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Updated 10:00 AM February 19, 2007
 

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Quality of medical translations impacts quality of care

An increasing number of Americans don't speak English, and when doctors and patients have language and cultural barriers, the quality of translations can be a problem, U-M researchers write in the Journal of Health Care for the Poor and Underserved.

Dr. Michael Fetters, associate professor of family medicine, and Daniela Garcia-Castillo, a biology student in the Undergraduate Research Opportunity Program, systematically reviewed and analyzed resources, translating clinical and medical research documents, and concluded that attention to translation procedures can improve the quality of care for limited English-proficient patients.

"Medical translation is a complex process involving more than mechanically converting one language to another," Fetters says. "Without quality translations of medical documents in the language of their patients, clinical providers cannot provide best quality care, and patients are at risk for receiving inferior care"

While many recent studies have attended to problems in medical settings with oral interpretation—the conversion of one language into the spoken language of another—the U-M research focused on accurately translating written materials from one language into an equivalent written form in another language.

The researchers note that:

• As many as 45 million U.S. adults are functionally illiterate, meaning they cannot perform basic reading tasks required to function in society, while another 50 million Americans are marginally literate;

• Limited English-proficiency individuals are at special risk. Research of predominantly indigent minorities found 35.1 percent of English-speaking and 67.1 percent of Spanish-speaking patients had inadequate or marginal health literacy. The same research found health illiteracy even worse among adults 60 and over: 81.3 percent for English-speaking and 82.6 percent for Spanish-speaking patients;

• Consent forms often are difficult to understand for some patients as the average U.S. reading level is now an eighth-grade level for most adults and a fifth-grade level for most Medicaid enrollees; and

• The Civil Rights Act of 1964 mandates that hospitals provide oral interpretation but not medical translation.

"An area receiving little attention has been the accuracy of translation of medical materials," Garcia-Castillo says. "Translation errors can have critical clinical consequences for patient-provider misunderstandings through delays in diagnosis or treatment, and unnecessary testing or hospitalization. Errors in research documents can cause inaccurate comparisons and conclusions."

A way to improve the quality of translation, the researchers say, is to test instruments before using them for actual data collection to get a better idea of how they convey the intended ideas. Other options include: training designed for developing and understanding both the subject matter and language, and making medical Spanish—the most common language besides English in the United States—part of the curriculum at more medical schools.

"Theoretically, better translation of documents could decrease hospital costs by reducing hospitalization duration and possibly the ordering of fewer diagnostic tests," Fetters says. "Generally, there is a sense, but no data confirming, that investing in accurate translation has long-term benefits that justify costs of well-trained translators and accurate translations."

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