Ambiguous discharge instructions: pronouns, aspect and agreement
A junior doctor drafts a discharge instruction in Bulgarian: 'Пациентът трябва да приема таблетките след хранене. Той ги приемаше и преди, но сега да приема само една. Ако се почувства зле, да не ги приема и да се обади. Болката в гърдите, който се появи, трябва да се отбележи.' The pharmacist returns it because 'само една' and 'ги' are ambiguous. The patient is a 64-year-old man with atrial fibrillation on apixaban 5 mg twice daily and bisoprolol 2.5 mg once daily; he also takes magnesium occasionally. You must produce a clear instruction and explain the grammar changes.
1. Rewrite the instruction in unambiguous Bulgarian. Keep the same clinical intent but specify every reference.
Read the worked answer
Rewrite: 'Пациентът трябва да приема апиксабан 5 mg два пъти дневно след хранене и бисопролол 2,5 mg веднъж дневно. Досега е приемал магнезий при нужда; ако се почувства зле, да не приема бисопролол и да се обади на лекаря. Да не спира апиксабан без указание. Болката в гърдите, която се появи, трябва да се отбележи.' Reasoning: 'ги' and 'таблетките' are replaced by the two drug names because they have different schedules. 'Само една' is replaced by exact doses, so it cannot mean one tablet, one drug, or one daily dose. The relative pronoun is corrected to feminine 'която' to agree with 'болката'.
2. Explain the grammar problems in the original using Bulgarian terms where useful: pronoun reference, aspect/tense, and relative pronoun agreement.
Read the worked answer
- Pronoun reference (местоименно заместване): 'ги' in 'Той ги приемаше' has no clear antecedent because 'таблетките' covers two different medicines. In a discharge text, a pronoun must not make the reader guess which drug is meant.
- Tense/aspect (вид и време): 'приемаше' is imperfective past and describes a habitual past action; it does not tell the patient what to do now. 'Да приема' is a present/subjunctive instruction, but 'само една' remains underspecified. Use explicit 'два пъти дневно' and 'веднъж дневно'.
- Relative pronoun agreement (съгласуване на относителното местоимение): 'болката' is feminine, so 'който' must be 'която'. The original 'болката ... който' is ungrammatical.
3. Identify one ambiguity that remains even after your rewrite and say how you would resolve it in speech.
Read the worked answer
Remaining ambiguity: 'след хранене' can mean after every meal or after a particular meal, and it is attached to a twice-daily drug. Resolution in speech: 'Апиксабанът се приема сутрин и вечер след закуска и след вечеря; бисопрололът - веднъж дневно, сутрин.' Reasoning: the written note is now grammatically clear, but the timing still depends on meal pattern. Adding actual meal anchors is a communication fix, not a grammar fix.