthcare representative: a physician, nurse, therapist,
pharmacologist, etc. Another thing in common – this time shared with
other specialised texts – is the subject matter of the discourse: objective,
Translation of Medical Texts from Discourse Perspective 89

measurable, terminologically coded on a largely internationalised scale

(Kielar 2003: 153; Lee-Jahnke 2005; Berghammer 2006; Górnicz 2013).
This results in the universalisation of medical standards, partly reflected
in the standardisation of specialised communication (a unified conceptual
system together with its corresponding terminology). On the other hand,
diagnostic and therapeutic processes based on international professional
standards occur within legal and cultural frameworks, which make pro-
fessional communication institutionally unique. This is significant in the
context of translation.
Since the dominating function of medical texts is the informative one,
as in the case of other specialised texts, the translator should aim to re-
construct all its components in the target language, with the use of ap-
propriate techniques. In such a case it is easy to direct the target text at
the target recipient (acceptability): since the purpose of the target text is
to impart information, it should be rendered in the language that meets
target communication norms. Yet, the information coded in the original
is of at least dual nature: it concerns the subject matter of the text and the
subject that communicates it. The latter gains particular importance in
view of the representational function that is fulfilled by every translation,
regardless of the text genre and status of the original.

2.1. Subject

As a second-level discourse, translation extends language activity, intend-

ed by the first-level communicating subject for the original interpreting
subject, to a sphere of another culture, broadening the contract which
binds the original partners to secondary recipients, not in command of
the source language. From this perspective, the translator is required to
make it possible for recipients to identify the speaker by revealing the
speaker’s characteristics and to fully understand their attributed discourse
role, especially in view of possible systemic differences between the source
and target cultures. In medical texts, the communicating subject is usually
presented nominally, through their proper name or their personal data
90 Barbara Walkiewicz

(a culturally dependent value), as well as verbally, through the use of spe-

cialised language (a functionally reproducible value).
The communicating subject can be an institution or a person identified
by name. In a hospital discharge summary, which is to be the object of our
further consideration, the institutional speaker figures in the heading as
the hospital authorised to offer healthcare services in the specified range.
The hospital name has a significant semantic value not only because of its
identifying function, but also owing to information about the status, form
of ownership or the extent of authorisation to provide healthcare services
(Łomzik 2016: 87). The scope of services provided is defined by the hospi-
tal unit where the patient is admitted (Górnicz 2011: 63–64). Its nominal
representatives are the attending physician and the head of department,
whose signatures and official stamps validate the document.
Apart from the formal attributes of the communicating subject, the
document bears verbal traces of their status in the form of style charac-
teristic of specialised communication. A hospital discharge summary is
a text constituting part of an individual hospital file, issued to the patient
at the end point of hospitalisation. The patient is not, however, the only
addressee of the hospital treatment information card, as there is also the
patient’s general practitioner and other medical specialists. The dual in-
terpreting subject – non-specialist (patient) and specialist (physician) – is
reflected in the presence of verbal features of two subject relationships:
specialist–non-specialist and specialist–specialist (Walkiewicz 2016: 128;
cf. Lee-Jahnke 2005: 81 and Guével 2007: 78). The former relationship is
exemplified by names of diseases in Polish (Dz.U. 2015), the latter by ab-
breviated forms referring to procedures and tests performed, characteris-
tic of communication within the specialist–specialist circuit (Walkiewicz
2016: 128; cf. Lee-Jahnke 2005: 81 and Guével 2007: 78). The translator
should render all information-bearing elements of the style in order to
preserve the standards of specialised communication in the target lan-
guage (Kielar 2003: 43; Karwacka 2016: 90). Only thus will the target text
at the internal-circuit level achieve a corresponding functional coherence
at the external-circuit level, and it will be able to operate in the target
Translation of Medical Texts from Discourse Perspective 91

polysystem next to other, non-translation texts (Lewicki 2000: 11). This

condition, as a criterion of communicative felicity, will be fulfilled when
the translation has been accepted by the medical community in the tar-
get culture, allowing the author of the original (first-level communicating
subject) to be acknowledged as its member (Karwacka 2016: 25; cf. Rou-
leau 2003: 150).

2.2. Object

The object of a medical text depends on the genre and the subject-situa-
tional framework on which it is based (Doroszewski 2014). In the case of
the hospital discharge summary, constituting an important component of
the patient’s individual medical documentation, the object includes the
preliminary diagnosis, as well as the tests, treatment, drugs and proce-
dures administered to the patient; the discourse object is articulated by
degrees – at the level of particular segments of the internal-circuit micro-
structure, as well as systemically – at the level of its macrostructure, map-
ping hospital procedures characteristic of a given culture.
Indeed, all the information referring to the object of the medical text
encoded in the text is verbalised point-by-point at the level of denomina-
tion (‘what’) and systemically at the level of discoursivisation, correspond-
ing to the culturally specific manner of speaking about the discourse ob-
ject (‘how’). Point-by-point presentation applies to disease entities, tests
administered, test results expressed in normalised units, medical proce-
dures applied (diagnostic and therapeutic) and medication (cf. Górnicz
2011). Difficulties in their translation are often discussed as typical chal-
lenges posed by medical terminology (Monin 1993; Rouleau 2003; Lee-
Jahnke 2005; Berghammer 2006; Balliu 2005; 2010; Walkiewicz 2016),
ameliorated to a large extent by the international terminology standardi-
sation (e.g. ICD-10). Translators are challenged by morphological diver-
sity, polylexy, synonymy, acronymy, eponymy or asymmetry of semantic
and terminological fields, yet in medical texts associated with the para-
digm of conventional medicine, cases of a total lack of equivalence at the
92 Barbara Walkiewicz

level of denomination are rare, which largely results from the symmetry of
the conceptual framework (Górnicz 2013: 70–71) based on the common
substrate, i.e., the human body and its ailments. Apart from the oldest,
i.e., anatomy (Lee-Jahnke 2005: 81), the factor that unifies the conceptual
and terminological frameworks is also what is the newest, i.e., the super-
strate, which may be recognised in diagnostic and therapeutic techniques,
as there are few as internationalised fields as medicine.
The situation presents itself rather differently at the level of discoursivi-
sation, i.e., institutionalisation of the way in which the object of denomi-
nation is spoken about, where we are dealing with culturally conditioned
diversity of medical text genres. As a socially sanctioned expression of cod-
ified verbal behaviour, genre is a strongly culturally marked instance not
only in the national dimension, but in the professional one as well. Thus it
reflects social and legal differences in how healthcare facilities operate. This
is why mapping the organisational order of utterance macrostructure in the
target language is indispensable for the preservation of the representative
function, so important in translating such documents as a hospital treat-
ment information card. Discourse asymmetry at the level of distribution of
particular elements of microstructure in functionally analogous text gen-
res is largely ameliorated through internationalisation of diagnostic and
therapeutic standards, thanks to which macrostructural differences can be
‘domesticated’ through the means of expressions functioning in the target
culture. This means that even if the recipient culture polysystem does not
have a symmetrical genre pattern, the missing elements can be found else-
where on the target genre map (Walkiewicz 2013: 23–24).
It needs to be emphasised that discourse parameters of medical text
translation are determined by the source text, i.e., first-level discourse.
This results from the assumption that the aim of translating a medical text
is to enlarge the circle of recipients to include specialists, in the way that
would allow the recipient, while reading the target text, to feel as if they
were a member of the same professional community as the author of the
original. This assumption implicates the following consequences concern-
ing the choice of translation strategy:
Translation of Medical Texts from Discourse Perspective 93

–– as a communicating subject actively participating in second-level

discourse, the speaker should preserve identity in the target text in
such a way as to allow the second-level interpreting subject – the
addressee of the translation – to be aware of its professional charac-
teristics (an institution, a physician, their position and specialty, as
well as their correspondent form of professional communication);
–– the object of first-level discourse (‘what’) should be communicated
by means of language forms used in analogous communication sit-
uations in the target culture, whereas the ‘scenario’ (‘how’) should
reproduce the utterance structure while preserving the speaker’s
intended materiality threshold (Karwacka 2016).
The dynamic choice of strategy requires from the translator to be aware
of discourse implications of translation. The following part of the article
will analyse from this perspective three translations of a hospital discharge
summary, made by three different translation agencies.

3. Case study

The French translations of a hospital discharge summary analysed here

were commissioned, which means that the translators were not aware
of the research purpose which their translations would serve. It must
be pointed out that the commissioning party did not require a certi-
fied translation, which is not without significance for the quality of the
translations provided. The original text is the hospital treatment card of
a patient hospitalised in the Greater Poland Cancer Centre (Wielkopol-
skie Centrum Onkologii – WCO) in Poznań, a document characterised
by a canonical genre structure* composed of the following elements:
a heading with the information about the healthcare provider, patient
data, diagnosis, tests, treatment, medical history report, blood products
and drugs administered, as well as recommendations (cf. Górnicz 2011:

* A list of components of the genre in question is defined in: (Dz.U. 2002).

94 Barbara Walkiewicz

63). All this is followed by names of physicians signing the documents,

as well as data concerning their position, specialty and medical licence
number. The simplicity of the internal circuit structure reflects the clar-
ity of the subject-situational relationship: the communicating subject
gives an account of the diagnostic-therapeutic measures taken for the
benefit of the patient during their stay in the facility. The addressee of
the report is the patient, who is guaranteed by law (Dz.U. 2008) to have
full access to information about their health and medical procedures
performed, as well as the general practitioner and, possibly, a cancer
specialist who provides or is to provide oncological care after discharge
from hospital*. Hence, this is a case of a dual interpreting subject, each
representing a different level of expertise: patient – non-specialist and
physician – specialist**.

3.1. Translating Verbal Markers of the Communicating Subject

A direct first-level communicating subject is the attending physician,

whose signature appears at the bottom of the document together with the
signature of the head of department, linking the direct communicating
subject with the institutional subject, featured in the heading of the docu-
ment. The institutional subject of the first-level discourse (the original),
here the WCO, is not only a physical framework for the situational con-
text, but also an institution legally entitled to provide healthcare services
with characteristics coded in its name. The information load of the com-
municating subject’s name imposes on the translator the duty of translat-
ing them, to the extent that their role in the first-level discourse is under-
stood institutionally and individually.

* On French equivalents of hospital treatment information cards – compte-rendu

d’hospitalisation – the addressees of the document are listed at the top of the text.
** A similar situation occurs in a construction project: a team of designers is a com-
municating subject addressing the project to the investor, and to builders as well, as it
is them, and not the investor, who are responsible for implementing the project.
Translation of Medical Texts from Discourse Perspective 95

3.1.1. Institutional Subject

The usually elaborate names assigned to healthcare facilities are loaded with
information concerning their locality, the type and status within the health-
care system, the form of ownership and the scope of functions (Łomzik
2016: 87). In the case of the WCO, the proper name of the institution in-
cludes information about its regional setting (Wielkopolska – Greater Po-
land), its position within the organisational structure (centre), its scope of
functions (oncology) and the name of its patron (Maria Skłodowska-Curie).
The information value is not contained within the individual components of
the name, but in their sum total: the ‘Greater Poland Cancer Centre’ means
that this is the largest regional healthcare facility offering oncology services,
and therefore a hospital of the highest referral level (the highest standard
of services). For the second-level interpreting subject, the specialist, this is
very important information, as it gives credit to the value of the test results
presented in the hospital discharge summary.
In the four translations obtained for the study, the authors applied dif-
ferent solutions.
The first translation renders the type of facility and its scope of func-
tions in the target language, preserving the toponym and the anthropo-
nym in their original forms (apart from the French version, the translator
preserves the original name), which is unjustified, considering that French
dictionaries list a lexicalised equivalent of Wielkopolska – Grande-Pologne.
The consequence of reducing the name by failing to use a toponym which
is clear to the second-level addressee obscures the status of the facility in
terms of the referral level. The change of form in the foreign-sounding
name is less jarring – after all, it is recommended to leave first names and
family names in their original forms. However, the hospital is named after
the person who is an individual of global importance, and the interna-
tionalisation of her name would be as natural as in the case of Poles using
the name ‘Kartezjusz’ for the French Descartes. Transferring the original
name is then an unjustified trace of foreignness, similar to solution No 2,
whose author fails to include the heading altogether. In the latter case, the
96 Barbara Walkiewicz

Table 1. French translations of the institutional subject’s proper name

Polish French Technique

Wielkopolskie 1. Centre d’Oncologie literal translation with
Centrum Onkologii de Wielkopolska Maria a change in word order and
im. Marii Skłodowska-Curie with the toponym in the
Skłodowskiej-Curie* (Wielkopolskie Centrum original form
Onkologii)

2. Ø omission

3. Wielkopolskie Centrum use of the original name

Onkologii im. Marii
Skłodowskiej-Curie

4. Centre oncologique de translation with a change

Grande-Pologne Marie in the syntactic structure
Skłodowska-Curie and position of the
[Wielkopolskie Centrum toponym, combined with
Onkologii im. Marii the original name
Skłodowskiej-Curie]
* Translator’s note: the full English translation is ‘the Maria Skłodowska-Curie On-
cology Centre of Greater Poland’; the official English name used by the centre is ‘the
Greater Poland Cancer Centre’.

trace originates from the incompatibility of the translation to the legally

defined norm (Legifrance 2018) based on international medical standards
for text genres corresponding to similar communication situations in the
target culture. There may be multiple reasons for such a decision: an in-
correct interpretation of the principle of (not) translating proper names,
a conviction about the integrity of the translation with the original or its
copy, an arbitrarily set threshold of the target text’s relevance. Solution
No 3 renders similar results by directly transferring the name of the hospi-
tal in its original form. Introducing a quote from the source language into
second-level internal circuit indicates a conscious choice, yet it results in
the failure to introduce the first-level communicating subject, so that the
Translation of Medical Texts from Discourse Perspective 97

translation does not preserve the precise subject relationship in compari-

son to the source discourse. Another technique was applied by the fourth
translator, who conveyed the full meaning of the original name in the tar-
get language while ensuring the appropriate level of acceptability, i.e., also
localising the toponym and the anthroponym. Supplementing the transla-
tion with the original name, the translator reconstructed both functions
of discourse – identification function and informative function, thanks to
which the contract binding second-level partners was implemented.
The name of the organisational unit within the hospital structure: Oddział
Chirurgii Onkologicznej Chorób Piersi (English: Breast Surgical Oncology
Department), turned out to be a less troublesome aspect of the translation
owing to the universality of hospital organisational structures. The univer-
sality is based on the previously mentioned anatomical substrate, as well as
the resulting conceptual and terminological symmetry at the level of medical
specialties. This justifies an exceptionally small range of the solutions pro-
posed, demonstrating a full structural analogy with few orthographic varia-
tions (use of capital letters with each lexical component of the name).

Table 2. French translations of the organisational unit of the institutional subject

Polish French Technique

Oddział Chirurgii 1, 3. Service de Chirurgie literal translation adapted
Onkologicznej oncologique des maladies to the target orthographic
Chorób Piersi du sein norm

2, 4. Service de Chirurgie literal translation in

Oncologique des Maladies compliance with the original
du Sein orthographic norm

Both solutions proposed fulfil the representative and informational func-

tions. Although French usage prefers capital letters only for the first element
of the multi-component proper name, it is true that equivalent documents
often employ capitals with every component of the name. This is probably
an effect of the spread of English standards in medical communication.
98 Barbara Walkiewicz

3.1.2. Individual Subject

The first-level individual communicating subject is expressed in the first-

level discourse in many ways: nominally (first and family name and sig-
nature) and professionally, where the professional aspect is characterised
by the medical specialty and the position occupied within the institutional
subject’s system.

Table 3. French translations of the organisational unit of the institutional subject

Polish French Technique

a. lekarz 1a. Médecin délivrant le 1a. descriptive translation
wypisujący compte-rendu 1b. literal translation
[discharging 1b. spécialisations en
physician] chirurgie générale

b. specjalizacje* 2a. Médecin préparant la 2a, 2b. descriptive

chirurgii ogólnej sortie du patient translation
[general surgery 2b. Spécialisations de la
specialties] chirurgie générale

3a. Médecin traitant 3a. translation by

3b. spécialité chirurgie a presumed equivalent**
générale 3b. equivalent

4a. Médecin traitant 4a. translation by

4b. spécialité chirurgien a presumed equivalent
généraliste 4b. equivalent
c. Ordynator 1c. Chef du service 1c. literal translation
[Head of 1d. spécialisations chirurgien 1d. word-for-word
department] oncologique translation

d. specjalizacje 2c. Chef du Service 2c, 2d. literal translation

chirurg onkolog 2d. spécialisations en
[cancer surgeon chirurgie générale
specialties]
Translation of Medical Texts from Discourse Perspective 99

Polish French Technique

3c. Chef du service 3c. literal translation
3d. spécialité chirurgien 3d. equivalent
oncologue

4c. Chef du service 4c. literal translation

4d. spécialité chirurgie 4d. metonymic equivalent
oncologique
* Original orthography.
** The translator chose an incorrect target phrase as a result of a presumption about
one word in the phrase.

Translation of medical specialties should not pose any problems because

there is a comparable list of medical specialties both in Poland and in France
(FHF; MZ), in contrast to names of positions physicians can occupy within
a particular facility, which reflect the unique administrative and organisa-
tional characteristics of the Polish healthcare system (cf. Fuentes 2016: 81).
The client may expect that the specialty of the first-level communicating
subject will be presented in the manner accepted in the target culture for
the needs of defining the equivalent professional characteristic. This was
achieved in merely four of the expressions (3b, 4b, 7d and 8d), which gives
as little as 50% of accuracy. In the other solutions, translators used a wrong
equivalent of the term ‘specjalizacja’ (spécialisation) or the name of specialty,
chirurgien oncologique, which is an incorrect structure, based probably on
the mistaken presumption of structural symmetry:

chirurgie oncologique → *chirurgien oncologique

Yet in France, the term preferred by usage is chirurgien cancérologue,

although chirurgien oncologue is also in use (more commonly in Belgium
and Switzerland). Thus, despite the possibility of a full localisation of the
name of the profession and the optimal presentation of the communicat-
ing subject as a member of the same medical community as its equivalent
100 Barbara Walkiewicz

in the target culture, translators did not use the systemic opportunity, in-
troducing an unintended trace of foreignness.
Apart from the problems caused by physicians’ specialties, dilem-
mas encountered by the authors of the target texts under analysis con-
cern the name of the position of the first-level communicating subject,
‘lekarz wypisujący’ (discharging physician). The Polish healthcare system
does not explicitly recognise the attending physician as the only person
authorised to prepare a hospital discharge summary, and consequently
a physician on duty at the moment of the patient’s discharge from hos-
pital can do that. The situation is different in France, where the attending
physician is obliged to prepare the document in question. This is reflected
in its microstructure: the compte-rendu d’hospitalisation has a rubric fait
par le docteur…, which unequivocally specifies the attending physician.
The systemic asymmetry is reflected in descriptive equivalents used in
translations No 1 and No 2. Both médecin délivrant le compte-rendu and
médecin préparant la sortie du patient render the function performed by
the speaker of the source text – ‘lekarz wypisujący’, without assigning to
them a role which they would additionally perform in the target culture
(diagnostic and therapeutic care of the patient). Such a role, on the other
hand, is assigned to the first-level communicating subject by a different
solution – médecin traitant, which modifies the professional characteristic
of the physician – from a hospital physician to a general practitioner.
What also needs to be noted is, above all, the lack of uniform usage,
which may result from numerous factors: lack of general-access resourc-
es on the subject, lack of standardisation of foreign-language versions
of proper names of Polish institutions, including healthcare facilities
(cf. Łomzik 2016: 88), as well as strict, inflexible use of translation rec-
ommendations, with no regard for the subject-contextual dimension of
translation understood as second-level discourse. A two-dimensional ap-
proach to a target text as a secondary text in relation to the source text has
led to omissions, two versions of names (translated and transferred from
the original) or failure to exploit the possibilities of reducing the cultural
and systemic distance of the target language (localisation of toponyms).
Translation of Medical Texts from Discourse Perspective 101

The observed deficiencies attest to the fact that the translations had not
been made by certified translators, who adhere to the Certified Transla-
tor’s Code of Ethics, at least in terms of using the standardised versions of
proper names. Names unconnected with the unique legal-administrative
characteristics, those based on the international medical conceptual sys-
tem (e.g. name of the organisational unit of the hospital, name of medi-
cal specialty) have caused fewer problems. Still, even here the translators
failed to use all possibilities of expressing the subject’s characteristics in
the way that would fully match target norms of professional communica-
tion. As a result, the first-level communicating subject appeared in most
of the translations under analysis as marked by foreignness, inadequate
to the relationship which should bind them to the second-level interpret-
ing subject.

3.2. Object

The object of the first-level discourse is defined in terms of genre: it is a de-

scription of diagnostic and therapeutic procedures performed during the
patient’s hospitalisation in connection with a particular clinical diagnosis.
As one of the major components of a patient’s individual medical docu-
mentation, the genre occurs in both cultures involved in the translation
act, which facilitates the broadening of the contract binding the first-level
speaker with the second-level addressee, as there are verbal structures in
the target system expressing analogous content at two levels: denomina-
tion (‘what’) and discoursivisation (‘how’). The object of the discourse
under discussion is composed of particular elements of the medical pro-
cedures applied, which represent symmetrical conceptual systems and the
corresponding terminological fields (Ligara and Szupelak 2011), subject
to international standardisation (e.g. ICD-10). Due to the limited format
of this text, only some elements of the denomination level are going to be
considered: the diagnosis, the tests selected and the resources used.
In all solutions offered by the translators, the diagnosis was rendered
in accordance with the French medical terminology.
102 Barbara Walkiewicz

Table 4. French translations of the name of disease entity

Polish French Technique

Czerniak złośliwy skóry, 1. Mélanome malin de la literal
czerniak złośliwy skóry peau, Mélanome de la peau, translation
nieokreślony (C43.9) sans précision (C43.9)
[malignant melanoma of skin;
malignant melanoma of skin, 2–4. Mélanome de la peau, equivalent
unspecified (C43.9)] sans précision (C43.9)

The generally available International Statistical Classification of Dis-

eases and Health Problems has undoubtedly facilitated accurate transla-
tion by making it possible to find the name of a disease entity through its
assigned numerical symbol.

Figure 3. The identification algorithm for equivalent disease names

(Walkiewicz 2016: 129)

One solution that may raise objections is the first one, constituting
a functionally unjustified mirror image of the source structure.
Another component taken into consideration as the first-level dis-
course object is the names of laboratory blood tests.
The catalogue of lab tests performed in different countries is univer-
salised, i.e., it has terminological equivalents in various languages. The
down-side is that there is no generally available terminological system that
would have a test classification comparable to the ICD-10 system. This
may have contributed to the three translators’ decisions to transfer all ab-
breviations to the second-level discourse in their original forms. Perhaps
Translation of Medical Texts from Discourse Perspective 103

Table 5. French translations of names of blood tests

Polish French Technique

PLT 1–3. PLT 1–3. direct transfer
4. plaquettes 4. equivalent
NEU 1–3. NEU 1–3. direct transfer
4. neutrophiles 4. equivalent
BASO 1–3. BASO 1–3. direct transfer
4. basophiles 4. equivalent
RBC 1–3. RBC 1–3. direct transfer
4. globules rouges 4. equivalent
LYM 1–3. LYM 1–3. direct transfer
4. lymphocytes 4. equivalent
MONO 1–3. MONO 1–3. direct transfer
4. monocytes 4. equivalent
WBC 1–3. WBC 1–3. direct transfer
4. globules blancs 4. equivalent
HGB 1–3. HGB 1–3. direct transfer
4. hémoglobine 4. equivalent
morfologia 1–3. Hémogramme 1–3. equivalent
[blood count] 4. analyse de sang 4. hypernonym
czas 1–4. temps de prothrombine 1–4. equivalent
protrombinowy
[prothrombin
time]

the decisive factor was the conviction of the status of the English language,
now seen as the current-day lingua franca of modern medicine. French
physicians certainly understand English-language abbreviations referring
to various types of tests, but in professional communication appropriate
for their language area they use their native forms, also for the sake of the
non-specialist recipient, as the functional equivalent of the hospital treat-
ment information card – compte-rendu d’hospitalisation – is based on the
analogous, dual subject relationship:
104 Barbara Walkiewicz

It is worth pointing out that translation by equivalent was applied only

to full lexemes – ‘morfologia’ (blood count) and ‘czas protrombinowy’
(prothrombin time), which seems to support the hypothesis of the ac-
knowledgement of the universality of English abbreviations. Only one of
the translators translated the names of tests according to the French norm
of communication, considering discourse genre and its characteristic sub-
ject-situational context.
The last element concerning the object of the first-level discourse is
a list of ‘resources used’, i.e., drugs and medical preparations administered
during the hospitalisation, whose names were transferred to the second-
level discourse in the original form by all the translators.

Table 6. French translations of names of drugs administered

Polish French Technique

Amoksiklav 1–4. Amoksiklav direct transfer
Atropinum sulfuricum 1–4. Atropinum sulfuricum direct transfer
Clexane 1–4. Clexane direct transfer
Bridion 1–4. Bridion direct transfer
Ecolav 0,9% 1–4. Ecolav 0,9% direct transfer
Paracetamol Kabi 1–4. Paracetamol Kabi direct transfer
Ephendrinum 1–4. Ephendrinum direct transfer
hydrochloricum hydrochloricum
Fentanyl 1–4. Fentanyl direct transfer

Transfer of drug trade names is motivated by respect for the original

form of the proper name of the drug due to its identifying function. How-
ever, if the name itself does not render the semantic and referential value
in the target culture it needs to be expressed by means of definition, as
Translation of Medical Texts from Discourse Perspective 105

it is done with toponyms non-lexicalised in the target culture. The trade

name of the drug is conventional and depends on the producer. If a given
preparation is not available on the target culture’s market (Amoksiklav,
Clexane, Ecolav 0,9%), its original trade name will mean nothing to the
second-level interpreting subject. Translators should explicitly name ac-
tive substances (Górnicz 2011: 67), which would help the addressee iden-
tify the drugs available under different names in their culture.

Conclusions

The aim of this article has been to present medical text translation from
the discourse perspective. An analysis was performed on four French
standard (uncertified) translations of a hospital discharge summary from
the point of view of strategies and techniques used by translators so as to
extend the relationship between the first-level speaker and addressee to
the second-level addressee while preserving both the first-level discourse
functions (informative) and second-level discourse functions (representa-
tional and communicative). The results of the analyses indicate low trans-
lation quality, resulting from little awareness of discourse implications of
translation. Consequently, the translations appear flat, devoid of any evi-
dence of the awareness of the role that particular verbal structures play
in the three dimensions of the subject-situational context. In connection
with that, most of the target texts did not achieve analogous relationships
between first- and second-level subjects. Neither was the object of the dis-
course, verbalised at the internal-circuit level, rendered according to the
scenario designed for target medical communication. It seems to be the
case that even though the authors of the translations are active in the com-
mercial translation market, they still demonstrate low discourse compe-
tence, which produced unjustified traces of interventions of the translator
as the second-level communicating subject, leading to imitation of surface
features of the first level internal circuit, and, consequently, to a serious
deficiency of communicative efficacy in the second-level circuit.
106 Barbara Walkiewicz

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 Goretti Faya-Ornia
University of Valladolid, Valladolid, Spain

Relevance of Formal
and Cultural Variations in Text
Genres for Medical Translation:
Medical Brochures, Web Pages of
Hospitals, Patient Information Leaflets
and Informed Consents

Introduction

The activity of translating medical texts is very old and, throughout his-
tory, has been an essential element for spreading medical (and, in gen-
eral, scientific) knowledge. However, medical translation has not been
frequently researched until the last few decades. In the last few years, sev-
eral studies dealing with very different matters and from very diverse ap-
proaches have been published.
Firstly, theoretical reflections on the fundamentals of medical trans-
lation as well as reflections on the translation strategies and methods re-
quired for this type of translation have been addressed. An example of
this trend might be the works of Fischbach (1998), Jammal (1999), López
Rodríguez (2000), Quérin (2001), Vandaele (2001a; 2001b; 2001c; 2003),
Balliu (2001), Muñoz Torres (2002), Feinauer and Luttig (2005), Montalt
i Resurrecció (2005; 2011; 2013), Mercy (2006), Gil (2008), Tuan (2011),
Wright (2012), Ross and Magris (2012), Sechel (2013), García Izquierdo
and Conde Ruano (2014), Montalt i Resurrecció and Shuttleworth (2012),
Montalt Resurrecció and González Davies (2007), Muñoz-Miquel (2014),
110 Goretti Faya-Ornia

Valero-Garcés, Navaza and Wahl-Kleiser (2014), Lázaro-Gutiérrez (2015)

and Dalton-Oates (2017), among many others.
Secondly, another common research area, which has become particu-
larly popular in the last few years, deals with linguistic issues, such as fre-
quent mistakes and terminological difficulties occurring in medical transla-
tion. Outstanding contributions have been made in this research area in
the numerous works of Williams (1996; 2007; 2008; 2009a; 2009b; 2010;
2012; 2013) and doctor Navarro (1996; 1997a; 1997b; 1998; 2000; 2001a;
2001b; 2002; 2003; 2006a; 2006b; 2006c; 2007a; 2007b; 2008a; 2008b; 2008c;
2008d; 2009a; 2009b; 2009c; 2010a; 2010b; 2011; 2012; 2013a; 2013b; 2014;
2015a; 2015b; 2017a; 2017b). However, many other works have also been
published on this subject, by researchers such as Díaz Prieto (1995), Ortega
Arjonilla et al. (1999), Gutiérrez Rodilla (1998; 2005), Webber, Snelgrove
and Mungra (2001), Cabré Castellví (2004), Zethsen (2004), Jiménez Gutié-
rrez and Mañas Castro (2007), Martínez López (2007; 2010), Ruiz Rosendo
(2008), Saladrigas et al. (2008a; 2008b), Texidor Pellón and Reyes Miranda
(2009), Mayor Serrano (2010a), Quijada Diez (2013), Khanmohammad
and Mousavinasab (2014), Frînculescu (2014), Wandji Tchami, L’Homme
and Grabar (2014), Gotti and Dossena (2001), Gotti (2015), Olivier-Bonfils
(2015; 2016), Claros Díaz (2016), Popineau (2016), Alarcón-Navío, López-
Rodríguez and Tercedor-Sánchez (2016) and Brogger (2017), to mention
only a few. Many of the works dealing with linguistic issues have a clear
pedagogical approach, such as the contributions of Williams (1999), Gómez
and Weinreb (2002), Mayor Serrano (2002; 2003a; 2003b; 2003c; 2005), Bal-
liu (2005), Muñoz-Miquel (2016), etc.
Also, works analysing a particular text genre and aiming to determine
its features or implications for translation have been common, especially
in the last decade (i.a. Salager-Meyer 1990; 1992; Nwogu 1991; Webber
1994; Saladrigas et al. 2008a; 2008b; García Izquierdo 2009; 2016; Mayor
Serrano 2010b; Muñoz Torres 2011; Salvador 2012; Ramos 2012; Vázquez
y Del Árbol 2013; 2014; Villalba Jiménez 2015; Díaz Alarcón 2016).
Finally, studies going beyond and dealing with cultural issues and tex-
tual approximations have also been frequent (He 1998; 2000; Marsh 1999;
Relevance of Formal and Cultural Variations in Text Genres… 111

Williams 2004; Mayor Serrano 2005; 2006; Kim 2006; López Arroyo and
Méndez-Cendón 2007; Dumas and Boucher 2012; Pietrzak 2015; Olmo
Cazevieille 2015; Faya Ornia 2015; Martínez Motos 2016; Lázaro-Gutié-
rrez 2016; 2017; Lázaro-Gutiérrez and Tejero González 2017; Jiménez-
Crespo 2017; Rial Díaz et al. 2017, etc.).
As we can see, there are many different research approaches to medi-
cal translation, and some of them might even be combined in the same
study (for example, the analysis of a particular text genre with pedagogi-
cal purposes). In this sense, the present work focuses mainly on the last
two approaches mentioned in this section (i.e., the analysis of text genres
and the discussion of cultural issues), since it aims at commenting on the
relevance of culture in medical text genres as well as its implications for
medical translators (it is essential that translators know and implement
the features of a particular text genre in a specific culture).

1. Medical Translation
and Specialised Translation

Medical translation is the translation of texts that belong to the medical

field. However, not all medical texts can be considered ‘specialised texts’.
Although the topic is one of the most determining factors for specialisa-
tion, it is not the only one (Cabré Castellví 1999: 24). Some extra-textual
criteria must also be taken into consideration: mainly the text function
and the features of the communication participants (Gamero Pérez 1998;
1999; 2001). Some authors even highlight the skills required to translate
these texts as another criterion to determine whether a text is special-
ised or not (Gläser 1990; 1998; Göpferich 1995a; 1995b; Gutiérrez Rodilla
1998; 2005; Gamero Pérez and Hurtado Albir 1999; Alcina Caudet and
Gamero Pérez 2002; Olohan 2016).
Medical texts (i.e., those pertaining to the field of medicine) can thus
be specialised or not depending on the function of the text and the partici-
pants of the communication. In this sense, the proceedings of a medical
112 Goretti Faya-Ornia

conference (whose text function is to report some research outcomes from

experts to experts) can be considered a specialised text, whereas a medical
brochure (which aims to explain a particular disease to patients) might not.
These three aspects (i.e., the field, the reader and the function of the
text), or, in other words, the fact that a text is specialised or not, will deter-
mine both the linguistic aspects (vocabulary, register, etc.) and the trans-
lation strategies that should be applied in each case. However, translation
strategies are not only determined by the topic and the communicative
situation, but also by the features of the textual genre.

2. Features of the Genre and Cultures

Text genres may present different features depending on the culture to

which they belong (Gamero Pérez 1998: 166), and in order to detect
these differences, cross-cultural studies of different textual genres (not
only in the medical context) have been carried out for a wide range of
purposes (Moreno 1997; Gamero Pérez 1998; 1999; 2001; Giannoni
2002; Al-Ali 2004; Vergaro 2004; 2005; Pounds 2005; López Arroyo
and Méndez-Cendón 2007; Kranich 2011; Soler-Monreal, Carbonell-
Olivares and Gil-Salom 2011; Giménez-Moreno and Skorczynska 2013;
Ketabi and Rahavard 2013; Aimoldina, Zharkynbekova and Akynova
2014; Lavid and Moratón 2015; Liu and Furneaux 2015; Faya Ornia
2015; 2018; Garrido Rodríguez 2015; López Arroyo and Roberts 2016;
2017; Moyetta 2016; Muñoz-Miquel 2016; Pérez Blanco 2016; Yu and
Liu 2016; Zarza and Tan 2016; Gladrow and Kotorova 2017; Orts Llopis
2017, among many others).
The variations between cultures can range from formal issues (such
as the design or the macrostructure of the text) to linguistic or stylistic
aspects. These differences might not be very frequent in formal and high-
ly specialised texts because scientists tend to follow a fixed pattern and
a similarly formal and objective style. The differences might, however, be
more frequent in texts addressed to the general public, since they may
Relevance of Formal and Cultural Variations in Text Genres… 113

require a greater degree of adaptation of both cultural issues and the con-
tent if a specialised matter is being discussed. This can be frequently seen
in medical texts addressed to patients or their relatives, i.e., the general
public, who have a low level of health literacy* (Coulter, Entwistle and
Gilbert 1998).
Text genres are determined by both the features of the textual genre
itself and the cultural conventions of the country in which they are devel-
oped. For that reason, in the next sections of this work, some examples
of patient-addressed text genres (medical brochures, web pages, patient
information leaflets and informed consents) will be commented on and
their features will be contrasted in, at least, two different languages (Eng-
lish and Spanish).

2.1. Medical Brochures

Medical brochures present recurring linguistic and structural elements

which make this text genre easily recognisable. These texts are usually ad-
dressed to patients and their relatives, and, although the content is more
important than the form in which the message is transmitted (Smith et al.
1998), they tend to adapt the vocabulary to the level of the health literacy
of the readers (i.e., general vocabulary).
In previous studies, this text genre was contrasted in different cultures
with the aim of detecting the features that it presents in each culture as
well as the possible variations. First, the genre was analysed in cultures of
different languages: the UK, Germany and Spain (Faya Ornia 2015; 2016).
In a subsequent study, the genre of medical brochures was contrasted
again in different cultures, but on this occasion the cultures shared the
same language: the UK and the US (Faya Ornia 2018). Each corpus was

* Healthy People (2010) and the Institute of Medicine (2004) define the term as ‘the
degree to which individuals have the capacity to obtain, process, and understand basic
health information and services needed to make appropriate health decisions’. According
to these organisations, there are several studies related to the different degrees of knowl-
edge as well as to determining factors (one of the main ones is the cultural context).
114 Goretti Faya-Ornia

formed by 100 brochures collected following the same criteria. In all the
analyses, both formal and linguistic differences were detected; here, some
of them are commented on.
American and particularly Spanish brochures are usually more appeal-
ing and informal than British ones: special thickness paper is frequently
used, colourful images abound, and the styles and fonts used are very di-
verse. In Spanish brochures, images are often informal drawings, whereas
American brochures include realistic images as well as impersonal struc-
tures which provide a more objective and technical tone. On the other
hand, German brochures, not being as appealing as Spanish brochures (in
fact, the styles and fonts are extremely sober), are more interactive and
informal than British texts regarding the type of paper and the kind of im-
ages included. In British brochures, a high number have no images, and
in those brochures that do contain them realistic photographs clearly pre-
vail. The layouts are also different: triptychs are undoubtedly preferred in
Spanish and American English, whereas the layouts of diptychs, triptychs,
booklets and even a collection of stapled sheets coexist in British English.
Among German brochures, booklets are the most frequent layout.
Some linguistic differences have also been detected in the analyses,
particularly regarding the terminology, the use of acronyms and the
length of sentences. For example, Greek-Latin terms are frequent in Span-
ish brochures, whereas in English and German they are avoided, and ex-
planations or terms with an English or German root are preferred. In this
sense, femur is less frequent than thigh bone, both referring to the same
concept. The same is true for clavicle and collar bone or paraesthesia and
pins and needles. In Spanish, this duplicity is much less frequent, though
it may also occur, such as in pediculosis and piojos or cefalea and dolor de
cabeza. Thus, we can conclude that the degree of specialisation of termi-
nology is higher in Spanish (i.e., technical terms are more frequent in this
language). Secondly, acronyms are much more frequent in English than
in Spanish (GP, HIV, ID, NHS, UK, etc.). It might be thought that acro-
nyms are also more common in general English, but the fact that they are
even more common in American brochures (which confers them a more
Relevance of Formal and Cultural Variations in Text Genres… 115

technical aspect) than in British brochures means that acronyms might be

considered a cultural feature rather than a linguistic one. Something simi-
lar happens with linguistic repetitions, which seem to be related more to
the function of the brochure rather than to the language or culture itself.
Finally, sentences in Spanish are longer due to the frequent subordina-
tion and coordination that usually take place in this language. However, in
this language, information is not usually structured in paragraphs (as hap-
pens with British and German brochures) but in independent sentences
(as happens in American brochures, in which sentences tend to be quite
short and direct).
The aspects analysed, particularly the lexical ones (i.e., general vocabu-
lary, specialised terminology, presence of acronyms, etc.), are influenced
by the linguistic features of the language itself (i.e., English, Spanish or
German) as well as by the conventions of the genre (i.e., lexis exclusive to
the field), the text class (i.e., vocabulary adapted because of brochures be-
ing informative texts) and the text type (i.e., the use of one term or another
depending on the intention and communicative situation). However, the
fact that American brochures behave slightly differently regarding issues
such as specialised terms and acronyms means that it may be a cultural
matter rather than a linguistic one (Wierzbicka 1985).

2.2. Web Pages

The necessity of adaption according to the reader and target culture re-
ferred to above is not only present in printed texts but can also be seen in
online materials, as is the case of web pages.
Although there are several works that focus on the linguistic aspects of
web pages as well as their legibility or the translation procedure (such as Sil-
berg, Lundberg and Musacchio 1997; Cleary 2000; Gouadec 2003; Diéguez
Morales 2008; Chen et al. 2009; Androutsopoulos 2010; Fernández Costales
2010; Gutiérrez y Restrepo and Martínez Normand 2010; Tercedor Sánchez
2010; Diéguez Morales and Lazo Rodríguez 2011; Jiménez-Crespo 2011;
2013; Jiménez-Crespo and Tercedor Sánchez 2011; Andreu Vall and Marcos
116 Goretti Faya-Ornia

2012; Bestué 2015; Chuang and Lee 2015; Medina Reguera and Ramírez
Delgado 2015; Rodríguez Tapia 2015; Rodríguez Vázquez 2015; Suau Jimé-
nez 2015; Desjardins 2016), none of them deals with the study of web pages
of hospitals or health centres nor contrasts them between different cultures
or languages, which might be very useful for translators.
For that reason, a reduced corpus of web pages was compiled. It was
formed by 30 web pages of British hospitals, 30 web pages of American
hospitals and 30 web pages of Spanish hospitals. The contrastive analy-
sis is based on the same model of analysis as that used for medical bro-
chures, and clear differences have been detected: Spanish public hospi-
tals share a homogenous layout, but this homogeneity is not so frequent
among English public hospitals. And even less homogenous is the case
of American websites, in which every single hospital website analysed
presented a completely different layout. This may be related to the fact
that healthcare in Spain and the UK is public, whereas it belongs to the
private sector in the US.
The Spanish hospital websites analysed have a clear structure and in-
clude plenty of information about the hospital itself, the services offered
and the healthcare team. Also, different kinds of guidelines for the patient
and even teaching and research-related options are offered. Their general
layout and the type of vocabulary used are similar to that stated for medi-
cal brochures: colourful layouts, pictures (both real or drawings) and user-
friendliness. The British public hospital websites analysed present a sober
aspect and follow the same patterns detected in the analysis of medical
brochures. Information is not so clearly structured as in the Spanish web-
sites and images are not very common, and, if included, they are real im-
ages (i.e., photographs). Details on location (or even details on how to
help) and information on the healthcare team are provided (although the
emphasis seems to be more on the ‘doctors’ and their career rather than
the ‘kind of services’ offered). However, teaching and research-related sec-
tions are missing. Finally, American hospitals have a more commercial
layout, in which persuading strategies are frequently used. The structure
is clear (though in many different formats) and information about the
Relevance of Formal and Cultural Variations in Text Genres… 117

hospital and the services offered is provided, including some details on

rankings and ratings, so that users can compare that particular centre with
other hospitals. As happens in marketing products, pictures are frequent,
but they are always real photographs that provide a more serious and re-
sponsible aspect.
This contrastive analysis of British, American and Spanish hospital
websites aims to be the first approach to this text genre and its variations
in different countries, but a further analysis would be required in order to
provide more conclusive outcomes. It would also be advisable for subse-
quent research to consider the ownership of the hospital as well (i.e., the
public sector in the case of Spain and the UK, and the private sector in
the case of the US) when assessing the results to determine how this fact
influences the features of the text genre (if it does).

2.3. Patient Information Leaflets

Information leaflets or package inserts are written documents which come

with medicines and are addressed to the consumer or user. They include
information on the authorisation holder or the manufacturer, the drug
composition, some guidelines for taking the medicine, maintenance, sec-
ondary effects, interactions, contraindications, etc.
However, although the text genre of patient information leaflets is
mainly addressed to patients, due to the macrostructure and the speci-
ficity of the vocabulary used some patients may have difficulties in un-
derstanding them (see ASEDEF 2007; Bradley et al. 1994; Mirón Canelo,
Sardón and Sáenz González 2000; Wilson et al. 2001; Pérez García 2004;
Blancafort, De Cambra and Navarro 2005; Clerehan and Buchbinder
2006; Barrio-Cantalejo et al. 2008; Pol Viedma et al. 2008; Auta et al.
2011; Jensen and Zethsen 2012; Berkel and Gerritsen 2012; Jensen 2013;
Vázquez y del Árbol 2013; 2014; Álvarez et al. 2014; Maglie 2015; Pierini
2015). These difficulties may be partially due to the degree of speciali-
sation of the terminology included as well as the diversity of formats.
There are two main formats of user information leaflets: traditional and
118 Goretti Faya-Ornia

modern. Traditional brochures are not numbered, their sentences are

short and they have a highly specialised aspect, as demonstrated by the
usage of specialised terms and complex syntax. Modern leaflets are fre-
quently numbered, tend to explain the contents, include images and use
less complex terms and sentences (Vázquez y del Árbol 2014: 119). The
first work of Vázquez y del Árbol (2013) focuses on traditional leaflets,
whereas the second (2014) focuses on modern ones – both contrastive
studies provide exhaustive summary charts with the main outcomes.
Currently, both formats co-exist, but the modern format is becoming
more and more frequent and has virtually replaced the traditional one.
For that reason, here only the most remarkable results of modern infor-
mation leaflets are mentioned.
Modern English information leaflets are more flexible and visual than
Spanish ones. The macrostructure in English leaflets is also more varied
than in Spanish (though in the corpus of traditional information leaflets
the opposite is apparent). They include non-verbal elements and punc-
tuation marks, whereas Spanish leaflets demonstrate a greater degree of
soberness and formality, and icons are rarely used. In this regard, Spanish
leaflets seem to follow a stricter layout (as a technical sheet), and thus
headings are less varied than in English. The register in English leaflets
is also lower than in Spanish ones, since plenty of contractions, phrasal
verbs or even exclamations may be found.
Moreover, patient information leaflets have been subject to differ-
ent laws and rules to determine their labelling, content, advertising, etc.,
meaning that the macrostructure has evolved differently in different cul-
tures. In this regard, as can be seen in the summary charts on macrostruc-
ture offered by Vázquez y del Árbol (2013: 92–96; 2014: 120–126), the
order of some sections may vary from English to Spanish patient informa-
tion leaflets. For this reason, translators must not only take into account
the norms established by each pharmaceutical laboratory, but also be
aware of changes in the macrostructure between the two cultures involved
and implement the necessary changes in the target text.
Relevance of Formal and Cultural Variations in Text Genres… 119

2.4. Informed Consents

Informed consents are formal written medical-legal documents of the

doctor–patient communication that match a clinical relationship based
on the ethics of autonomy (Ramos 2012). The relevance of this common
kind of text in doctor–patient communication has generated great inter-
est among scholars, who have published several papers with different ap-
proaches (i.a. Brown et al. 2004; Bührig 2005; Montalt Resurrecció and
González Davies 2007; Penney et al. 2011; Albi 2012; Ramos 2012; Busque
2015; Specker Sullivan 2017).
Some differences have been observed between English and Spanish
informed consents. They relate not only to the kind of content included
(which is determined by the legislation of each country and the rules of
each hospital) or the vocabulary used (as happened with medical bro-
chures, Latin terms are frequent in Spanish but not in English), but are
also related to the format (as happened with patient information leaflets
and in opposite to medical brochures, informed consents in English and
in Spanish are very formal, but Spanish informed consents are even more
serious). Moreover, differences regarding some linguistic aspects have also
been recorded: for example, the greater length of Spanish sentences, the
structuring of information into paragraphs in English and sentences in
Spanish or the frequent use of verbs at the beginning of sentences in Eng-
lish against the prevalence of nouns in Spanish.
Despite all the work done in this field, further contributions related to
informed consents seem necessary since the translating activity of these
texts challenges the translator, who must deal with different disciplines,
registers, specialised terminology and possible macrostructure adapta-
tions, such as the type and content of elements included. An exhaustive
contrastive analysis of the languages involved in the translation may thus
be of great help for the translator.
120 Goretti Faya-Ornia

Conclusions and Limitations of the Research

As we have seen, the features of text genres may vary from one culture to an-
other (Gamero Pérez 1998). These changes may be due to linguistic or cul-
tural conventions, or even the economic restrictions of a particular country.
It is advisable that translators (though it can be applied to any profes-
sionals dealing with languages, such as editors or proof-readers) be aware
of the differences that a particular genre presents in the source and target
languages (García Izquierdo 2000; 2002; Gamero Pérez 2001) in order to
obtain a target text that complies with the features that a specific genre
presents in the target culture, and therefore with readers’ expectations.
Translated texts including these types of changes are better accepted by
their addressees and comply more effectively with the function with which
they were created (García Izquierdo 2002; Sánchez Trigo 2002; Muñoz
Torres 2002). In order to detect these similarities and differences, contras-
tive analyses may be useful (Firbas 1992; Johansson 2003).
In this sense, based on previous contrastive research, in the present
study we have commented on the differences found in the text genres of
medical brochures, web pages of hospitals, patient information leaflets
and informed consents, mainly in English and Spanish, but also in Ger-
man in the case of medical brochures (because of previous research in that
language) and in American English (in the case of medical brochures and
web pages).
In our opinion, the results obtained might be interesting and useful to
both translators and editors of these kinds of texts so that they can com-
ply with the expectations of the readers in the target culture. However,
this work might also be completed with future research. For example, the
model of analysis could be extended so that further linguistic and formal
elements can be contrasted. Also, the corpora can be enlarged either with
a greater number of documents or even with the inclusion of new subcor-
pora (for example, a corpus of translated documents, to see the current
trends of translation, such as we did with medical brochures; a corpus
of texts in other languages to observe the behaviour of a particular text
Relevance of Formal and Cultural Variations in Text Genres… 121

genre in a different language, such as we did with the German medical

brochures; or even a corpus on different accents or varieties of the same
language, as we did with medical brochures and webpages of hospitals,
where we also analysed the American version).

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 Ewa Kościałkowska-Okońska
Nicolaus Copernicus University, Toruń, Poland

Translating Patient
Information Leaflets:
Expectations of Users and the Reality

1. Translating Medical Texts:

Needs and Expectations of Users

Due to the diversity of medical texts, translators have to find an effective

way to communicate with the receivers of these text and to take into ac-
count their needs, requirements and expectations (Montalt Resurrecció
and González Davies 2007). Therefore, the challenge for the translator is
not only the terminology applied and the proper use of terms in trans-
lation, but also the communicative effectiveness of such a message, i.e.,
ensuring the correct understanding of the text by the user. The users in
the context of this paper shall be the final receivers of the Patient Informa-
tion Leaflets, i.e., the patients (this group also includes members of their
families or caregivers).
Medical texts, similarly to other types of texts devoted to scientific or
technical topics, are intended to convey objective (objectified) informa-
tion but not cultural references (Montalt Resurrecció and González Davies
2007). This results in a relatively neutral, impersonal and homogeneous
style. Generally, medical texts can be divided into three groups, namely:
–– official documentation relating to the marketing of medicinal prod-
ucts and medical devices (so-called regulatory documents), which
is very extensive and must meet rigorous subject-specific, technical
and formal requirements;
138 Ewa Kościałkowska-Okońska

–– medical texts of educational and informational character (e.g. in-

formation about new medicines, presentations of research results,
papers to be published in medical journals) that are targeted at spe-
cific groups of users (health professionals, patients);
–– medical documentation related to the patient’s health (e.g. hospital
discharge reports, hospital records, diagnostic results).
All the above texts are, for various purposes, translated. The translator
should therefore find a balance between translation-related requirements
and the features of each type of text. These features are primarily syntax,
specialised terms (terms of art), terminologicality and precision, and as
such constitute the characteristics of a specialised language. The way in
which content is communicated is, apart from specialised terminology,
the most serious challenge for the translator. The aforementioned absence
of cultural references, typical of medical texts, means more emphasis on
the informative function of the text. Therefore, the priority and basic re-
quirement for the translator is an effective way of communicating with
the receivers of the text and meeting their needs, requirements and ex-
pectations (Albin 1998; a wider overview of translation of medical texts in
Kościałkowska-Okońska 2012; 2015).
Medical language is very domain-specific and is seen in the contextual
variety of medical genres (that became the focus of research of, e.g., Gotti
and Salager-Meyer 2006). Yet, apart from the genres that are targeted at
health professionals, medical experts, etc., there is a growing tendency to
involve patients – as non-experts or lay receivers – in health communica-
tion. Within the last several years this increased focus on health commu-
nication has aimed at making it more effective, easier to understand for
users and thus more lay-friendly. An increased emphasis on the needs of
patients (Montalt i Resurrecció and Shuttleworth 2012) and the tendency
to expand patient participation in the treatment process result in the med-
ication-related information being one of the most important components
of the health education process. The educational level of societies has been
steadily on the increase in general, which is reflected in the patients’ moti-
vated willingness to expand knowledge and apply it using state-of-the-art
Translating Patient Information Leaflets… 139

technologies and Internet sources. Patients are keenly interested in infor-

mation about their health and healthcare (see e.g. Kenny et al. 1998: 476),
as general health education on a satisfactory level is conducive to health
promotion and disease prevention which, in turn, is becoming an increas-
ingly essential trend in contemporary societies. Further, due to rapid and
outstanding developments and achievements of medicine and related
fields, information about new revolutionary procedures, treatment meth-
ods or medications is widely recognised and spreading quickly. However,
there is one problematic issue that cannot be ignored: as research and
studies demonstrate, nearly 30% of all drugs are not taken in accordance
with doctors’ instructions (this phenomenon is known as patient non-
compliance; Derkacz et al. 2014: 92). Moreover, many patients do not read
leaflets as these seem too long or too many adverse effects are mentioned
(the so-called fright factor; see MHRA 2005: 36–39). Further, functional
illiteracy (affecting ca. 70 million people in Europe and nearly 20% of the
Polish population; ELINET 2015) is taking its toll since limited reading
and comprehension skills may result in health impairment, problems with
treatment of chronic diseases, not to mention more (and longer) hospital
stays and higher treatment costs. The lack of comprehension on the part
of the patient may also lead to other serious consequences, such as over-
dosing the medication or not reporting existing side effects. These factors
illustrate how complex and difficult it is to cater for all needs and expecta-
tions of users and to ensure that patients understand the information and
are capable of complying with instructions given.

1.1. Legal Regulations: The Establishment of PIL as a New Genre

In order for those needs and expectations to be satisfied, since 1999 all
medicines must be accompanied by leaflets (Patient Information Leaflets,
hence PILs) that patients as users will be able to read and understand.
The applicable legal regulations are the following directives: 92/27/EEC,
2001/83/EC and 2004/27/EC. The need to develop patient- or lay-friendly
communication resulted in the establishment of new genres, including the
140 Ewa Kościałkowska-Okońska

PIL (implemented mandatorily by the Council Directive 92/27/EEC). As

stipulated in Article 63(2) of EU Directive 2001/83/EC, the PIL ‘must be
written and designed to be clear, understandable and enable the users to
act appropriately’, thus safeguarding lay-friendliness.
The PIL – discussed in this paper from the perspective of EU regula-
tions – is a document developed by a pharmaceutical company that goes
with the medicine as a package insert and is intended to inform the user
about a given medication. Since the pharmaceutical industry is – as any
industry – regulated by legal regulations established by European insti-
tutions, the PIL is also a regulated document: on the European level by
the European Medicines Agency (EMA), and on the local level by locally
competent authorities (e.g. the Medicines and Healthcare products Regu-
latory Agency, or MHRA, in the UK). In Poland, this nationally compe-
tent body is the Office for Registration of Medicinal Products, Medical
Devices and Biocidal Products (Urząd Rejestracji Produktów Lecznic-
zych, Wyrobów Medycznych i Produktów Biobójczych). It should also be
noted that the PIL is named differently in the literature: Askehave and
Zethsen (2003) and Connor et al. (2008) call it the ‘patient package insert’.
For Clerehan and Buchbinder (2006) and Kenny et al. (1998), ‘patient in-
formation leaflets’ are varieties of types of medicinal informational mate-
rials for patients. As far as the research on PILs is concerned (regrettably,
still not too extensive), some studies refer to textual reception (e.g. Hirsh
et al. 2009; Bernardini et al. 2001; Pander Maat and Lentz 2010) or to the
text of PILs per se. Askehave and Zethsen (2003) focused in their research
on communication barriers to patient comprehension, whereas Clerehan
and Buchbinder (2006) and Garner, Ning and Francis (2011) attempted to
evaluate PILs from a more conceptual framework-oriented perspective.
PILs represent a category of documents whose structure is conven-
tionalised. Genres in general develop at a rather slow rate, yet in PILs the
changes are – dynamically – triggered by legal regulations. A PIL template
was produced by the committee of the EMA, i.e., the Quality Review of
Documents group (hence it is called a QRD template), to facilitate the
production process of the text and to ensure its consolidated layout. This
Translating Patient Information Leaflets… 141

template enumerates a sequence of headings and specifies types of infor-

mation to be given within these particular sections as well as assumes (and
requires) the use of wordings for a variety of information types. While
the sequence of information is stipulated in legal regulations, the remain-
ing part tends to be enforced (see Pander Maat, Lentz and Raynor 2015).
Following the regulatory procedures templates are turned into complete
documents and as such are not always compatible with the patients’ needs.
Studies by, e.g., Pander Maat and Lentz (2010) and Askehave and Zethsen
(2003) show that most patients do not find leaflets helpful: they cannot
find relevant information, they do not understand the information given
and are not always capable of applying it, or they do not feel the need
to read the information and comply with the instructions. PILs also are
perceived as lengthy and difficult to understand due to technical details
included and a huge bulk of information covered. The EU regulations pro-
vide for PILs’ consolidated uniformity in terms of format, content, head-
ings and wordings for given terms, yet they cannot ensure the usability
of the leaflet. Usability refers to linguistic readability and visual legibility
which depends on such factors as font sizes and types or paper quality. The
PIL should be easily comprehensible so that patients can use a given medi-
cation safely, and the level of discourse specialisation should be rather low
(see Gotti 2005: 25–27). This is related to the treatment of medical terms
in PILs, and this issue is elaborated in the readability guideline recom-
mended by the European Commission:

Medical terms should be translated into language which patients can un-
derstand. Consistency should be assured in how translations are explained
by giving the lay term with a description first and the detailed medical
term immediately after. On a case by case basis, the most appropriate term
(lay or medical) may then be used thereafter throughout the leaflet in or-
der to achieve a readable text. (EC 2009: 9–10)

The importance of medical terms used was also highlighted in the report
published by the MHRA which suggests developing a glossary of lay terms:
142 Ewa Kościałkowska-Okońska

There are many factors to consider when describing side effects. Currently,
descriptions of side effects are submitted by companies and assessed indi-
vidually for each PIL, resulting in differing and inconsistent terminology.
For patients, who may read about the same side effect described in two
or more quite different ways, this inconsistency is likely to be unhelpful.
Standardisation of side effect terminology would therefore seem desirable,
and adoption of ‘preferred lay terms’ for specific side effects would also be
helpful to industry and regulators. (MHRA 2005: 46)

Annex 8 (MHRA 2005: 123–128) to this report includes a list of 56 medi-

cal terms with their proposed lay correspondents to replace the medical
terms and thus ensure effective communication, e.g.:

leucopenia – reduction in the number of white blood cells, which

makes infections more likely
bradycardia – slower heart beat
ectopic pregnancy – pregnancy outside the womb which can cause se-
vere pain, bleeding or collapse
hypokalaemia – low blood levels of potassium which can cause mus-
cle weakness, twitching or abnormal heart rhythm
hyperkalaemia – high blood levels of potassium which can cause ab-
normal heart rhythm
jaundice – yellowing of the skin or whites of the eyes caused by
liver or blood problems

Obviously, descriptive terms provided facilitate understanding of the PIL

on the part of patients who do not have extensive (or even any) knowl-
edge of medical language. The explanation of medical terms in the leaflet
should – at least theoretically, considering the phenomenon of non-com-
pliance – contribute to more effective observance of treatment regimens
through following and understanding the mechanisms and processes in-
volved in the action of medications.
Translating Patient Information Leaflets… 143

1.2. PILs in Translation: Requirements

Due to the fact that Poland as a non-English speaking country imports

products of pharmaceutical companies (e.g. from the UK), PILs have to
be translated from English into Polish. The pharmaceutical company is
responsible for the production and, in the later stage, revision, analysis
and correction of the translation of the leaflet. When the original leaflet is
in English, the entire content (the Summary of Product Characteristics –
SPC) is transferred. After successful completion of the market authorisa-
tion for a given medicinal product (compliant with all relevant regulations
and procedures), the material is translated into Polish.
The production of PILs entails not only the need to observe valid le-
gal requirements but also the awareness of the knowledge asymmetry be-
tween the author or sender (health professional) and the receiver or lay
user: the author is an expert and the user is not. Moreover, the producers
of the text try to reach the population as a whole, thus there is no specific
reader, and – following Askehave and Zethsen (2003) – they may have
problems with conceptualising the potential user and with being knowl-
edgeable about his needs and expectations.
The patient leaflet must also comply with the SPC, which applies to all
authorised medicinal products intended for market commercialisation.
This division of medicinal information materials is justified by the con-
tent of these documents. The SPC is quite extensive, intended primarily
for doctors or pharmacists, and includes medical terminology, which the
average patient may find difficult to understand. The patient leaflet con-
tains data on the efficacy and safety of the medicinal product. The leaflet
layout is part of the whole process of registration of a medicinal product
and must meet certain requirements (in Poland as stipulated in the Regu-
lation of the Polish Minister of Health of 20 February 2009 concerning the
labelling of medicinal product packaging and the package leaflet).
The guidelines in the Polish and European legislation (Directive
2001/83/EC, the Guidelines of the European Commission of 2009) specify
the detailed requirements for the layout and contents of all information
144 Ewa Kościałkowska-Okońska

materials. In light of these regulations, the leaflet must be understand-

able, accurate and useful to the patient, as well as legible and transpar-
ent; in other words, it must be communicatively effective. Article 63(1) of
Directive 2001/83/EC provides for the following: ‘The information leaflet
must be written in a language that is understandable and affordable to the
patient and drawn up in the official language or languages of the Member
State where the product is placed on the market’.
This assumption is also reflected in Article 59(3), which stipulates that
‘the leaflet included in the package of the medicinal product specifies the
results of consultation with the target patient groups to ensure that the
leaflet is legible, clear and easy to use’.
Statutory requirements address a number of issues, and the commu-
nicative efficiency of the leaflet is conditioned by the users’ ability to read
and understand written texts; therefore, prior to being approved and ac-
cepted by the Office for Registration of Medicinal Products, Medical De-
vices and Biocidal Products, the leaflet must be subject to the readability
test. PILs are, by virtue of EU legal regulations in force since 2005, user-
tested. User-testing must be done by pharmaceutical companies (prior to
marketing authorisation and product commercialisation). Yet, it must be
noted that only one language version must be tested (in compliance with
regulations as stipulated by the European Commission in 2006), this ver-
sion being the English one in the absolute majority of cases. The English
version (non-translated) is usually the first to be drafted and further sub-
mitted to regulatory authorities; consequently, the results of user-testing
procedures are submitted to the EMA.
The requirements mentioned are categorised into formal and commu-
nicative ones. Formal requirements refer to the font size, which should be
as large as possible to aid users in reading. The minimum to be considered
is a font size of 9 points (measured in Times New Roman) that is not nar-
rowed, and the space between lines should have at least 3 mm. Capitals
should be rather avoided (the Guidelines explain that the brain recognises
words in written documents by the word shape so lower case text should
be chosen for large text fragments). Another important issue is the con-
Translating Patient Information Leaflets… 145

trast between the text and the background; this includes paper weight,
size, weight and colour of the font and of the paper itself.
The other category of communicative requirements recommends the
use of simple words of few syllables (due to poor reading skills of some
receivers) and avoiding long sentences (maximum sentence length being
up to 20 words). Further, the Guidelines stress that it is better to use a few
shorter sentences rather than one long sentence. Similarly, long paragraphs
can be confusing for readers, especially when side effects are enumerated.
The passive voice should give place to more direct and more personal style
and so the active voice is preferable. When patients are informed about ac-
tions they should take in particular, those instructions should be followed
by reasons and explanations. In situations when there is a need to use (or
repeat) the name of the medication, demonstratives (e.g. this medication)
or possessives (e.g. your medication) are recommended, yet the context
must be explicit as to the object of reference. Medical terms occurring in
the text should be explained and more lay-friendly language should be
used, thus enabling comprehension on the part of the users.
Legal requirements, formal and communicative requirements, and the
asymmetry of knowledge between the author and the user result in even
more difficulties for the translator. The translator is somewhat in the mid-
dle, between the text producer and the lay text receiver (Jensen 2012).
Moreover, by the force of law the PIL must be available in all EU languages
in all the states in which a given medicinal product or a medical device
are marketed.

2. Comparison of the English and Polish

Versions of the Patient Information Leaflet
and the Summary of Product Characteristics

The two main genres in medicinal information materials that are of inter-
est to us in the following section are the Summary of Product Character-
istics and the Patient Information Leaflet. As already mentioned, the SPC
146 Ewa Kościałkowska-Okońska

covers information of pivotal importance for health professionals on safe

and effective use of the medication, and forms the basis for the PIL, which
is said to be a simplified summary version of the SPC to be understood by
non-experts who could then use the medication safely and in a relevant
manner. A typical feature of the PIL is its shortness: it is usually much
shorter than the SPC. As it is conventionalised, it follows the ‘working’
framework of the sender, communicative purpose, intended audience,
content, textual structure and graphological aspects (such as font type and
size, paper colour, etc.). The intended audience are the final users of the
medication (patients) who, as Piorno (2012) observes, are a large and het-
erogeneous non-expert audience (also Albin 1998: 118) that vary by age,
background knowledge and education.
These two genres fulfil different functions and address the needs of
specific receivers (see concepts of referential and functional intertextu-
ality in Montalt Resurrecció and González Davies 2007: 55–56). They
have to reflect in their structure and communicative content, respective-
ly, decreasing degrees of formality and specialisation (also Piorno 2012)
to the benefit of simplification in PILs. What is further emphasised by
Montalt Resurrecció and González Davies (2007: 162–164) is the emer-
gence of other procedures that can be applied when developing PILs out
of SPCs. These procedures include synthesising information, expanding
information that is of relevance for the target readers, shifting the focus
from the author of the text and the textual content to comprehension
on the part of the user. Other essential procedures consist in adjusting
the tenor so as to achieve more personalised and direct communication
with the user, simplifying syntactic structures, using verbs instead of
nouns or noun phrases that may be perceived as too complicated or too
difficult, and finally making complex medical terms less complicated,
and thus more lay-friendly.
To illustrate differences in information content and ways of addressing
the needs and expectations of the users, an analysis of the translation of
commonly recognised and used painkillers (Nurofen Express, produced
by the UK-based manufacturer Reckitt-Benckiser) was performed. The
Translating Patient Information Leaflets… 147

original texts submitted by the manufacturer for approval to undergo reg-

istration procedures by competent authorities are the Patient Information
Leaflet and the Specific Product Characteristics. Both these documents
were originally developed in English. All leaflets are updated once a year
on average (the analysed material is the valid version for 2014 and 2015).
In compliance with the law, the PIL and the SPC in Polish are to be trans-
lated from the PIL and the SPC in English.
The material in the table below is divided into four columns cor-
responding to the original PIL and SPC in English (columns 1 and 2)
and their versions in Polish (‘ulotka dla pacjenta’ and ‘Charakterystyka
Produktu Leczniczego’ in columns 3 and 4) in the registration docu-
ments. Due to the spatial limitations of this paper, the number of exam-
ples presented – accompanied by comments – was reduced to 8. Because
of the specificity of the text (a leaflet), criteria such as the use of ordinary
or specialised language and terminology, directiveness, syntax typical
of specialised text, compliance with the objective, i.e., readability, sim-
plicity of expressions, accuracy and precision were used to evaluate the
translation. The examples demonstrated below are accurate reproduc-
tions of the original content layout that occur in graphically correspond-
ent positions in both texts.

Table 1. Example 1

Patient Summary Charakterystyka

Ulotka dla
Information of Product Produktu
pacjenta
Leaflet Characteristics Leczniczego
How to take Posology and Sposób podania Dawkowanie
Nurofen Express method of i sposób
200mg liquid administration podawania
capsules?

The English version of the leaflet includes a question which is followed

by a direct answer in the text. No specialised terminology was used. In the
SPC, the word ‘posology’ appears and is used exclusively in a specialised
148 Ewa Kościałkowska-Okońska

(pharmacological) context. There is no significant difference between the

PIL and SPC in Polish – ‘dawkowanie’ (‘administration’) is omitted in the
former, but ‘sposób podania’ does not differ semantically from ‘sposób po-
dawania’, only the verb form is longer.

Table 2. Example 2

Patient Summary Charakterystyka

Ulotka dla
Information of Product Produktu
pacjenta
Leaflet Characteristics Leczniczego
You should take Undesirable Przyjmowanie Działania
the lowest dose effects may leku niepożądane
for the shortest be minimized w najmniejszej można ograniczyć
time necessary by using the dawce skutecznej stosując
to relieve your lowest effective przez najkrótszy najmniejszą
symptoms. dose for the okres konieczny skuteczną dawkę
shortest duration do łagodzenia przez najkrótszy
necessary to objawów możliwy okres
control symptoms. zmniejsza konieczny do
ryzyko działań łagodzenia
niepożądanych. objawów.

The English leaflet directly addresses the user, while the information
is synthetic and focuses on the important issue of not taking excessive
amounts of the drug. The SPC, in a manner typical for medical texts spe-
cifically and for specialised texts in general, uses the passive voice, the sen-
tence is impersonal and ‘thick’ content-wise. In the PIL, the information
relevant for the patient is clarified by shifting to the second person form
(‘You should take…’).
In the Polish leaflet, the sentence is again very similar to the sen-
tence in the Polish SPC, but a shift of emphasis is visible: in the former,
the first information item is ‘przyjmowanie leku w najmniejszej dawce’
(‘taking the lowest dose’), while in the SPC, the reduction of side effects
is the priority.
Translating Patient Information Leaflets… 149

Table 3. Example 3

Patient Summary Charakterystyka

Information of Product Ulotka dla pacjenta Produktu
Leaflet Characteristics Leczniczego
Do not take Contraindications: Kiedy nie stosować Przeciwwskazania:
Nurofen Patients who have leku Nurofen – u pacjentów
Express previously shown Express: z reakcjami
200mg liquid hypersensitivity – jeśli u pacjenta nadwrażliwości
capsules if reactions (e.g. kiedykolwiek w wywiadzie
you: asthma, rhinitis, występowały (np. skurcz oskrzeli,
– have had angioedema, duszność, astma, astma, zapalenie
a worsening or urticaria) nieżyt nosa, obrzęk błony śluzowej
of asthma, in response to lub pokrzywka po nosa, obrzęk
skin rash, aspirin or other przyjęciu kwasu naczynioruchowy
itchy runny non-steroidal acetylosalicylowego lub pokrzywka)
nose or facial anti-inflammatory lub innych związanymi
swelling when drugs (NSAIDs) podobnych leków z przyjęciem kwasu
previously przeciwbólowych acetylosalicylowego
taking (NLPZ) (ASA) lub innych
ibuprofen, niesteroidowych
aspirin or leków
similar przeciwzapalnych
medicines (NLPZ)

In the English materials, the difference in terminology applied is very

clear – in the PIL all terms describing the patient’s sensations or com-
plaints are given in lay terms, while the SPC uses specialised terminology
which a lay user would certainly have difficulties in understanding (e.g.
‘urticaria’ from Latin is replaced with ‘rash’).
Expressions characteristic of scientific language, such as ‘contraindica-
tions’ or ‘hypersensitivity’, are translated into full sentences: ‘Do not take
Nurofen (…) if you have had a worsening of…’. In order to achieve a more
personalised communication, the tenor is adjusted in the PIL, and the lan-
guage is more personal. The degree of formality decreases (e.g. ‘rhinitis’ is
translated as ‘itchy runny nose’).
150 Ewa Kościałkowska-Okońska

In the Polish PIL, ‘nieżyt nosa’ (‘rhinitis’) may not be a concept with
which an average user is familiar. In addition, at the end of the sentence the
initialism NLPZ (NSAID) is used, which – not entirely in compliance with
the principles of translation logic – was provided in the SPC (which is in-
tended for professionals who certainly know the term). This explanation of
the initialism is, unfortunately, missing in the package leaflet where it would
be far more useful and helpful, especially considering the fact that the pa-
tient may not associate NSAIDs (NLPZ) with commonly taken analgesics.

Table 4. Example 4

Patient Summary Charakterystyka

Ulotka dla
Information of Product Produktu
pacjenta
Leaflet Characteristics Leczniczego
(Patients who) Patients with – jeśli u pacjentów – u pacjentów
– have severe severe hepatic stwierdzono z ciężką
liver or kidney failure, severe ciężką chorobę niewydolnością
problems renal failure wątroby, nerek, wątroby, ciężką
or severe heart choroby wieńcowe niewydolnością
failure (NYHA lub niewydolność nerek lub ciężką
Class IV) serca niewydolnością
serca

The distinction between ‘liver’ and ‘hepatic’ (lay and specialised terms
for the liver and related terms) or ‘kidney’ and ‘renal’ (for issues related
to kidney problems) is visible in English. In the Polish leaflet, ‘choroby
wątroby’ and ‘choroby nerek’ (‘liver disease’ and ‘kidney disease’, respec-
tively) are used instead of ‘ciężka niewydolność wątroby’ and ‘ciężka
niewydolność nerek’ (‘severe hepatic failure’ and ‘severe renal failure’) in
the SPC. This solution is certainly conducive to understanding the term by
the patient as scientific terms are avoided and replaced by popular terms.
In the Polish leaflet, the term ‘choroby wieńcowe lub niewydolność
serca’ (‘coronary heart disease or heart failure’) was retained and, surpris-
ingly, the SPC version does not mention ‘coronary heart disease’ at all.
Translating Patient Information Leaflets… 151

Table 5. Example 5

Patient Summary Charakterystyka

Information of Product Ulotka dla pacjenta Produktu
Leaflet Characteristics Leczniczego
– are taking Use with Należy unikać Jednoczesne
other NSAIDs concomitant jednoczesnego stosowanie
(non- NSAIDs, stosowania z NLPZ, w tym
steroidal anti- including cyclo- z innymi z selektywnymi
inflammatory oxygenase-2 NLPZ, w tym inhibitorami
drugs) or more specific z selektywnymi cyklooksygenazy-2,
than 75mg inhibitors – inhibitorami zwiększa ryzyko
aspirin a day increased risk cyklooksygenazy-2, wystąpienia reakcji
of adverse ze względu na niepożądanych,
reactions. zwiększone ryzyko należy zatem
wystąpienia działań takiego połączenia
niepożądanych. unikać.

In the PIL, the information is clear and understandable, and the initial-
ism has been explained descriptively. The SPC contains highly specialised
information and the name of the active substance (‘cyclo-oxygenase-2’) is
used which would be incomprehensible for the lay user but understood by
the health professional.
In the Polish version of the PIL, the name of the active substance was
retained (‘cyklooksygenazy-2’) which renders communication ineffective:
the name of this compound is not common knowledge. The leaflet version
is only slightly different from the SPC, the only difference being certain
stylistic changes (e.g. shifts in word order) that do not, however, affect the
overall information content.
The English leaflet as the first information item presents the way to
avoid side effects and, what follows, the need to not take other NSAIDs,
which is further enhanced by an imperative (‘do not take this product’).
The names of active substances are also given. The SPC, in turn, starts
with the necessity to avoid more NSAIDs being co-administered due to
the possible side effects.
152 Ewa Kościałkowska-Okońska

Table 6. Example 6

Patient Summary Charakterystyka

Information of Product Ulotka dla pacjenta Produktu
Leaflet Characteristics Leczniczego
To reduce the Avoid Należy Jednoczesne
risk of side concomitant poinformować stosowanie kilku
effects, do use of two or o przyjmowaniu NLPZ może
not take this more NSAIDs kwasu zwiększać ryzyko
product with as this may acetylosalicylowego owrzodzenia
other NSAID increase the lub innych przewodu
containing risk of side NLPZ (leków pokarmowego
products effects. przeciwzapalnych oraz krwawienia
(e.g. aspirin, i przeciwbólowych), ze względu na
ibuprofen). gdyż może to synergistyczne
zwiększyć ryzyko działanie.
wystąpienia Z tego względu
owrzodzenia należy unikać
przewodu jednoczesnego
pokarmowego lub stosowania leku
krwawienia. z innymi NLPZ.

In the Polish leaflet, the patient is instructed to inform – presumably

the doctor, but the sentence is impersonal and does not make any refer-
ence to the person that should be informed – about taking other medica-
tions. In contrast to the English leaflet, the names of active substances are
not given, even though it would certainly make the choice of drugs easier
for the patients. The chemical compound name, i.e., acetylsalicylic acid,
was given, which does not necessarily result in any associations and many
patients will not be familiar with it. In addition, the sentence structure is
very similar to the sentence in the SPC – apart from the explanation of the
initialism (NLPZ/NSAID), medical terms used are identical. Moreover,
contrary to the general rule, the PIL is longer than the SPC due to the
inclusion of the acetylsalicylic acid and its responsibility for the risk of oc-
currence of gastrointestinal ulceration or haemorrhage (this information
is present only in the PIL in Polish).
Translating Patient Information Leaflets… 153

Table 7. Example 7

Patient Summary Charakterystyka

Ulotka dla
Information of Product Produktu
pacjenta
Leaflet Characteristics Leczniczego
– to stimulate – cardiac – digoksyny – digoksyna:
your heart (e.g. glycosides: (lek stosowany jednoczesne
glycosides) NSAIDs may w niewydolności stosowanie
exacerbate cardiac serca), gdyż produktu
failure, reduce działanie leczniczego
GFR and increase digoksyny może z lekami
plasma glycoside się nasilić zawierającymi
levels digoksynę może
zwiększać stężenie
tych leków
w surowicy krwi

The leaflet in English refers to medications by their specific purpose,

whereas their chemical names are given in parentheses. The SPC explains
the effects – using medical terms – of interactions with NSAIDs. Informa-
tion concerning clinical usage of the medication, pharmaceutical particu-
lars and pharmacological details of the SPC is synthesised to a minimum
in the PIL.
The name of the active substance (which is also the trade name of
the medicinal product) is given in the Polish leaflet, and an expression
that its performance can be enhanced (‘może się nasilić’) does not carry
any information for the patient that could be treated as a major warning.
In addition, ‘glikozydy’ (‘glycosides’) were replaced by ‘digoksyny’ (‘di-
goxins’) that are more common in the Polish medical context. The SPC
contains only the information on the effect of digoxins. In the Polish SPC,
the information about GFR (i.e., glomerular filtration rate) reduction and
the increasing severity of heart failure was omitted. This omission can
raise doubts since the SPC is intended for health professionals, for whom
this information is necessary and relevant in their daily practice, and not
for lay users.
154 Ewa Kościałkowska-Okońska

Table 8. Example 8

Patient Summary Charakterystyka

Information of Product Ulotka dla pacjenta Produktu
Leaflet Characteristics Leczniczego
– for HIV – Zidovudine: – zydowudyna – zydowudyna:
treatment increased risk of (lek stosowany istnieją dane
(e.g. haematological w leczeniu HIV/ wskazujące na
zidovudine) toxicity when AIDS), gdyż zwiększone ryzyko
NSAIDs are given stosowanie leku krwawienia
with zidovudine. Nurofen Express do stawu oraz
There is evidence może zwiększać powstawania
of an increased risk ryzyko krwawienia krwiaków
of haemarthroses do stawu lub u HIV-dodatnich
and haematoma krwawienia hemofilików
in HIV(+) prowadzącego otrzymujących
haemophiliacs do obrzęku jednoczesne
receiving concurrent u pacjentów leczenie
treatment with z hemofilią zydowudyną
zidovudine and zakażonych HIV i ibuprofenem
ibuprofen

In this case, there is a very clear difference between the English PIL
and SPC and their Polish translation. The English PIL informs only about
the purpose of the treatment and the name of the medication, while in-
formation concerning clinical usage of the medicine, pharmaceutical par-
ticulars and pharmacological details present in the SPC is synthesised to
a minimum. The SPC explains the negative effects of using NSAIDs to-
gether with the drug – specialised terms are used and additional informa-
tion is provided.
The Polish leaflet provides the information given in the SPC; the dif-
ference between the English and the Polish leaflet is very distinctive: the
latter is a slightly modified version of the SPC. Nominalisations (‘HIV-do-
datni hemofilik/HIV(+) haemophiliac’) are turned into a full expression
(‘pacjent z hemofilią zakażony HIV/patient with haemophilia and HIV’).
Translating Patient Information Leaflets… 155

Even a very cursory glance at the materials allows to draw preliminary

conclusions: the materials in English are two largely independent docu-
ments, differing not only in terms of the layout, but above all in terms
of the language used. The leaflet, contrary to the SPC, employs ordinary
language and does not include specialised terms.
It should be stressed that in the examples above extensive differences
can be seen as to the volume of the English version of the leaflet and its
Polish translated version. Certain words are missing from the translation,
while other words, not present in the original, are added. The two docu-
ments also vary in length: the leaflet in English is two pages long (ca. four
pages of standard print) and the SPC is eight pages long. In contrast, the
materials in Polish are 11 and 14 pages long, respectively.
The fact that the English leaflet was produced in a non-specialist, non-
hermetic language that is not intended specifically for professionals is
a much more important issue, and undoubtedly it is more significant in
terms of communication efficiency. The wording is understandable, clear
and communicatively effective, and thus it accomplishes the assumed ob-
jective: a clear informative message for the patient that will help him to
use the medication, which will improve his health or wellbeing. From the
point of view of communicative efficiency, it is important to note that the
Polish leaflet and SPC are actually very similar, and thus the first condi-
tion of adapting the text to the needs and expectations of the receiver has
not been fulfilled. The leaflet was somewhat shortened, several terms – as
shown in the examples in the table – were slightly simplified, yet its gen-
eral image and content do not facilitate understanding. The terms used
are not lay terms and the language is definitely not lay-friendly, and thus
the text itself is not clearly understandable to the user. In addition, the
‘parallelism’ of the document translation process itself was not used, i.e.,
the basis for the Polish translation of the leaflet was not the English PIL.
In a sense, the leaflet in Polish was developed as an adaptation of the SPC
in Polish (which was translated from the SPC in English). Therefore, it is
more formal and largely dominated by lay-unfriendly syntax and special-
ised terms.
156 Ewa Kościałkowska-Okońska

Conclusions

The observed differences in the translated materials evidence the differ-

ence in lay-friendliness, and this certainly deserves a further analysis and
more profound insights in future research. The understanding of the in-
formation in the medication leaflets and medicinal information materials
is of primary importance for the users as their health and wellbeing is at
stake. Therefore, good and relevant translation of medication-related doc-
uments is a key issue: potential problems with the understanding of the
leaflets and very negative consequences resulting from failure to compre-
hend these texts (e.g. deterioration of one’s health) can be eliminated by
the production of texts adapted to the needs and expectations of the user.
The translated versions of original English materials analysed in this
paper do not meet their users’ expectations: they are too formal, too im-
personal, too stylistically complex, too specialised terminologically and
too lay-unfriendly. Lay-friendly language is more understandable to lay
users, and as such should be used in leaflets. However, although the ten-
dency to involve patients in the treatment process, e.g. by shifting the
focus to communicative efficiency of these texts, has been increasingly
becoming a worldwide trend, in Poland there is still a lot to be done in the
field of both social awareness and the pharmaceutical companies’ percep-
tion of the local market, the users, their needs and expectations.

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 Arkadiusz Badziński
University of Silesia, Katowice, Poland

Teaching Medical
Simultaneous Interpreting:
From Theory to Practice

Introduction

Simultaneous interpreting (SI), which is the most modern form of inter-

preting, is a type of real-time conference interpreting formally introduced
for the first time in Germany during the Nuremberg trials in 1945 (Gaiba
1998). This mode is frequently applied at international (or multinational)
meetings, conferences and symposia with the use of specialised electronic
equipment (i.e., soundproof booths, headphones and a microphone) and
is also known as booth interpreting. In turn, whispered interpreting (also
known as chuchotage) is conducted without the use of specialised techni-
cal equipment by interpreters who stand (or sit) next to a person or a small
group of listeners and provide interpreting of what is being said in a low
voice. Also sight interpretation, in which an interpreter reads a written
text and simultaneously interprets it, is part of SI (Florczak 2013: 32). The
last form of SI, known as relay interpreting (or indirect interpreting), is
most commonly adopted when there are multiple target languages em-
ployed in a conference, meeting or event or if no interpreter can be found
for a particular language combination. The process of SI ‘encompasses
listening, processing of the original discourse and its restitution in the
target language with operations of linguistic decoding bringing into play
different types of memory and language production’; therefore, this pro-
cess ‘implies attention sharing and decision-taking, with the management
of risks and difficulties’ (Gile 1995: 17 qtd. in Setton 1999: 34).
162 Arkadiusz Badziński

Medical interpretation belongs to the most rapidly developing areas of

interpreting. It covers the whole spectrum, from community interpreting
at medical settings to specialised conferences and whispered interpreting,
particularly in the case of medical specialties that develop at an immense
rate (invasive cardiology, oncology or genetics).
Medical SI is related to the communication process either among health-
care professionals themselves who use different languages or among patients
(or their families) and medical specialists. The process of SI is conducted
by an interpreter who is usually formally educated to provide interpreta-
tion services. Medical SI requires experience and subject matter expertise
in medical nomenclature and medically-related procedures. Medical back-
ground of an interpreter, though highly desired, is an asset – not a necessity.
Due to a rapid increase in the demand for medical SI, the need for
proper training of medical interpreters seems to be of great importance –
not only to meet the demands and requirements of the market in terms of
the number of interpreters, but first and foremost to disseminate medical
knowledge between the specialist–specialist domain and the specialist–
layman domain in the ever-changing medical settings and realities. Flor­
czak (2013: 54 after Płusa 2007) is of the opinion that teaching interpret-
ing is a necessity rather than a possibility and that it should be taught and
‘the specificity of the acquisition of immensely complex interpreting skills
requires an organised training course and practice conducted by special-
ised university centres with high level experts’.
The main difficulties of medical interpreting encountered by students are
related to their unfamiliarity with medical knowledge and terminology on
the one hand, and the process of interpreting on the other. Both problems
can be overcome by preparing a special program allowing students to gain
experience in the process of interpreting, which depends on the abilities
to process the information and the use of specific strategies to convey the
meaning of the source text (ST) so that it is reflected in the target text (TT).
At the same time, they also extend their knowledge connected with medi-
cine. Therefore, a fully comprehensive programme of teaching medical in-
terpreting can be prepared only when these two components are combined.
Teaching Medical Simultaneous Interpreting… 163

1. Medical SI Training

The programme proposed in this paper is based on the elements that have
already been implemented in the training process of students at the In-
stitute of English of the University of Silesia in Sosnowiec, Poland. The
University provides excellent conditions for SI (including the booths). The
SI course is conducted for 3 years, starting from Year 3, and covers 6 se-
mesters in total. Each semester consists of fifteen 90-minute classes.
Year 3 is dedicated to the explanation of certain theoretical issues relat-
ed to interpreting and practical classes. Medical interpreting is introduced
starting from Year 4. Additionally, different domains are also discussed,
including economy, business, politics or law.
The proposed holistic system of teaching SI with special attention paid
to the medical domain is as follows.

1.1. Year 3 (Both Semesters)

Teaching SI cannot be detached from the theoretical framework. There-

fore certain concepts must be introduced at the very early stage of the
student training.
Active listening is the first principle that Stoica (2008: 205) considers
to be of prime importance in SI. It is crucial and prepares the foundations
for further processes. Stoica (2008: 205) quotes Bowen and Bowen (1984),
who distinguish 4 types of listening, i.e., passive, protective, selective and
active, of which only the last one is related to the process of interpretation
and, as Jones (1998) rightly states, must be learnt and trained as it is not an
innate ability. It is of particular importance due to the fact that in medical
SI a prefix or a suffix can determine the meaning of the word as a whole.
In the simultaneous mode particular attention should be paid to the
cognitive nature of the process of SI and the differences between SI and
the consecutive mode or translation. Students need to be familiarised with
the theoretical framework of SI, including information processing mod-
els, the effort model and the interpretative theory of translation (Lederer
164 Arkadiusz Badziński

1981; Gile 1995). The processes of memory and comprehension in SI with

the analysis of a model of memory proposed by Daró and Fabbro (1994) is
discussed. Although the above may appear to be a little extensive for a the-
oretical background, it must be borne in mind that without the awareness
of the processes involved in SI interpreting cannot be done properly. Ad-
ditionally, such a detailed explanation is necessary partly due to the fact
that at the University of Silesia simultaneous and consecutive interpreting
are introduced at the same time. Listening and analysis, memory effort,
production effort and coordination effort are interpreting phases and stu-
dents should be able to find a balance among them with respect to energy.
Additionally, the phenomenon of simultaneous listening and production
must be also discussed as it is not present in any other mode of translation
or interpreting.
Furthermore, the management of time lag between the ST input and
the interpreter’s target (ear-voice span) requires further explanation. The
Polish language is not characterised by a fixed word order (compared
to English) and therefore some syntactic changes (subject-predicate-
object) must be implemented into English, which may also entail lag
(Bartłomiejczyk 2015: 209).
The above concepts obviously do not have to (and should not) be in-
troduced in the form of a formal lecture – they can be discussed as ‘mini-
lectures’ (Bartłomiejczyk 2015: 210). Despite the fact that both shadow-
ing and paraphrasing of the ST have been criticised by some researchers
(Dejéan le Féal 1997), they may be useful at the initial stages of learning.
Of note, sight interpreting may also be provided at the very beginning of
classes as a warming-up activity (Bartłomiejczyk 2015: 210). The opinion
presented by Dejéan le Féal (1997), according to which students at the ini-
tial level of interpreting should interpret the text firstly in the consecutive
and then in the simultaneous mode, seems to be very useful and practi-
cal. At this stage commonly known fairy tales (such as Little Red Riding
Hood) are recommend to be interpreted both from and into English. The
speed at which the material is recorded should be around 130 words per
minute (wpm). These tales may be interpreted several times (Gillies 2004:
Teaching Medical Simultaneous Interpreting… 165

127). Although such a situation is almost impossible in real interpreting

settings, it provides the possibility for a deeper analysis of the TT and
students’ mistakes. It should be borne in mind that the level of STs should
be appropriate and should not exceed the capability of students. Students
may initially listen to certain material and then interpret it, which is ben-
eficial in respect to understanding, particularly in the case of some more
complex or specialised terms that can additionally be provided to students
in the form of handouts.
Another crucial aspect that needs to be taken into account is related
to one of the most controversial issues in interpreting studies (Dejéan le
Féal 1998) – directionality, which refers to language combination and di-
rection (e.g. English into Polish vs. Polish into English). In the process
of SI training, interpreting from A language to B language and from B to
A is considered, which is consistent with the studies using neurolinguis-
tic techniques, which revealed that different brain areas are activated de-
pending on the direction of interpretation (Tommola et al. 2000/2001).
Special attention in the interpreter training should be paid to the anal-
ysis of strategies used in SI. First of all, however, the following question
should be posed: what elements define strategy? Liontou (2011: 38) dis-
tinguishes 4 components required to form the strategy: (1) procedures
performed by an individual, (2) which contain an element of planning,
(3) aim at fulfilling particular targets, and (4) refer to a sequence of activi-
ties during the process of target realisation.
Teaching various strategies during SI classes is an essential compo-
nent of the interpreter training. Interpreting strategies, known as ‘coping
tactics’ (Gile 1995) or ‘techniques’ (Jones 1998), are crucial aspects of in-
terpreting expertise (Xiangdong 2013: 105). Since the beginning of the
1970s, many studies on this issue have been conducted (e.g. Barik 1971;
Wilss 1978; Kirchhoff 2002; Bartłomiejczyk 2006, to name just a few).
These strategies are both intentional and goal-oriented procedures that
are employed to solve certain problems stemming from the limitations
of the processing capacity of interpreters or the gaps in their knowledge.
Strategies can also be employed to facilitate tasks of interpreters and
166 Arkadiusz Badziński

prevent the occurrence of potential problems (Kalina 1992; Gile 1995;

Bartłomiejczyk 2006: 152; Liontou 2011; Xiangdong 2013: 106). Conse-
quently, the appropriate implementation of strategies results in overcom-
ing the capacity limitations and taking advantage of available processing
capacity (Riccardi 2005: 758). As a result, the intentional and automatic
use of some strategies (from the total number of over 30 found in the liter-
ature; Xiangdong 2013: 109) contributes to the reduction in the cognitive
load thus facilitating the interpreting process. Obviously, students need to
be informed that the very same strategy may be given a different name by
different researchers. To illustrate, the omission strategy understood here
as a non-interpreted message resulting from, for instance, memory failure
and considered either as a mistake or a technique that may be implement-
ed in extremely difficult conditions in the case of cognitive overload is also
termed message abandonment (Bialystok 1990: 39), skipping (Al-Salman
and Al-Khanji 2002) or ellipsis, depending on the researcher.
Among the most common strategies, the following are found in SI
(Bartłomiejczyk 2006; cf. Xiangdong 2013):
–– compression (interpreting delivered in a concise manner with no
repetitive or redundant information);
–– omission (abandonment of certain messages that are not interpret-
ed at all);
–– morpho-syntactic transformation (providing the meaning of the
original message with the use of different syntactic constructions);
–– calque (word-for-word interpreting);
–– substitution (invention of the message to avoid, e.g., unfinished
sentences);
–– addition (extra information provided by an interpreter for better
understanding of the TT);
–– approximation (providing a near equivalent term in the TT in the
absence of the correct term);
–– repair (self-correction employed to correct previous misinterpreting);
–– no repair (conscious choice not to make repairs as they could result
in poorer interpreting);
Teaching Medical Simultaneous Interpreting… 167

–– inference (recovery of the lost information either based on context

or the general knowledge of an interpreter);
–– reconstructing (different positioning of the information by an in-
terpreter);
–– delaying response (providing generic utterances in order to cover
long pauses in the output).
The above-discussed phenomena constitute the basis for both theo-
retical and practical aspects of SI irrespective of a scientific area or field
(e.g. technical, legal or medical).

1.2. Years 4 and 5 (Four Semesters)

Once students have been familiarised with the theoretical framework

and strategies related to SI, the next stage of their training should include
preparation in terms of medical SI. In the very beginning, different types
of competence are briefly discussed, including strategic competence,
transfer competence and extra-linguistic competence consisting of spe-
cialist knowledge, which is of great significance for medical interpreting.
At this stage students are also made aware of the significance and re-
sponsibility of medical interpreting and its further consequences related
to patient wellbeing. Medical interpreting unlike any other field is directly
related to human health and therefore any mistake in interpretation may
have (literally) fatal consequences. This, however, should not discourage
students from the process of interpreting.
Students should be encouraged to familiarise themselves with medical
texts at home, firstly in Polish and then in English. They can start from
texts addressed to the general public and then proceed to more scientif-
ically-related texts in both languages. It would be most beneficial if the
texts in both languages were similar in terms of the subject matter (paral-
lel texts), which could facilitate not only memorising some words, phrases
or even collocations but also contribute to the broadening of the knowl-
edge related to particular medical issues.
168 Arkadiusz Badziński

In terms of directionality, interpreting is performed from and to B lan-

guage. However, it should be borne in mind that in real circumstances
(e.g. at conference settings) medical simultaneous interpreters usually in-
terpret to English. There is a relatively smaller demand for interpreting
from English (to Polish, for instance) since the majority of doctors are at
least passively familiarised with the English language and the medically-
related terms from their specialty. Consequently, problems are usually re-
lated to the output in English.
After the presentation of the subject matter scheduled for interpreting
in the following week, students are (strongly) advised to do some research
at home on this particular issue. Then, the subject is introduced by the
teacher followed by a brief discussion with students (in case of any ambi-
guity). At this point the role of the teacher is to provide adequate explana-
tion of unknown terms and strategies for learning with the continuous
encouragement of learner autonomy (cf. González Davies, Scott-Tennent
and Rodríguez Torras 2001).
The main criterion in the selection of medical STs is the authentic-
ity of the material. Obviously, initial texts for medical interpreting may
be prepared specifically for the purpose of the interpreter training (e.g.
abridged versions of the original texts and lectures), but not artificially
since such preparation might result in a distortion of the subject matter.
Consequently, at the initial stage STs should contain a lower amount of
specialised terminology and refer to less complex medical issues. Seeber
(2015: 85) postulates that speed and density of STs should not be consid-
ered as separate components but as one item since ‘discourse with low
lexical density presented at a high speaking rate can be perceived as slow
[and] discourse with high lexical density presented at a low speaking rate
can be perceived as fast’.
Speed is, in fact, a factor that may be particularly challenging in medi-
cal interpreting. In practice, the average number of 100–120 wpm given
by Seleskovitch (1978) or Lederer (1981) as the ideal speaking rate for SI
may be considerably exceeded in the real settings. At some medical con-
ferences, however, speaking rates have been found to considerably exceed
Teaching Medical Simultaneous Interpreting… 169

170 wpm and to reach almost 205 words wpm, which obviously may result
in a substantial incidence of mistakes. This, however, most often occurs
when certain information and data are read by the speakers. Consequent-
ly, in the classroom settings such a high rate does not seem to be attainable
at the level of novice interpreters. Obviously, students must be informed
that higher speed is the product of practice and experience.
The first two months (8 classes) are dedicated to the explanation of the
medically-related issues (mainly pathologies and normal and abnormal
conditions). These include the following 6 main domains:
–– structures of medical words derived from Latin and Greek (i.e.,
processes of word-formation with particular attention paid to pre-
fixation and suffixation);
–– pronunciation of medical terms;
–– differences between British and American English;
–– medical abbreviations and acronyms;
–– medical eponymy, synonymy and antonymy;
–– medical register (lay terms versus specialised terms) (cf. Waka-
bayashi 1996).
The above components are essential in understanding medical issues.
Attention should also be paid to sub-medical terminology defined by
Brunt (1987) as neither highly specialised nor highly colloquial, which is
normally adopted by patients during patient–doctor conversations and by
physicians if they wish to be properly understood by their patients.
Florczak (2013) proposes a number of very useful exercises that can
be successfully implemented during SI classes. Despite the fact that the
efficiency of these exercises has not undergone any scientific analysis nor
has it been confirmed empirically, they seem to be of great benefit to fu-
ture interpreters as they cover a large spectrum of possibilities for future
use (different types of exercises such as selective listening, single output,
gap filling or sentence completion). Additionally, exercises proposed by
Bartłomiejczyk (2015) are equally useful and constitute a source of a very
rich material not only for SI but also for the consecutive mode.
170 Arkadiusz Badziński

Another factor to be considered in the teaching process is related to the

selection of appropriate material. Internal medicine offers a broad spec-
trum of different STs and therefore seems the most appropriate field at
the initial stage. Later on, other medical specialties should be introduced.
These might include blocks such as neurologic and psychiatric disorders,
endocrine and metabolic disorders or epidemiology and public health is-
sues, since multidisciplinary studies are currently common in medicine
too. Consequently, students may be provided with the tasks that can pose
the greatest challenge to interpreters due to their overlapping with differ-
ent medical specialties. In this respect oncology, genetics and radiology
(including imagining studies) would be examples par excellence.
The selection of medical specialties cannot be random. It should be
done in accordance with the level of difficulty and the curriculum at medi-
cal universities. Obviously, time limitation (4 semesters) may be the main
obstacle in extending the number of specialties for interpreting since such
a period of time does not allow for the inclusion of even a quarter of all
medical specialties that formally exist in Poland (over 40). On the other
hand, many of the specialties are partially incorporated due to the overlap
(paediatric oncology is linked to paediatrics, immunology and genetics).

2. Teacher’s Role and the Quality Criteria in SI

The role of the teacher cannot be overestimated in the process of inter-

preter training. Conducting classes at a highly professional level is a pre-
requisite. Ideally, teaching medical interpreting should be conducted by
a person having some medical background or at least extensively famil-
iarised with medical issues, which is particularly significant in the case of
medically-related questions posed by students themselves and connected
with the materials provided for SI.
Additionally, among other significant features connected with this
role, the following should be considered: appropriate methods of teach-
ing, time management, proper selection of materials for particular classes
Teaching Medical Simultaneous Interpreting… 171

and, last but not least, personal involvement of the teacher in conducting
the classes (cf. Karwacka-Campo 2008: 224). Ideally, teachers conducting
classes in SI should be interpreters themselves. This would be beneficial
due to the possibility of performing the analysis from two different per-
spectives: of a person who evaluates the simultaneous process and of an
active interpreter, thus making the teacher more credible in the eyes of
students as he follows the ‘practise what you teach’ procedure.
Aside from the above considerations, the teacher should also pay spe-
cial attention to the stress factor, which is one of non-cognitive components
of interpreter aptitude as distinguished by Chabasse (2009). Stress factors
were discussed in detail by Korpal (2016). Various sources of stress can be
observed starting from inadequate memory, apprehension due to inexpe-
rience, fear of misunderstanding the ST, of being misunderstood or being
assessed (negatively) either by colleagues or by the teacher (Stoica 2008:
205). If stress occurs, certain methods of its decrease should be introduced.
The physiological stress-related symptoms (increased heart rate and blood
pressure or elevated cortisol level) may have a tremendously negative im-
pact on the performance of SI. Therefore, certain stress-coping strategies
should be discussed with students and implemented in the teaching pro-
cess. Among these strategies, Korpal (2016: 310–311) distinguishes, e.g.,
isolation and focus on task as well as a supporting interpreter in a booth or
sufficient rest. Additionally, to decrease tension and stress, classes should
start with easier tasks or even jokes (as proposed by Stoica 2008: 205).
In the process of SI training, special attention should also be paid to the
notion of student assessment using the quality criteria. No consensus has
been reached yet as to how the quality in the field of interpreting should
be defined (Tymoszuk 2016: 98). It is particularly difficult due to a number
of different variables and perspectives involved in SI and a uniform defini-
tion of interpreting quality may even be impossible to find. The assessment
must consider many variables, such as for whom, how and under what
circumstances quality is investigated (Zwischenberger 2010: 128). Zwi­
schenberger uses 11 output-related quality criteria for SI that are grouped
in 3 main domains: content-related, form-related and delivery-related.
172 Arkadiusz Badziński

Content-related criteria include sense consistency with the original,

logical cohesion and completeness; form-related criteria consist of cor-
rect terminology, correct grammar and appropriate style; finally, delivery-
related criteria include fluency of delivery, proper intonation, pleasant
voice, synchronicity and native accent (Zwischenberger 2010). The results
of a survey conducted by Kopczyński (1994) among Polish users of inter-
preting services revealed that they considered detailed content and termi-
nological precision to be the two top priorities and wrong terminology to
be the most important irritant.
In the case of medical SI, correct terminology and completeness are
of great importance or even the top priority, whereas proper intonation,
pleasant voice, synchronicity, though important, are less significant. The
assessment of interpreting is a complex process and hence the related deci-
sions must be of both qualitative and quantitative nature (Kościałkowska-
Okońska 2015: 308). Furthermore, interpreting is not a homogenous pro-
cess, partly due to the different circumstances in which it takes place and
the parties involved (mid- and high-level medical personnel, patient–doc-
tor relationship). Therefore, the above elements must be considered dur-
ing the course of interpreting and included in student evaluation.
The teacher’s role may be viewed in terms of providing formative and
summative assessment (Kościałkowska-Okońska 2015 after Sawyer 2004:
6). The aim of the former is to monitor student learning within certain
time framework and provide ongoing feedback in order to improve stu-
dent learning by means of the identification of student’s strengths and
weaknesses as well as certain target areas which require improvement.
The goal of summative assessment is, in turn, to evaluate student’s overall
learning process at the end of a learning period (e.g. semester), which al-
lows to provide a summary of the final achievements and a verification of
the target(s). Special attention should be paid to the familiarity not only
with words or terms but also the appropriate medical register. The qual-
ity criteria should be provided with details because their ever-increasing
number may, in fact, result in a never-ending process of criteria formation
(Kościałkowska-Okońska 2015).
Teaching Medical Simultaneous Interpreting… 173

It would be most optimal to assess student interpreting in two man-

ners. Firstly, the assessment should be conducted by the teacher followed
by a feedback from classmates. These two opinions (not necessarily coin-
ciding) should be then confronted to provide the final feedback to a stu-
dent. Kościałkowska-Okońska (2015: 308) stresses the importance of in-
dividualisation of the assessment model with the adopted key criteria.
The significance of the quality criteria varies depending on the setting
of SI – conferences, seminars, lectures or workshops. The quality stand-
ards related to SI must always be evaluated in relation to a particular type
of professional task. Therefore, quality should not be perceived ‘as an in-
trinsic feature but as a time-, context-, and culture-bound social construct
which is continuously (re)negotiated’ (Zwischenberger 2010: 128).

3. Course Limitations

Due to the limited time-span (6 semesters), the number of hours may seem
insufficient to fully grasp SI. No special post-course questionnaire has been
distributed to the students of the University of Silesia (English Department)
to assess their needs and their expectations related to such training. With
student feedback, other components could be introduced to the course in
the following academic years. The questionnaire is planned to be prepared
and distributed among all students at the end of their course as the compo-
nent of studies related to their expectations and satisfaction.

Conclusions

Simultaneous interpretation is considered the most challenging type of

interpreting. Furthermore, the field of medicine and its specialised ter-
minology may account for the insufficient number of medical interpret-
ers in the Polish market. Scepticism among students related to the falsely
perceived lack of transparency of medical terms might be overcome by
174 Arkadiusz Badziński

providing them with a clear and tailor-made course of interpreting that

covers medical terminology and essential strategies in SI. Such actions
could reduce students’ uncertainty related to the process of medical SI.
The course in medical interpreting at the University of Silesia is still in
progress. It should be further developed and modified to meet the needs
of the market as well as the needs of students. The increasing demand
for medical (simultaneous) interpreting is one of the reasons that may
encourage both students and teachers to conduct similar courses. The fact
that some of the students did become medical translators or interpreters
shows some promise for such courses. Special attention therefore should
be paid to student training in terms of medical background and strategies
ensuring successful interpreting.

References

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Barik, H. (1971). A Description of Various Types of Omissions, Additions and
Errors Encountered in Simultaneous Interpretation. Meta, 15(1), pp. 199–210.
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 Wioleta Karwacka
University of Gdańsk, Gdańsk, Poland

Medical Translation Training:

From a Translation Student
to a Medical Translation
Professional

Introduction

Medical translators need a broad range of skills to perform their task and
produce a quality target text. Prescriptive and descriptive texts on medi-
cal translation provide some insight into the expectations which medical
translators need to meet or, for that matter, what competences and tools
a medical translator or interpreter needs and is expected to have acquired
(O’Neil 1998; Reeves-Ellington 1998; Kassatkina 2005; Fischbach 2007;
IMIA 2009). These include a good command of terminology, good com-
mand of the source and the target language, possibly linguistic or medical
background*, and – finally – the ability to produce high quality, accurate
and understandable translation in which the target language is used in
a natural manner.
This paper presents a medical translation course outline which reflects
the generic diversity within the medical discourse and addresses the field-
specific problems. The course is also skills-oriented and consistent with
the PACTE** (2003; 2005; 2008) model of translator sub-competences.

* The dispute over the medical qualifications of medical translators is discussed in

several papers (e.g. O’Neil 1998) or in IMIA (2009) guidelines for translators.
** Procés d’Adquisició de la Competència Traductora i Avaluació.
178 Wioleta Karwacka

1. Medical Translator Competence

The range of competences which are desired in medical translation are,

in fact, wider and can be mapped onto the PACTE (2003; 2005; 2008)
model of translator sub-competences which covers the bilingual, extralin-
guistic, strategic and instrumental sub-competence, as well as knowledge
about translation and psycho-physiological components. Table 1 presents
a number of essential sub-competences in medical translation, such as
proficiency in specialised medical language in a given language pair, back-
ground medical knowledge, compliance with appropriate standards and
conventions, use of medical databases, repositories of texts, dictionaries,
CAT tools, skilfulness in applying translation procedures etc.

Table 1. Medical translator sub-competences based on the PACTE model of

translator sub-competences (PACTE 2003; 2005; 2008; Karwacka 2012)

Sub-competence Medical translation sub-

Description (PACTE)
(PACTE) competence
Bilingual procedural knowledge specialised medical language
sub-competence required to communicate (S/T), including terms,
in two languages acronyms; registers; doublets
of lay and professional terms;
controlled terminologies and
classification
Extra-linguistic declarative; general background medical
sub-competence world knowledge, knowledge, bicultural
domain-specific competence: culture-specific
knowledge, bicultural concepts relevant to medical
etc. translation
Knowledge about declarative knowledge of standards, conventions,
translation translation function and procedures relevant to
aspects of the profession medical translation
Instrumental procedural; use of use of medical databases,
sub-competence resources, information repositories of texts,
and communication dictionaries, CAT tools etc.
technologies
Medical Translation Training… 179

Sub-competence Medical translation sub-

Description (PACTE)
(PACTE) competence
Strategic procedural; ability to apply translation procedures
sub-competence identify translation appropriately
problems and apply
procedures to solve them
Psycho-physiological memory, perception, decision-making,
components attention, intellectual thoroughness, honesty,
curiosity, perseverance, punctuality etc.
rigour, creativity, logical
reasoning, analysis and
synthesis, etc.

Those expectations, however, do not seem to be reflected in the reality of

the medical translation market. The analysis of a corpus of 30 texts and their
translations revealed recurring problems in the following areas: incorrect
use of multiword terms, problems with adequate use of BME (basic medical
English) and FME (fundamental medical English) (cf. Salager-Meyer 1983),
problems in managing polysemy, inadequate use of EBM (evidence-based
medicine) language, insufficient readability (Karwacka 2016). Another
analysis was conducted with the use of keylogged translation (Translog)
and a retrospective interview with 15 participants. It indicated the following
problem areas: recognising multiword terms, BME and FME use, polysemy,
inadequately managing implied information in medical texts (Karwacka
2013). Similar observations are made by Walkiewicz and Kościałkowska-
Okońska, other contributors to this volume, who analyse medical files in
translation and Polish versions of PILs. That means that there is still room
for improvement in the area of medical translator training.
180 Wioleta Karwacka

2. Medical Translator Training

The medical translation training programme presented in this paper was

originally designed in 2008 (Karwacka 2012). The programme has been
evolving since to address the needs of translation students more adequate-
ly and to accurately reflect the reality of the medical translation market.
The programme was originally based on the generic diversity of medi-
cal translation discourse, which seems to be the most justified approach
(cf. Keresztes 2013). As students gained more expertise and confidence,
they progressed to more complex and more specialised texts. Conse-
quently, we started with texts designed for lay recipients and later worked
with texts written by medical professionals for medical professionals. The
programme is still genre-based – the introductory course covers the fol-
lowing texts: brochure, ICF, package insert, product characteristics, case
history, discharge summary, imaging reports and scientific articles. The
advanced course focuses on the expert–expert communication and – in
the revised version of the course – mastering medical terminology. One of
the new features of the course (introduced in 2016) is a glossary project,
in which students collaborate as a group to compile a bilingual glossary of
medical terms they encountered in translation assignments. The glossary
is developed and verified by the whole group and the course supervisor.
As a result, the students develop a tool they can use and expand later in
their individual careers as medical translators.
I have recently asked course participants for feedback and informa-
tion on the most challenging aspects of medical translation. The results
indicate that a large part of students (or graduates) find the following
tasks most useful: terminology exercises (66% respondents consider
them very useful) and tasks focusing on practicing isolated translation
problems (93% respondents consider them very useful) such as avoid-
ing calques. That is why the focus on those two aspects has been an
important factor in revising the course*. What is more, most respond-
* The respondents were asked to mark how useful they consider the following task
types (not useful, fairly useful, very useful): terminology exercises, translating texts
Medical Translation Training… 181

ents indicated that they struggle most with badly written and ambiguous
texts (60% of respondent indicated that such tasks are difficult or very
difficult) and with producing target texts which are both accurate and
natural in terms of target language use (40% of respondents indicated
that it is difficult or very difficult). That is why post-editing tasks are rec-
ommended in the course. They also indicated that terminology research
and finding reliable sources was challenging (40% of respondent indi-
cated that it is difficult or very difficult)*. The full revised programme is
presented in Table 2 with examples of tasks. The programme is genre-
based and skills-oriented, and it is consistent with the PACTE model of
translator sub-competences.

at home and discussing them in class, timed translation of short excerpts in class,
reviewing a peer’s translation, watching videos or presentations on medical facts,
practising how to solve specific translation problems, e.g. avoiding calques, enhanc-
ing readability.
* The respondents were asked to indicate how difficult they find the following as-
pects of medical translation on the scale from 1 (easy) to 5 (very difficult): dealing with
concepts and disciplines I do not know/understand, terminology research and finding
reliable sources, adjusting style and register to the conventions applicable to a given
text type, making sure that a text is translated accurately and sounds natural in the
target language, dealing with ambiguous and badly-written texts, managing to submit
assignments on time.
 Table 2. Medical translation training course outline
182

Description/
Stage Examples of tasks Focus on skills and sub-competences
Course contents
characteristics of group project: a report on the medical English – mastering basic
medical texts medical translation market – text terminology, affixation
types, problems, purpose and
purpose of medical function of translation in the medical knowing text types in medical translation
translation community
identifying valuable resources for
confidentiality in Greek and Latin prefixes, suffixes and information-mining and fact checking
medical translation roots – analysis and exercises
awareness of standards, norms and
introduction to medical medical terminology – exercises conventions in medical translation
language
analysis of translated texts: how do knowledge of medical translation

Introduction
translation strategies translators solve problems? What procedures and the field-specific jargon
could be improved? Are the text
translation tools translated accurately and do they adequate use of translation shifts,
sound natural in the target language? avoiding calque, avoiding unjustified and
unintended adaptation and paraphrase
pairwork/groupwork: translating
short excerpts of simple medical
texts, discussing possible solutions to
translation problems
Wioleta Karwacka
 Description/
Stage Examples of tasks Focus on skills and sub-competences
Course contents
patient information collecting a portfolio of sample mastering specialised and lay vocabulary
form, brochure consent forms
(informative texts for expectations in medical translation for
laypersons) discussion: recipient needs in the lay recipients
communication in healthcare settings
informed consent form expanding the students’ command of
Medical Translation Training…

(ICF) terminology exercises: practicing the registers in expert-lay communication

use of lay vs. professional terms (term
patient information doublets) information mining
leaflet (PIL)
translation of ICF excerpts coherence and cohesion

readability tests cultural concepts

pairwork: reviewing each other’s

translation for adapting texts to

Patient–medical professional communication

the recipient’s needs and the target
culture
183
 Description/
184

Stage Examples of tasks Focus on skills and sub-competences

Course contents
drug registration – comparison of English and Polish medical language – institutional
product characteristics PILs against product characteristics – terminology and jargon
and PIL critical analysis
text types and functions
medical files – discharge group project: research into drug
summary registration process – find out what intertextuality in medical translation
has to be done and what text types
imaging test reports need to be translated developing language skills: terminology
(systems approach, with particular
scientific papers translation of excerpts from focus on polysemic terms, anatomical
pharmaceutical/drug registration orientation, eponymy)
texts
grammatical shifts in translation
translating names of institutions
medical classifications and controlled
translating excerpts from discharge terminologies
summaries
information mining and fact-checking
pairwork: editing a partner’s
translation of a discharge summary using adequate strategies to produce
a publishable rendition of a research

Expert–expert communication in the medical community

translating excerpts from scientific paper
articles
focus on medical background knowledge
Wioleta Karwacka
 Description/
Stage Examples of tasks Focus on skills and sub-competences
Course contents
pairwork: editing a partner’s
translation of a scientific paper
quality management groupwork: find out what quality mastering medical language
in medical translation assurance models are applied in
(assurance, assessment, medical translation knowledge of norms and standards
verification, translation,
Medical Translation Training…

review, proofreading) groupwork: translation project instrumental sub-competence

simulation of a medical translation
project, where a project manager psychophisiological sub-competence
assigns roles and tasks:
–– translation

Quality management
–– review
–– proofreading
(consider backtranslation or parallel
translation)
185
186 Wioleta Karwacka

Examples of tasks

Task 1. Terminology, translating texts for lay recipients*

a) Fill in the gaps.

b) Translate the underlined fragments into Polish.
c) What are these diseases called in Polish?
–– multiple sclerosis
–– diabetes
–– rheumatoid arthritis
–– myasthenia gravis

_________ means protection from disease and especially infectious

disease. Cells and molecules involved in such protection constitute
the __________and the response to introduction of a foreign agent is
known as the___________. Not all immune responses protect from dis-
ease; some foreign agents, such as the ___________ found in house dust
___________, cat dander or grass __________, cause disease as a con-
sequence of inducing an immune response. Likewise some individuals
mount immune responses to their own tissues as if they were foreign
agents. Thus, the immune response can cause the ___________ diseases
common to man such as multiple sclerosis, diabetes, rheumatoid arthri-
tis or myasthenia gravis. Most individuals do not suffer from such dis-
eases because they have __________ ___________ towards their own
(self) tissues.

immune system pollen tolerance

immune response mite allergens
immunity autoimmune developed

* Adapted from: (CPA 2009).

Medical Translation Training… 187

Task 2. Terminology, translating texts for lay recipients*

a) Arrange the stages of the immune response in the correct order.

Some of the dead bacteria or their breakdown products are taken up

by the tissue resident dendritic cells. The combined action of bacte-
rial products and cytokines (from acute inflammation etc.) activate the
tissue dendritic cells. This causes them to migrate to the local lymph
node via lymph vessels.

You receive a cut.

Dendritic cells enter the node and display their ‘wares’. T cells enter the
node from the blood. Those which recognise the bacterial antigenic
peptides displayed on the dendritic cells stop, activate, divide and dif-
ferentiate; some later become memory T cells.

Bacteria enter the wound. Many are destroyed rapidly by complement

and the phagocytes recruited through acute inflammation (innate im-
munity).

b) Translate the final text into Polish.

Task 3. Terminology, translating texts for expert recipients**

a) Look at these two texts. What is their type and function?

b) Can you find pairs of equivalents in text A and B?
c) Translate text A into Polish.
d) Translate text B into English.

* Adapted from: (MLT 2008).

** Adapted from: (WP abcZdrowie).
188 Wioleta Karwacka

Source Text A EN (sample)

The left upper lobe 1.3 centimetre lung mass is moderately hypermetabol-
ic with SUV value of 4.4. Malignant by PET criteria. There are 2 to 3 pre-
vascular lymph nodes, which show increased fluorodeoxyglucose uptake.
The larger pre-vascular lymph node does not show increased fluorode-
oxyglucose uptake. There is no suggestion of left hilar adenopathy. Neck,
abdomen and pelvis show physiologic fluorodeoxyglucose metabolism.
The left kidney is atrophic. There are a few right renal cysts. Osseous up-
take is unremarkable.

Source Text B PL (sample)

Fizjologiczny, symetryczny wychwyt 18F-FDG w korze mózgowej. KLAT-
KA PIERSIOWA: Fizjologiczny wychwyt 18F-FDG. Węzły chłonne nie-
powiększone, nieaktywne metabolicznie. Płuca wolne od zmian ognisko-
wych. JAMA BRZUSZNA: Fizjologiczny wychwyt 18F-FDG. Śledziona
niepowiększona o wym. 109x52 mm bez ognisk wzmożonego wychwytu
18F-FDG. Pojedyncze węzły chłonne po lewej stronie aorty brzusznej po-
niżej naczyń nerkowych o wym. do 12 mm bez wychwytu 18F-FDG.

Useful resources

Medical Translation Step by Step. Learning by Drafting – a coursebook by Vicent

Montalt Resurrecció and Maria Gonzáles Davies.
Medical Terminology: Language for Healthcare – a coursebook by Nina Thierer,
Deborah Nelson, Judy K. Ward and La Tanya Young.
Medical Terminology: A Body Systems Approach – a coursebook by Barbara
A. Gylys and Mary Ellen Wedding.
European Medicines Agency website: https://www.ema.europa.eu/.
SNOMED International’s SNOMED CT browser: http://browser.ihtsdotools.org.
ICD browser: http://apps.who.int/classifications/icd10/browse/2016/en.
ICNP browser: http://www.old.icn.ch/what-we-do/ICNP-Browser/.
Human Anatomy and Disease in Interactive 3D: https://human.biodigital.com/.
Medical Translation Training… 189

Conclusions

Medical translation is undoubtedly a diverse and complex field of transla-

tion. Thanks to increasing interest in medical translator competence and
training, the task of preparing non-medical students to manage medical
texts is feasible. The medical translation genre-based and skills-oriented
course presented in this paper is designed to gradually introduce transla-
tion students into the field of medical translation. The first stage of the
course involves dealing with texts written by medical professionals for pa-
tients – lay recipients. Since non-medical students also belong to that cat-
egory, this stage has a few aims, including offering basic elements of medi-
cal translation and medical language and preparing students to gradually
gain expertise in the field as they progress through the course. The next
stage involves translating texts written by medical professionals for medi-
cal professionals: a variety of text types which pose a variety of translation
problems. Finally, the last stage is in fact a brief introduction to quality
assurance in medical translation. This approach seems to be an efficient
pathway to gaining expertise in medical translation.

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 Abstracts

Various Aspects of Medical English Terminology

Božena Džuganová
Terminology is a linguistic discipline which studies, analyses and describes a spe-
cialised area of the lexicon. Medical terminology is one of the oldest specialised
terminologies in the world. As it is closely connected with the global spread of
science and technology, it is very wide. The language of medicine thus offers re-
markable challenges to medical historians, linguists, translators and interpreters.
In medical terminology two completely different phenomena can generally be
observed: (1) a precisely worked-out and internationally standardised anatomi-
cal nomenclature and (2) a quickly developing non-standardised terminology
of individual clinical branches, characterised by a certain terminological chaos.
The internationally standardised medical terminology has transformed into a vast
number of national terminologies. Each national terminology is fully dependent
on Greek-Latin terminology. In our paper we will briefly analyse English medical
terms and consider their historical, etymological, semantic, morphological, and
didactic aspects.

Keywords: English medical terminology, etymology, morphology, synonymy,

polysemy

Terminology Mapping: CSIOZ Recommendation, ICNP® and SNOMED CT

Barbara Librowska, Paulina Szydłowska-Pawlak,
Małgorzata Greber, Dorota Kilańska
The aim of the project was to map the nursing history card included in the Rec-
ommendation of the Council for e-Health in Nursing at the Centre for Health-
care Information Systems on the International Classification of Nursing Practice
192 Abstracts

ICNP® reference terminology. Our aim was to implement the ICNP® version as
the standard of electronic health records.

Keywords: ICNP®, SNOMED, terminology mapping, nursing terminology

Collocations, Equivalence and Untranslatability

as Selected Critical Aspects in Medical Translation
Arkadiusz Badziński
Medical translation requires not only familiarity with medical language but also
a thorough knowledge of the source and target texts, which are the initial prereq-
uisites. Other critical aspects are also involved, of which collocations, equivalence
and untranslatability form a triad that is of great importance and significantly af-
fects the quality of the translation process of specialised medical texts. The notion
of collocations is a universal linguistic phenomenon – no language is devoid of
collocations which are an outstanding feature of any (specialised) language and
should thus be of particular interest to translators. The aim of the paper is to dis-
cuss the above concepts bearing in mind that poor translation not only distorts
the comprehension of medical aspects but also prevents further dissemination of
medical knowledge.

Keywords: collocations, equivalence, untranslatability, medical translation

Translation of Medical Texts from Discourse Perspective

Barbara Walkiewicz
The aim of this paper is to present medical text translation from the discourse
perspective. An analysis was performed on four French translations of a hospi-
tal discharge summary from the point of view of strategies and techniques used
by translators so as to extend the relationship between the first-level speaker and
addressee to the second-level addressee, while preserving both the first-level
discourse functions (informative) and second-level discourse functions (repre-
sentational and communicative). The results of the analyses show little aware-
ness of discourse implications of translation, which led to the interpretations
and translations of texts that could be characterissed as flat, devoid of aware-
ness of the role that particular verbal structures play in the three dimensions of
the subject-situational context. Most of the translates did not achieve analogous
Abstracts 193

relationships between first- and second-level subjects. Neither was the object
of the discourse, verbalised at the internal-circuit level, rendered according to
the scenario designed for target medical communication. The authors of the
translations demonstrated low discourse competence, which produced unjusti-
fied traces of interventions of the translator as the second-level communicating
subject, which led to imitation of surface features of the first-level internal cir-
cuit, and, consequently, to a serious deficiency of communicative efficacy in the
second-level circuit.

Keywords: discourse, translation, medical texts, hospital discharge summary

Relevance of Formal and Cultural Variations in Text Genres

for Medical Translation: Medical Brochures, Web Pages of Hospitals,
Patient Information Leaflets and Informed Consents
Goretti Faya-Ornia
Text genres present fixed features (particularly in the medical environment)
which make the target readers recognise and identify that particular genre. These
features may, however, vary among cultures. Translators should know the features
of the text genres they have to translate and be aware of the variations of that genre
in the cultures involved, so that their target texts can comply with target readers’
expectations. This work briefly comments on the variations occurring in differ-
ent medical text genres: medical brochures, web pages of hospitals, patient infor-
mation leaflets and informed consents. The contrastive analyses are performed
mainly between the British and the Spanish culture and language, as these are the
author’s working languages. However, in the case of medical brochures and web
pages of hospitals, the cultures of America and Germany are also briefly com-
mented on.

Keywords: formal variations, cultural variations, variations in text genres, changes

in text genres, medical translation, medical brochures, web pages of hospitals, pa-
tient information leaflets, informed consents, contrastive analysis
194 Abstracts

Translating Patient Information Leaflets:

Expectations of Users and the Reality
Ewa Kościałkowska-Okońska
The primary purpose of the language of medical texts is communication, both at
the scientific (doctor–specialist or expert–expert communication) and universal
level (e.g. doctor–patient communication). Due to the diversity of texts and vari-
ous groups of end-users, the translator of medical texts has to find an effective way
to communicate with text receivers, to consider their needs, requirements and
expectations. The purpose of this article is to analyse the language used in me-
dicinal information materials (Patient Information Leaflets) targeted at patients,
with special emphasis placed on the differences that result from the needs and
expectations of the users.

Keywords: text communication, medical language, translation of medical texts,

translator, users

Teaching Medical Simultaneous Interpreting: From Theory to Practice

Arkadiusz Badziński
Medicine is developing at an enormous pace, which entails the need for transla-
tion and interpretation of the most recent discoveries in this field. Consequently,
medical simultaneous interpreting is used at conferences, meetings or workshops
and is often conducted by interpreters who are not physicians by profession.
Therefore, in order to provide top quality interpreting, students from transla-
tion departments should be properly educated. The aim of the paper is to present
a system of student training with attention paid to simultaneous interpreting and
medical nomenclature to meet the demand of the market in the ever-changing
medical settings. The role of the teacher and the quality criteria are also discussed
in the process of teaching medical simultaneous interpreting. The proposed sys-
tem includes theoretical background and practical issues. It also shows some im-
plications for further studies on the education of medical interpreters.

Keywords: medical simultaneous interpreting, teaching simultaneous interpret-

ing, student interpreting training
Abstracts 195

Medical Translation Training: From a Translation Student

to a Medical Translation Professional
Wioleta Karwacka
The medical translation genre-based and skills-oriented course presented in this
paper is designed to gradually introduce translation students into the field of
medical translation. The first stage of the course involves dealing with texts writ-
ten by medical professionals for patients – lay recipients. Since non-medical stu-
dents also belong to that category, this stage has a few aims, including offering ba-
sic elements of medical translation and medical language and preparing students
to gradually gain expertise in the field as they progress through the course. The
next stage involves translating texts written by medical professionals for medi-
cal professionals: a variety of text types which pose a variety of translation prob-
lems. Finally, the last stage is a brief introduction to quality assurance in medical
translation. This approach seems to be an efficient pathway to gaining expertise
in medical translation.

Keywords: medical translation, medical translator, medical translator compe-

tence, medical translator training
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