Conquering language barriers with the ‘ART’ of OMM

As a newly minted family medicine intern, I began my residency training in the summer of 2019 at a federally qualified health center (FQHC). My patients faced multiple hurdles to health care, the most challenging being the language barrier. I started my intern year with a heavy reliance on interpreter services to communicate with my patients, 70% of whom were Spanish-speaking. Thankfully, I started to cultivate my proficiency in medical Spanish six months into my intern year. This was largely due to an unlikely resource—osteopathic manipulative medicine (OMM).

OMM gave me the means to go into the language barrier. OMM became my Trojan horse, used to breach the isolation that many non-English-speaking patients experience during a medical encounter. During my OMM sessions, I discovered a new adaptation of the mnemonic device TART (often taught to osteopathic medical students to outline the diagnostic elements of somatic dysfunction). I discovered “ART”—a mnemonic that describes OMM as a humanizing approach to patient care for vulnerable populations.

A is for asymmetry: Adjusting the asymmetry of privilege and power

Oftentimes, my new OMM patients were recent migrants from Central America with chronic moderate pain who spoke very little English. A 52-year-old woman from Guatemala suffered a lower back injury during her migration journey, and her pain was now exacerbated by her odd jobs in domestic work and childcare. Within that examination room, the asymmetry of privilege and power between myself and my patients was evident. With OMM, I manipulated the dynamics of power to attain a greater symmetry between the two of us.

My first attempt at approaching symmetry in this context was to ask my patient’s forgiveness for my elementary-level Spanish proficiency and my mispronunciation of words, as I was still learning the language. At which point, my patient would often pardon me and say that my Spanish was relatively decent, or they would confess that they too were in the process of learning English.

I would ask my patient to please correct my Spanish if I said anything incorrectly. At this point, the power, or dynamic of authority, at least linguistically, was set in my patient’s favor. This is my deliberate posture of humility. And thus ensues the medley of a bilingual encounter.

Low-stakes and low-pressure, our OMM sessions often became sessions of “other mouth movements.” I would try my hand at the double R pronunciation in Spanish, while my patients would try their hand at the English pronunciation of the letter Y, which would often be pronounced as the letter J. By the end of the OMM session, my patient’s somatic dysfunction was alleviated. By the end of the session, I was feeling the pleasure of serving and connecting with patients genuinely.

I often learned new words or phrases in Spanish by the end of the session. Likewise, my patient would have used their growing English skills with a greater sense of confidence, as we’d spent the last 20 minutes encouraging each other’s linguistic odyssey. And more often than not, we would have shared a laugh or two, as my patient shared jokes or chuckled at my blaring promotion and encouragement of their English abilities. I often found that my patient knew more English than they had originally let on. Oftentimes Spanish-speaking patients were reluctant to mispronounce words in English.

R is for restriction: Recognize the restrictions faced by the patient

The recognized restriction of the language barrier, which once plagued my previous medical encounters with patients, dissolved during my OMM sessions. Muscles and perceptions were manipulated to the point of the barrier’s dissolution. The differences in language became a point of expansion, a point of sharing, a subject of inclusion as we both enveloped ourselves in the vulnerability of not having the right words.

Words are meant to convey messages, concepts and ideas. However, if the message of care can be conveyed through touch and sincere attempts to connect with another human being, it stands that words of any language may be dwarfed in their importance. Without a word, the most important messages had been conveyed via the compassionate healing touch of our OMM session—trust, tenderness and a dignified experience of medical treatment.

T is for tenderness: Tenderness and thankfulness as a means of connection

Tenderness, in the strictest sense of osteopathic medical training, conveys the presence of physical pain and represents somatic dysfunction. In my OMM sessions, tenderness evolved into the presence of emotional connection. A humanizing element of medicine had been achieved through the osteopathic touch.

Staying connected

Today, I am an attending physician in urgent care and family medicine. I continue to serve a diverse patient population, many of whom are Spanish speakers. Thankfully, my medical Spanish has greatly improved since my intern year!

A sense of thankfulness overcomes me as I get a chance to reconnect with patients on a personal, meaningful and enjoyable level. By discovering the “ART” of OMM, I also discovered an appreciation for the osteopathic training that enabled me to connect with patients in a manner that is deeply profound and deeply human.

Related reading:

Compassion in medicine: It’s not just the right thing to do—it also makes the most cents

DOs go global: What to know about practicing osteopathic medicine abroad