Lost in translation. Homer in English; the patient's story in medicine

Abstract

In a series of previous articles, we have considered how we might reconceptualise central themes in medicine and medical education through 'thinking with Homer'. This has involved using textual approaches, scenes and characters from the Iliad and Odyssey for rethinking what is a 'communication skill', and what do we mean by 'empathy' in medical practice; in what sense is medical practice formulaic, like a Homeric 'song'; and what is lyrical about medical practice. Our approach is not to historicise medicine and medical education, but to use thinking with Homer as a medium and metaphor for questioning the habitual and the taken-for-granted in contemporary practice.In this article, we tackle the complex theme of 'translation'. We use the lens of translation studies to examine the process of turning the patient's story into medical language. We address the questions: what makes a 'good' translation? What are the consequences of mistranslation and poor translation? And, while things are inevitably lost in translation, does this matter?'Translation it is that openeth the window, to let in the light' ( preface to King James Bible). INTRODUCTIONIn a series of articles, [1][2][3][4] we have considered how we might reconceptualise central themes in medicine and medical education through 'thinking with Homer'. This has involved using textual approaches, scenes and characters from the Iliad and Odyssey for rethinking what is a 'communication skill' 1 and what we mean by 'empathy' 2 in medical practice; in what sense is medical practice formulaic, like a Homeric 'song'3 ; and what is lyrical about medical practice 4 ? Our approach is not to historicise medicine and medical education, but to use thinking with Homer as a medium and metaphor for questioning the habitual and the taken-for-granted in contemporary practice.In this article, we tackle the complex theme of 'translation'. We use the lens of translation studies to examine the process of turning the patient's story into medical language. We address the questions: what makes a 'good' translation? What are the consequences of mistranslation and poor translation? And, while things are inevitably lost in translation, does this matter? RECEIVING A HISTORY'Taking a history' is the process of rephrasing the story a patient tells into specialist medical language. Our students at Peninsula College of Medicine and Dentistry, UK, were encouraged not to 'take' a history, but to 'receive' it, a change designed to emphasise the importance of listening, of giving the patient a voice. However, intervention at this first level of translation is often lost at a second level, when the history is converted into a written, permanent record. Here, the patient's voice is usually lost in translation.'Taking' a history can have serious unintended consequences. It is an old saw in medicine that most of the diagnosis can be found in the patient's story. William Osler's most famous saying was 'listen to your patient, he is telling you the diagnosis'. Yet, between 10% and 15% of patients s...

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“…Accurate and comprehensive history‐taking is essential in order to gather sufficient information in order to formulate a diagnosis and treatment plan . The medical consultation has been described as “a transaction that involves translation,” and further that “the physician's concern is to translate the subjective experience of illness into the recognizable discourse of medicine.” It has also been suggested that we should not be “taking” a history but “receiving it.” Inaccurate or inappropriate “translation” can lead to inaccuracy of diagnosis and impair the therapeutic relationship.…”

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