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Since it was first published in 1991 the primary aim of this book for English speakers has been to offer the health professional a lightweight, easy-to-use reference to be used in real time while communicating with Spanish-speaking patients. For this fourth edition every term was individually reviewed with an eye toward ensuring that the reader will understand and use effectively the terms she has looked up. Several thousand entries were expanded or improved, and about 2,000 new terms were added (4,000 if you count the terms in both English and Spanish). New procedures, concepts, and drugs account for many of the added terms, and the rest cover all fields. Mental health deserves mention because it is such an important component of overall health and may finally get more attention following passage of the Affordable Care Act. Many psychiatric terms have been added, and because providers need to know what their patients are feeling, I have added terms that describe human emotions. I have also added terms that involve the "mechanics" of medicine: scheduling of appointments, referrals, insurance issues, charting, advance directives, confidentiality, and the like.

For readers unfamiliar with this book, it is laid out simply. The front matter contains some tips on medical Spanish and a pronunciation guide, the text is straightforward and uncluttered, and at the back there is an appendix with sample conversations relating to medicine in general, nursing, pediatrics, dentistry, and radiology. The questions in these conversations are the questions my colleagues and I use in our daily practice and have been crafted over decades to be the best questions for eliciting the information desired. The appendix ends with a sample discussion of code status.

Choosing which terms to include in this dictionary has been a challenge. Highly technical terms that are unlikely to occur in conversations with patients have been excluded. Thanks to their Latin and Greek roots, most of these terms aren't that difficult. Few would fail to recognize "hemodinámico," "monoterapia," and "hepatectomía," and with a little practice one can become adept at translating this type of term in the other direction (English to Spanish). All other medically-related terms are potential candidates for inclusion, and over the years I have strived to maintain a list that is thorough, relevant, and concise. It should be hard to stump this little book. In particular, I have made a point of including many compound terms and phrases. These multi-word terms don't always translate literally and are often neglected in standard reference works. Examples include: acting out, breakthrough pain, case manager, comfort zone, coping mechanism, death with dignity, doctor-patient confidentiality, drug-eluting stent, durable power of attorney, flesh-eating, free-floating anxiety, life partner, noninvasive positive pressure ventilation, parenting workshop, patient-centered, patient service representative, peer pressure, point of care, ritonavir-boosted, secondhand smoke, self-fulfilling prophecy, shared decision making, sibling rivalry, skilled nursing facility, sliding scale, thin liquid diet, tight glucose control, to stay on task, to bite your nails, to suck your thumb, and upper limit of normal.

Other exceptional features of this book include its grammatical rigor and the extent to which the reader is guided toward correct use of a translation. Since its first printing the book has included parts of speech; notations of gender; indications of subject, region, and usage (formal, familiar, vulgar); irregular past participles; parenthetical disambiguations; example phrases and sentences; and editorial notes. Exceptional, too, is the inclusion of generic drug names. Along with the names of the 200 top-selling pharmaceuticals for 2012 I have included approximately 600 others chosen for their relevance to the Spanish-speaking population. Where appropriate, labels for International Nonproprietary Name (INN) and United States Adopted Names (USAN) are included (see the section "How to Use this Dictionary.")

Accuracy of translation has been a priority for this work. For all but the most straightforward translations, frequency analyses were performed on large data bases in both Spanish and English, some technical, some lay. The results were then vetted by myself and by José Francisco Durán Blanco, a Colombian physician who has an eagle eye for subtleties. The Spanish technical terms then are the terms used by researchers publishing in Spanish, and the lay terms are the terms most commonly used by Spanish-speaking people discussing their health. Regional variations often exist and are included, with labels. For the technical English terms I have relied heavily on the language used in the New England Journal of Medicine and Mayo Clinic Proceedings.

Very special thanks go to Dr. Durán. Without his help the ambitious goals I set for this revision could not have been accomplished. Thanks go to the team at McGraw-Hill for their continued support since this book's inception, now over 20 years ago, and thanks go to those readers who wrote to my publisher or otherwise tracked me down in order to express their appreciation and offer thoughts. Comments are appreciated and can be sent to: Finally I would like to thank my family for their support as well as their patience with regard to my long work hours.

Glenn Rogers
Willits, CA

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