www.Medtipster.com Source: Chicago Tribune, 5.12.2010 – Whitney Woodward, Alejandra Cancino and Julie Deardorff
Martha Jimenez was worried when the antibiotic she was giving her 8-year-old daughter, Linda, ran out a day early.
“I got scared,” said Jimenez, who usually sees a doctor who speaks Spanish but made an emergency appointment because her daughter had a fever and bad nosebleeds. Jimenez left the doctor’s office without really understanding how to administer the medicine, and relied on the directions the pharmacist attached. But they were confusing, and Jimenez couldn’t figure out the dosage, so she guessed.
A study released recently suggests that similar miscommunications are not uncommon. Pharmacies that print prescription labels translated into Spanish often issue inaccurate or confusing instructions that could be potentially hazardous to a patient’s health, according to a report in the May issue of Pediatrics journal.
Researchers looked at 76 medicine labels generated by 13 different computer programs that many pharmacies use to make translations and found an overall error rate of 50 percent.
“It’s not surprising, and it’s something I experience in practice every day,” said Dr. Alejandro Clavier, who works at Esperanza Health Center in Chicago’s Little Village neighborhood on the Southwest Side.
He gave an example of an anemic patient who showed no signs of improved iron levels after taking prescribed supplements. Clavier discovered the patient had been taking only one drop of the supplements instead of the amount that Clavier had prescribed. The patient had received confusing prescription instructions from the pharmacy.
Prescription information delivered in “Spanglish,” a mix of English and Spanish, is a frequent problem, according to the study. For example, instructions to take iron “once” a day would mean one time. But in Spanish, once means 11. It could be harmful for a patient to take 11 doses of iron a day, the study noted.
Misspellings also created errors. The study found that instead of the word boca, which means “mouth” in Spanish, poca, which means “little,” was used.
Other words and phrases — including “dropperfuls,” “take with food,” “apply topically,” “for 7 days” and “apply to affected areas” — were not translated into Spanish at all.
“It’s scary how high the error rate is,” said lead author Dr. Iman Sharif, chief of the division of general pediatrics at the Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del. “If we can’t do this right in Spanish — the most commonly spoken non-English language in the U.S. — I’m afraid to think what happens with the other languages.”
Sharif’s report, which surveyed pharmacies in the Bronx, N.Y., goes hand-in-hand with the findings of a study last year from Northwestern University’s Feinberg School of Medicine. According to that study, many pharmacies in four states with large or rapidly growing Latino populations cannot provide prescription translations. That 2009 study also found that almost 35 percent of pharmacies surveyed did not offer translation services, and about 22 percent offered only limited translation services.
“It’s not that pharmacists are horrible people, it’s just that if they don’t speak the language … they don’t want to guess,” said Stacy Cooper Bailey, a clinical research associate at the Feinberg School of Medicine who was the lead researcher of the study. “They can’t do any spot checks for accuracy, so you can understand why there’d be some hesitancy there to do translations.”
During her research, one pharmacy employee said he would “run to the Mexican restaurant down the street” if a translation was needed, Bailey said. Others employed pharmacy staff members who had taken Spanish in high school, Bailey said.
The Alivio Medical Center in Chicago’s Pilsen neighborhood provides its 21,000 patients — the majority of whom speak Spanish — with services in Spanish and English. The center’s executive director, Carmen Velasquez, said using computers to translate important medical information is an inappropriate substitute for a human being.
“It’s health care. If you have the responsibility of human life, you better well know what you are doing and saying,” Velasquez said.
Sharif, the study’s author, said that one of the biggest problems is that English prescription instructions aren’t standardized. Because the same instructions can be written in multiple ways, the available databases can’t translate every word that doctors use to write prescription instructions, she said.
That’s why doctors and pharmacists must go over the instructions with patients and explain what they need to do, regardless of what language they speak, Sharif said.
That’s what Akil Ghoghawala does. The pharmacist manager of Bienestar Pharmacy, which operates inside the Alivio Medical Center, speaks five languages, including Spanish, and says he makes it a point to orally explain to patients how to take medications.
“It doesn’t only apply to someone who has a language barrier — it applies to everybody,” he said. But he has seen some bad translations, including ones that are verbatim. That leads to mistakes, he said.
“I override (the program), each and every time,” Ghoghawala said, adding that it is not a new problem.
Jimenez, 35, is thankful there was no serious injury to her daughter, but she still is not sure what went wrong. Back at Esperanza Health Center recently — this time for her 16-year-old son, Erick, who had a bad cough — she said she’ll make sure she understands the directions before she leaves the doctor’s office.
“If I don’t understand, I look for someone who speaks Spanish,” she said, or have her 14-year-old daughter translate.