Lost in Translation: A Prescription for Disaster

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Picture Source: AARP

Every person who reads this likely speaks English, and speaks it well. However California is home to 100 languages including 6 million who have limited English proficiency, have difficulty negotiating everyday life.

“Take Ms. Z, The directions on the bottle of blood-sugar pills read: Take once a day But to Ms. Z who speaks Spanish she interprets the prescription as Take 11 a day”

She takes eleven pills and is rushed to the hospital with severely low blood sugar. Medical misadventures like these occur far too often in California.
In a report published by the California Senate it is estimated that more than 150,000 preventable medication errors occur every year costing California 17 billion dollars in health care costs. The report found that labeling was the main reason for medication errors in the out-patient setting. For those taking multiple medications the risk of medication error is even greater. To take medications safely, patients need to understand the prescription label: the patient name, the name of the drug, and the dosage.
Providing instructions on Prescription Labels in other Languages is Easy to Do

The California Board of Pharmacy will translate and post directions for medication use into the most common non-English languages for down-load and use by pharmacies.

California must make it a requirement that prescription labels be made available in non-English for patients with limited English-proficiency. Click here to support that prescription labels be translated into languages other than English. All Californians have the right to  understand their prescription medication labels

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5 Responses to “Lost in Translation: A Prescription for Disaster”

  1. vgundareddy Says:

    As a physician I can totally relate to this problem. I am sure this is the case all over United States not only in California. The question then arises is it the language barrier or is it inability to read any language ( which I often encounter with my patients). A policy that will make it mandatory for the pharmacy to know the patient’s ability to comprehend what is written ( in any language ) if illiterate graphics can be used would be a great help. Though the resistance might come from local pharmacies that need to invest in soft ware that can do typing in various languages and possibly graphics. If the policy can provide for funding to these pharmacies to upgrade their machines it would be a win win for all. However with the current economic situation the California state is in I do not think the government will provide funds to the pharmacy.

  2. ymc0214 Says:

    I absolutely agree this is a critical matter as I have also personally seen patients dangerously overdosing themselves unintentionally. Such cases also happened in patients with no language barriers however, and sometimes written instruction alone is not enough. This then requires physicians, pharmacists or assistants to explain verbally to the patient how to take the medicines. This is not always feasible as there are numerous languages spoken throughout the U.S. I agree that instructions written in the patient’s native language will be effective, and it would be worth investing for, but the benefit will also be maximised if there is an interpreter present also to explain verbally (interpreter can be present either physically or over telephone). Such intervention of course needs funding from health division within the state government.

  3. hacowie Says:

    What a great blog. I am wondering if prescribing lower amounts of medication at one time would help to alleviate the dangers of overdosing- in other words Rx medications for one week or having medications packaged in per day bubble packs to help with clarification. It can be really difficult especially if a patient is isolated and does not have access to translation assistance. Is this an issue across most states in the US? or particularly California?

  4. likobayashi Says:

    I like the suggestions of vgundareddy and ymc0214 re: different ways to make this information available to patients, although also acknowledge the difficulty that such initiatives/actions would run into (mainly funding, and of course staff time). I think that as you mentioned, underlying the overdose is simple misunderstanding of the instructions, but also possibly misunderstanding the use or reason for taking the drugs. I’ve seen cases where the physician I work for prescribes fewer pills with one prescription (similar to hacowie’s suggestion of prescribing lower amounts at a time) to monitor whether the patient is getting their refills and therefore taking their medications correctly, but ideally we could assess that just by speaking with the patient, rather than depending on finding out a month later, or maybe not even ever knowing. Overall, I don’t think that translating the medication instructions into different languages would solve ALL problems with proper medication usage, but it would definitely help and if it could be passed, it would be one additional way to help people take their medications correctly. Thanks for the post!

  5. boylemc Says:

    Very important topic with implications for both patient care and health economics. In this age of technology I should imagine that an IPad application would be relatively straightforward to develop and use which would provide a visual reminder of their medication regime regarding indication, frequency, dosage and potential side effects of their medication. Generic drug prescribing may also be of benefit – drugs being marketed under a variety of brand names can only serve to confuse, even for patients and healthcare workers speaking English as their first language.

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