When patients experience pain, they instinctively touch the area that hurts. Since opening my clinic in 1992, one statement I hear on occasion from patients is "feel this bump, it was never there before." Sometimes they are right, the bump is abnormal and they must consult their doctor immediately. Other times, the patient is pointing to a bony landmark. I want to share a few practice building tips for educating your patients about their "bumps," which can then provide ways for you to introduce yourself to their health care team.

The foundation of my practice continues to be medical doctors referring patients for the treatment of myofascial pain in the head, neck and back. The pain usually originated from injuries sustained in a motor vehicle accident, while performing a home improvement or work related activity. So, in my clinic, patients most commonly report the following bony landmarks as "never there before:"

• External Occipital Protuberance
• Mastoid Process
• Vertebra Prominens, Spinous Process of C7
• Posterior Superior Iliac Spine

Pain affects every area of a patient's life: physically, emotionally, spiritually, financially, relationships at home and work, etc. Patients are scared and concerned about their pain. As health care providers, we must assume our patients do not know about bony landmarks or the structures that attach to them. This is a perfect opportunity to educate patients about form and function. To teach them about the roles bones and muscles play in providing structural support and movement.

I educate patients about bony landmarks using charts and models. I explain how and why bony landmarks form, why they might be tender after physical activity, stress or trauma and how we as health care providers use bony landmarks for postural analysis and other physical assessments. I also show the bony landmark on myself and on other people in the clinic. It is reassuring and comforting for the patient to understand the "bump" is normal and exists on everyone.

Making Connections

Some patients, when they are in pain, will see many different healthcare providers at one time. They will leave your clinic and drive directly to their chiropractor and or medical doctor. So, here is a simple and effective practice building tip. Write the name of the bony landmark with a note on the back of your business card and give it to the patient. For example "The External Occipital Protuberance is tender to palpation." You would be amazed how the patient will show your card to their doctors. This starts a conversation about your practice and the next thing you know, the doctor wants to meet you.

Patients are relying on you for guidance. It is important that you are familiar with normal human anatomy so you can identify abnormalities. Sometimes, the painful spot, is a "bump they have never felt before" and the patient is pushing into soft tissue, not a bony landmark and could cause potential harm. For example, if the spot is in the anterior neck region, running along the sternocliodmastiod muscle. The "bump" may not be the mastoid process, but a swollen lymph node or something more serious and the patient should be referred to a physician. The carotid sinus, body and vessels are in the same region and fatal circumstances could result from the patient randomly pushing deeply into the anterior neck.

Your knowledge of anatomy helps to protect your patients, improve assessment/treatment outcomes and build your practice by educating patients who then become raving fans. One unique way to learn about the skin, fascia, muscles, nerves, ligaments, vessels and other structures that compose the body is in an anatomy lab. Performing a human dissection is a unique opportunity to see, touch and learn about the body without any concern of causing harm. You can compare the same structure on multiple specimens of different gender, age, size, cause of death and occupation. You palpate diseased and normal organ tissue, examine surgical incisions to uncover pacemakers, artificial hips, or the rods, screws and connectors installed during a spinal fusion. You feel the elasticity, density, size and position of structures throughout the body like the spinal cord, heart, lungs, organs, etc. You leave the lab with a new level of confidence and knowledge that is integrated into your practice.

Be prepared when you here the words "feel this bump… it was never there before." If you laugh and make fun of the patient for pointing to a bony landmark, the odds of them scheduling follow-up treatments or referring others is very low. There is also the possibility you could identify an abnormality that ultimately saves their life. Apply your knowledge and turn the situation into a patient education and practice building opportunity.