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Dr. James Custis
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October 13, 2025
Just before I enter a patient’s room, I always pause. I take a small breath, then knock twice — a double rap with the first knuckle of my third finger. It’s such a small ritual that no one else notices. But for me, it marks the transition into something sacred: stepping into the space where doctor and patient meet, where everything else fades away.
Behind that door, something happens that is unlike anywhere else. It is in that room that I can sit with a patient, listen to their story, and find meaning in the details that shape a diagnosis or a decision.
The First Voice
When I enter, I begin simply. I introduce myself, confirm identity, ask a question, and then let the patient speak.
That first response matters. I resist the urge to interrupt, giving them space to unburden whatever brought them here. Sometimes the words pour out in a torrent, as with a middle-aged man in a manic phase of bipolar disorder. Sometimes they are nearly absent, as with an elderly woman with advanced dementia, silent for a decade.
But whether long or short, the act of being heard is the starting point — and the act of being seen is fundamental.
The Others in the Room
The Patient’s Family: Every patient belongs to someone — parents, children, siblings, friends, colleagues. Their lives ripple outward, connected to others who will be shaped by what happens in this room.
My Nurse and Her Assistant: Their careful hands and watchful eyes collect vital signs, observations, and details that help form a complete picture.
My Medical Director: Though unseen, their presence reminds me of the standards we hold ourselves to, the responsibility to practice at the highest level.
My Teachers and Mentors: Their voices still echo — the analogies, the warnings, the lessons that shaped how I practice medicine today.
The Administrator: A silent observer ensuring protocols are followed, that safety is never compromised.
The Insurance Reviewer: An unseen arbiter who demands that every order is justified, evidence-based, necessary.
That makes seven: the patient, plus all these invisible companions who hover in thought, influence, and accountability.
The Connection
With all of these voices present, the room can feel crowded. Yet the most important connection remains the simplest one: doctor and patient, face to face.
It is in that space — listening, watching, responding — that the complexity of medicine becomes human again.
Reflections
Every patient encounter is more than two people in a room. It is family, colleagues, mentors, systems, and structures, all woven into the conversation. But the center is always the patient. The pause before I knock, the silence after their first words, the eye contact that follows — those are the moments that keep the medicine human. They remind me, every time I enter a room: see the person, not just the patient.About Stories from Beyond the Chart
Stories from Beyond the Chart is an ongoing series from Iatria General Medicine, where medicine meets humanity. Written from the perspective of a practicing physician, each piece explores the moments, lessons, and conversations that go deeper than the data in a patient’s chart. These reflections highlight how care is about people, not just problems — and how medicine, when done with attention and heart, becomes a shared journey.
Learn more at www.iatria.com
Traditional Medicine, Modern Philosophy