One referral, two audiences: portal patient and nephrologist
You must prepare a cardiology referral in Bulgarian from an English source: '72-year-old man with exertional dyspnea, palpitations, bilateral ankle edema, comorbidities including hypertension and CKD stage 3; follow-up in 6 weeks; no history of NSAID intolerance.' The referral will be read by the patient through a portal and sent to a nephrologist. The patient has limited health literacy and reads Bulgarian but not English. A colleague suggests using 'диспнея', 'палпитации', 'едем', 'коморбидитети' and 'проследяване' because they are precise. The portal has no glossary and the nephrologist expects formal terminology. You have one draft and cannot send two different letters.
1. Decide which of the colleague's five terms you would keep, replace, or explain. Distinguish the patient-facing wording from the specialist wording, even though there is one letter.
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Keep with explanation: 'диспнея' may appear once in the formal paragraph as 'диспнея (задух)', but the patient sentence should use 'задух'. Replace for both: 'палпитации' → 'сърцебиене'; 'едем' → 'оток'; 'коморбидитети' → 'съпътстващи заболявания'; 'проследяване' → 'контролен преглед'. Reasoning: the nephrologist needs precision, not Latinized vocabulary for its own sake. 'Съпътстващи заболявания' is formal enough and clearer. One letter can open with a plain-language summary paragraph, then give a structured clinical paragraph with the same facts. Parentheses at first mention satisfy both readers without creating two documents.
2. Identify the phrase 'no history of NSAID intolerance' that is most likely to be misread and propose a Bulgarian wording that is safe for both readers.
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Risk: 'непоносимост' can be read as allergy, side effect, or simply dislike; 'no history' may be read as 'never had problems' even if the patient had dyspepsia. For both readers: 'Няма данни за алергия или тежка нежелана реакция към НСПВС (болкоуспокояващи като ибупрофен).' This makes the drug class concrete. Caution: if the source only says 'intolerance', do not upgrade it to 'алергия' without confirmation; write 'няма данни за непоносимост към НСПВС' and add the example. The wording must not invent a negative allergy history.
3. Write the patient-facing opening sentence in Bulgarian, using no more than 35 words, that preserves the clinical facts and the follow-up date.
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Sentence: 'Имате задух при натоварване, сърцебиене и оток на глезените; имате и високо кръвно налягане, и хронично бъбречно заболяване III стадий. Контролен преглед след 6 седмици.' Reasoning: it uses 'задух', 'сърцебиене', 'оток', and spells out 'хронично бъбречно заболяване III стадий' rather than 'ХБЗ', because the patient has limited literacy. It keeps the 6-week date and avoids unexplained 'диспнея' or 'едем'.