Do you trust your pharmacy computer to accurately translate label directions from English to Spanish for your Spanish-speaking customers?

Here’s a common scenario: Say a doctor’s prescription for a Spanish-speaking patient has a standard abbreviation that doctors use for all of their patients. Say the doctor indicates on the prescription, “1 tab tid.” This means “1 tablet three times a day.” Most pharmacy computers are programmed to recognize Latin abbreviations like “tid.” So, for example, in this case, the pharmacist might enter the following into the computer: “T 1 T TID.” The computer will translate this to “Take 1 tablet three times a day” when it prints on the customer’s label. 

Many pharmacists routinely instruct the computer to translate the directions to Spanish for our Spanish-speaking customers, thinking we’re helping those customers. But, according to an article on HealthDay.com, this translation can be unclear, resulting in a hazardous situation. For simple directions like “Take one tablet three times a day,” the pharmacy computer probably does a pretty good job in translating this to Spanish. But, in a very large number of cases, the doctor’s directions are not so simple and straightforward, resulting in confusing translations.

I was never a big fan of the computer’s translation skills when translating from Latin or English to Spanish. I never felt comfortable dispensing a prescription for which I had no idea whether the directions on the label were clear to our customers, or worse, inaccurate. So I think I never translated a doctor’s directions from Latin or English to Spanish, even for the simplest directions like “Take one tablet 3 times a day.” My hope was that these Spanish-speaking customers would show the label to a bilingual person who could read English directions and translate those directions to Spanish.

From the HealthDay News article (D. Thompson, “Prescriptions Translated to Spanish Could Be Hazardous to Health: Computer Translation Programs Give Confusing, Incomplete Instructions, Study Finds,” HealthDay.com, April 8, 2010:

Many Spanish-speaking people in the United States receive prescription instructions from the pharmacy so poorly translated that the medications are potentially hazardous to their health, a new study shows.

The errors occur largely because of deficiencies in computer programs that most pharmacies rely on to translate medication information from English to Spanish, said lead researcher Dr. Iman Sharif, chief of the division of general pediatrics at the Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del.

“The technologies that are currently available to produce instructions in the patient’s language are inadequate,” Sharif said.

Half of the Spanish-language prescription labels reviewed for the study contained errors, and some of those errors could result in life-threatening situations if misinterpreted by the patient, Sharif said.

The study is published in the May [2010] issue of Pediatrics.

Of the New York City pharmacies surveyed that provide Spanish-language labels, more than four of every five used a computer program to translate their labels from English to Spanish. Nearly all the pharmacies said they had someone double-check the labels for errors, but researchers found dozens of examples of poorly translated instructions.

A common problem was “Spanglish,” Sharif said. The programs produced a mix of English and Spanish on the labels, creating confusing and difficult-to-read instructions.

The use of “Spanglish” also created some potentially dangerous situations. For example, the word “once” means “eleven” in Spanish. “You mean to say ‘once,’ as in ‘take once a day,’ and a Spanish-speaking person could interpret that to mean ‘eleven,’” Sharif said. Such a mistake could result in an overdose.

Other phrases that weren’t accurately translated include “dropperfuls,” “apply topically,” “for seven days,” “for 30 days,” “apply to affected areas,” “with juice” and “take with food.”

Misspellings also created errors. Incorrect use of the word “poca” for the word “boca” meant patients were told “by the little” instead of “by the mouth.” One set of instructions included “dos besos,” which means “two kisses”; the intended instructions likely were “dos veces,” which means “two times.”

Poor translations specifically cited in the study included:

• “Take 1.2 aldia give dropperfuls with juice eleven to day.”
• “Taking 0.6 mL 2 times to the day by the little with juice.”
• “Apply to affected area twice to the indicated day like.”

Dr. David Flockhart, director of the division of clinical pharmacology at the Indiana University School of Medicine in Indianapolis, said it’s not surprising that these computer-generated errors are occurring.

 “Word-for-word, you probably could get it right, but you can’t get the entire sense of what’s being communicated through a computer program,” Flockhart said.