Unlike too many practitioners, Dr. Patel believed what I said about my lived experience in my body, and understood that we needed to change the narrative. His inventing the Patel Pause was one of the ways he helped me do that.
Five years ago, my first pain specialist, Dr. Hersh Patel, came up with a simple practice to help me build a sense of safety and navigate painful procedures. At the time, severe Complex PTSD and medical trauma left me freezing up during appointments: holding still, shutting up, and taking whatever pain came, just as I had been trained to do. Dr. Patel offered a trial run before an injection, gently pressing a capped needle against the site and asking me to tell him when to stop. It was a tiny moment of safety, but it changed everything. Given the opportunity to name it, I called it the Patel Pause. Dr. Patel incorporated it into his practice.
I took that initial idea and ran with it. What started in one office became my baseline for healthcare. I began introducing the protocol to physical therapists, chiropractors, dermatologists, and specialists across the board.
The Patel Pause Protocol: Building Agency and Medical Trauma Recovery
The core of the Patel Pause is simple, but its neurobiological impact is profound. It isn’t just asking for permission before touching; it completely shifts the power dynamic so the patient is fully in charge of the interaction.
- Initial Consent: Before any hands-on treatment or examination, the practitioner and patient agree on a specific type and location of touch. The patient tells the practitioner when they may begin.
- Touch and Immediate Stop: The practitioner touches in the agreed-upon manner. At any point, for any reason—not just pain—the patient says “stop” (even in a whisper). The practitioner stops immediately without argument, hesitation, explanation, or delay.
- Three Repetitions: The sequence is repeated three times:
Consent → Withdrawal of consent → Renewed consent.
[ Patient says “OK” ] ──► [ practitioner Touches ] ──► [ Patient says “Stop” ] ──► [practitioner Stops Immediately ] ( Repeat 3 Times )
What looks like a one-minute exercise teaches the nervous system more about safety than years of being told “you’re safe”. Safety does not come from what a practitioner says; it emerges through repeated experiences where boundaries are recognized and respected.
Practitioner by Practitioner: Establishing Patient Agency Through Repetition
Over the past five years, I have used the Patel Pause with nearly every practitioner I see. Practicing this protocol hundreds of times has allowed my body to gather real evidence about each specific human being in the room with me. My nervous system pays close attention to whether a practitioner stops when I say stop, especially male practitioners, even those who have already demonstrated safety.
People often assume that once trust is established, agency becomes less important. My experience has been the exact opposite: agency is the mechanism through which trust is established and maintained.
The practice has caught on in unexpected, inspiring ways. One of my practitioners was so moved by the protocol that she began using it with her partner at home. She shared that she believes the Patel Pause should be taught in schools as an essential part of learning consent, bodily autonomy, and agency.
Reading the Affect: Assessing Practitioner Attunement and Relational Safety
Every practitioner implements the Patel Pause in their own unique way, and that variance is part of the healing. The protocol acts as a window into the practitioner’s internal state, allowing my nervous system to read their attunement, pace, and presence:
- The Mindful Pause: My chiropractor pauses for a moment himself before touching. I am face-down at the table when he places his open hand on my back, allowing my nervous system to move at “nervous system speed”. His touch feels deeply intentional, creating an exceptional, grounding connection.
- The Routine Compliance: One pain specialist carries out the pause in a standard, routine manner. He seems somewhat unsure of the deep why behind it, but he is willing to go along with it and honor my boundary.
- Repairing the Connection: Early on with one practitioner, his initial touch felt almost like distaste, which immediately alerted my nervous system. But because the boundary was held, he adjusted over time, listened, and has done much better since, proving that safety can be repaired.
- Down-Regulating CRPS Through Trust: My assisted stretching coach touches various parts of my body while I keep my eyes closed. Because I have established deep trust with her, I don’t need to visually monitor what’s coming. It feels like a game. She uses various forms of touch—holding, resting, or gently rubbing—which has helped my nervous system build safety around CRPS-affected areas, contributing directly to down-regulating pain and sensitivity.
Interpersonal Neurobiology: Why Patient Agency and Autonomy Rule
From an Interpersonal Neurobiology (IPNB) perspective, the Patel Pause interrupts automatic stress cycles, creates predictability, and offers clear cues of relational safety. Standard trauma-informed care often focuses on the doctor asking, “May I touch you here?” While well-intentioned, that still leaves the practitioner in charge of leading the interaction.
During the Patel Pause, my agency rules. I decide when touch begins, when it ends, and when it resumes. That single minute of agency reminds my nervous system of what is happening in the present moment: this person hears me, believes me, and honors my boundary. Having control over my boundaries changes everything, transforming medical care from a trigger for survival instincts into a space that supports healing.
