The Cost of Lost Agency

Medical settings can easily become places of deep vulnerability. For anyone with medical PTSD or trauma, standard clinical interactions often carry an unspoken tension around control, safety, and physical boundaries. Long before my recent visit with my current dermatologist, an experience with a different one made this starkly clear: during an exam at that earlier clinic, the male doctor stood behind me and said, “We’ll just pull this” as he tugged at the bow to open the back of the hospital gown I wore. It was my first dermatology visit, and he did not ask or even give advance warning. That was deeply triggering and disempowering. A man in a position of power had exercised control over my body without adequately respecting my agency or bodily autonomy. It was an echo of the same dynamic I experienced with multiple abusers, and left a lasting imprint, further compromising my sense of safety during medical care and creating an added burden of hypervigilance in clinical spaces.

A Corrective Interpersonal Experience

A recent encounter with my current dermatologist offered a profound contrast. She has increased my sense of safety in large part because she is the first doctor I haven’t had to teach about supporting my sense of safety through agency, being believed, and being offered options.

Her response to my disclosure about the prior dermatologist was restorative. She didn’t minimize it, question it, ask for details, or make me defend my emotional response.

Instead, she demonstrated immediate recognition and empathy, acknowledging the impact of what he had done.

Crucially, she restored choice where it had previously been denied. She let me choose whether to undo the gown myself or have her undo it. That recognition and restored agency over my body were all I needed.

Why Agency and Choice Matter to the Nervous System

This kind of response is powerfully restorative for several key reasons:

First, it eliminates the exhausting burden of having to teach healthcare providers about trauma, nervous-system safety, or basic boundaries. She recognized what was needed without requiring me to explain or defend it.

Second, it honors bodily autonomy: the fundamental principle that my body belongs to me and I hold the right to determine who touches it and what happens to it. She recognized that my bodily autonomy is non-negotiable.

Finally, returning choice acts as a powerful, corrective interpersonal experience for medical PTSD. New experiences in which another person respects our boundaries, believes our account, and offers meaningful choices actively help rebuild trust and safety.

Relational Safety as Standard Healthcare

For patients who haven’t experienced medical trauma, her approach may simply feel like good, ordinary healthcare. They expect to be believed, offered choices, and treated with respect. Yet, those ordinary interactions are developmentally and neurologically important, contributing to our expectations about relationships, safety, and trust.

For someone with medical PTSD, the difference is particularly profound. I know what happens when those things are absent, and what it costs to have to teach a doctor that my sense of safety matters before I can even receive care.

It’s especially meaningful that this doctor doesn’t make patients earn this kind of treatment by disclosing trauma or demonstrating distress. She offers it as the ordinary way she practices medicine.

I wish more healthcare professionals understood that respecting agency, believing patients, and offering choices aren’t special accommodations. They are vital to relationally-safe healthcare that is supportive of fundamental human well-being.