The American Translators Association, as part of its Webinar Series and in collaboration with the Spanish Language Division, offered the webinar Back Translation: A Specialized Market for Spanish to English Medical Translators presented by Danielle Maxson on May 18, 2021. The following are answers to questions left pending during the live presentation.

If you missed this very engaging and informative webinar, it is available on-demand HERE for ATA members and non-members.


First of all, thank you to all who attended this webinar. I was thrilled to see so many people interested in this type of translation service and gratified by your interest, participation, and thoughtful questions. Here are my answers to the questions we didn’t have time to address live. Some questions have been edited slightly to explain the context in which they were asked. If you have another question that isn’t answered here, please check my bio below for my contact information.

1. The steps of the process are: translation into Spanish, back translation into English, and reconciliation with the source text. So the reconciliation process is done in English about the Spanish version?

Back translation can be done with any language pair, but in the context we discussed, yes. These back translations compare two English texts in order to evaluate a translation into Spanish.

2. The semicolons [in a slide showing an excerpt from a reconciliation file] were not corrected to put commas. Why?

They should be, yes. I used this example simply to show you what a reconciliation query can look like. If we had done a workshop instead of a webinar, we would have gone over the specific queries and practiced addressing them. That would include providing an updated back translation with errors fixed or commentary added, as appropriate.

3. One of your examples was the phrase “comprender por qué consideró que este medicamento era correcto para ella.” Could you please repeat the explanation? What is the point here? 

One of the issues to keep in mind during back translation is that problems with meaning may arise from either inclusion or exclusion of subject pronouns. In this case, I received a checklist of actions to be taken. The list included this Spanish phrase. If the last two words had been omitted, I would have to make a choice about how to deal with the lack of a subject pronoun in the Spanish. I would probably use gender-neutral language and include a note, as described for the next question. Since the Spanish included a subject pronoun here, I was able to translate “for her” with confidence. What I didn’t realize was that this correct translation would still be flagged during reconciliation because the original text said “Understand why they thought this medication was right for them.” The into-Spanish translator struggled with the gender-neutral language in the English source and chose a gendered pronoun. In that case, the process worked as it’s supposed to: it highlighted an error that may have gone unnoticed otherwise.

4. How do you deal with gender in back translation, especially considering that English is generally inching toward gender-neutral writing?

Deciding whether to use gender-neutral language is definitely a tricky issue in all types of translation. In back translation, I tend to rely on two strategies: sticking as closely as possible to the Spanish text, and over-communicating with the client. If the Spanish text is gendered, I reflect that in the back translation. Maybe the English source really did use gendered pronouns, or maybe the Spanish translator wasn’t sure how to handle the gender-neutral construction and fell back on gendered language. Either way, the reviewer needs to know that the Spanish text is not gender-neutral.

If the Spanish allows for a neutral translation into English, I tend to use it, but I add a comment for the reviewer to let them know that I made this choice consciously, especially if the Spanish can be translated in more than one way. If it’s possible to get guidance from the client before you begin the back translation, that’s also a good idea. Some clients do have preferences and instructions for how to execute the back translation, so they may just tell you upfront to use singular “they”, for example.

Ultimately, the reviewer is the one who is going to decide whether there is an issue with the translation. I try to provide as much information as possible so they can make an informed decision, and with gender issues, that sometimes means I need to provide some lengthy commentary during the reconciliation phase. But I try not to insist on using either gendered or non-gendered language in the BT. In a “normal” translation I may, but if the Spanish is gendered and the source text wasn’t, I’ll probably say that I can update the back translation when the Spanish is changed. If I’m asked to adapt the BT for gender after I see all three versions together, and if the Spanish version fits what the client wants, I go ahead and make the changes.

5. In a regular translation would you use [ ] to indicate that there was a typo (e.g. source: pro / target: [pero]), or simply mention it when you deliver the translation? I’ve seen it done both ways.

In a regular translation, I’ve also seen it done both ways, and I normally follow the client’s preferences for dealing with source text errors. In a back translation, however, I follow the “Don’t Fix Anything” rule. Most of the time I reflect the error in the translation (some clients may want exceptions made for minor issues like punctuation or typos that don’t affect meaning), and I will often add a comment, especially if the error leads to strange wording, like “Choose Patient Information” instead of “Selected Patient Information.” The comment may help the reviewer make decisions, and as one person mentioned, it also helps to prove that the error wasn’t mine.

6. Do you see that Spanish shows more of a “noun” format and English more of a “verbal” format in sentences?

I think this question was about the examples that showed parts of speech may not match in English and Spanish, even if the back translation looks correct (e.g., “Plan” is obviously a noun in Spanish but may sometimes be read as either a noun or an imperative verb in English). I’m not sure that I could make that generalization without further thought, but a couple of things occur to me: greater use of the passive voice in Spanish sentences could make a literal translation into English look more noun-focused; and for lists or section headers like this example, the focus in either language will likely reflect the writer’s objective. If the writer wants to detail the actions a reader should take, for example, the list items or section titles will likely have a “verbal” focus. A list of characteristics or a description of possible side effects would probably make greater use of nouns and adjectives in both languages. But please get in touch with me if you asked this question; I’d love to hear your ideas!

7. There may be mistranslations that may not be caught in the back-translation process. For example:
Source: vital signs – ES: señales vitales – Back-Translation: vital signs. However, in Spanish, the correct term in Spanish is “signos vitales”, therefore, it may have been better to back-translate this as “vital signals” to convey the issue with the way “vital signs” was originally translated. What do you think about these situations?

I think that you’re correct and this should have been translated differently. The example that included the term “señales vitales” came from an article on back translation. I made the mistake of assuming that the authors pointed out all errors in the sample back translations they included. This term was translated incorrectly into Spanish, and “vital signals” would be a good way to show this in the English back translation. Incidentally, this is also a good illustration of why we should not charge less for back translation than we do for other translation work. Catching errors in the Spanish text might mean reading more slowly and carefully, as well as doing more research, which means a back translation could take more time than a normal job. Charging less for more detailed and time-consuming work is, of course, a bad idea.

8. Who corrects the errors introduced by the back translator?

This would be the back translator’s responsibility, in my experience. Generally, if the back translator introduces an error into their work, the reviewer will pick up on it when comparing the three texts and will query the translators. The back translator would simply respond with “Yes, this is my mistake” and provide a corrected version of the text.

9. Does this kind of work usually come from direct clients or is it common for it to come from agencies?

It’s available in both places! I work almost exclusively for agencies, but a colleague I know who works in back translation used to work directly for an IRB (Institutional Review Board), and others probably work for a mix of clients.

10. I’ve done a few back translations without being told it was back translations. Is this common?

I don’t know how common it is, but at best it’s not useful to the client. If you don’t know you’re doing a back translation, you’re likely to smooth out errors and adjust the language to create a more natural-sounding text. Both practices defeat the purpose of the back translation job. If the client needs back translation for legal or regulatory reasons, the client needs to tell you so you do point out any errors. If the client has other reasons for requesting this process and doesn’t tell you what you’re doing, then they’re wasting their own money by buying a translation that doesn’t serve the purpose they want it to serve.

11. I found the original source on the Internet. What should I do? So far I’ve just used these to make synonyms homogeneous and did what you said [not refer to the English source while translating]. Is this okay?

It’s tempting to use the source to make sure the correct synonyms are used because that will make the reconciliation process more efficient. On the other hand, I would be worried that seeing the English source would influence my understanding of the Spanish, albeit subconsciously. Since we’re not supposed to have any access at all to the source, I would suggest making a note of the URL where you found the English text, avoiding that website while translating, and alerting the client that you ran across it and stopped reading it as soon as you determined that it was the same text. I would also give the client the URL where the source was found.

12. If the translation depends on culture or context, how do you achieve reconciliation?

I think this question refers to an example sentence that used the term “droga” instead of “medicamento” or “medicina” and included other errors. I said during the question and answer portion of the webinar that at some point we need to trust the expertise of the into-Spanish translator and not raise questions about their choices without good cause. Several people, however, rightly pointed out that use of this term in particular could provide good cause for raising a question. Knowing when to question the translation is certainly easier if you know the target audience for the Spanish text. It’s advisable to get that information whenever you can. If you do have a reason to question the translation, try to include the question in comments that are delivered with your back translation. The reviewer can then send that query to the into-Spanish translator with the other reconciliation queries. Again, the reviewer will make the final decision based on feedback from both translators.

13. How do you market your skills and interest in this type of work on your resume or LinkedIn?

You can market this the way you market any service! Add it to the list of services available on your resume or LinkedIn profile, mention it in cover letters to potential clients, or do anything else you would normally do to let a client know how you can help them. For example, I’ve recently added a section on back translation to the “Translation Services” page on my website. Clients who need back translation may find that page and click on the Contact button, and I will also mention it in cover letters when inviting potential clients to work with me.

14. Is back translation done primarily for clinical trials or you see that in any other topics?

I’ve heard that it’s sometimes done for financial or legal texts, and in theory, back translation can be done whenever a client wants it. In practice, the client will have to realize that back translation will have a significant impact on the translation’s cost and the amount of time needed. LSPs that address back translation on their websites or blogs sometimes mention that clients ask to back translate financial or marketing information. Personally, I’ve back translated a few medical device manuals and pharmaceutical texts, like the package inserts, but most of what I see is for clinical trials. It’s not always patient-facing information, however. Every now and then I’m asked to back translate information meant for study staff or ethics committees, not just the documentation for the subjects.

IMG_2563-squareDanielle Maxson, CT has been translating since 2009, and specializes in medical translation with a focus on patient records. She is ATA-certified in Portuguese>English and Spanish>English and a member of ATA’s Business Practices Education Committee. Before focusing on translation as a career, Danielle taught Spanish and worked as a medical interpreter. She is also part of the team working on ATA’s upcoming business practices blog Next Level. She can be reached at