I heard “20” used as a verb

The patients with brains that disturb?

We don’t kick them out to the curb

We can keep them from harm

With the medicine’s charm

And here we make 20 a verb


Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I went back to traveling and adventures in temporary positions. Assignments in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska have followed.  I finished my most recent assignment in Clarinda on May 18.  Right now I’m in northern British Columbia, about to get a first-hand look at the Canadian system. Any identifiable patient information has been included with permission.

Over the course of a quarter century, I got used to rising before 6:00AM, so that I could round at up to 3 hospitals and arrive at clinic in time to see patients starting at 9:00AM. Eventually I found I moved much more efficiently in the mornings, and as the decades went by my physiology embraced the change into a morning person.

I still get up early, even when I can walk to work at one hospital and round under the same roof where I do clinic; even when I don’t have any work in the morning. Today, before I could go to work, I had to stop at the bank and open an account.  I needed the account so I could pay for professional liability insurance automatically.  The bank didn’t open till 9:30.  So I felt like I was playing hooky.

The extremely personable young woman at the bank looked at my passport and did a double take. “You’re an American?”

I nodded. “I thought my accent would have given me away,” I said.  Although, because it hadn’t, I suspect that my accent is changing without any conscious effort.

I deposited most of my cash. With the exception of the Laundromat, I have been able to do all my transactions via credit card.

But the 8 page form for professional liability insurance asked for all the professional liability carriers I’ve had. Thirty-five years of medical practice has included a lot of carriers, as well as 8 years of coverage by the Federal Tort Claims Act.  I called Bethany; we compiled that data last year for credentialing elsewhere, and within an hour she’d found it.

At noon I walked over to one of the Chinese restaurants.

All medical facilities need meetings so that small problems don’t become big problems. In the Indian Health Service, the entire hospital did nothing but meetings on Thursdays.  Other places allotted an hour, usually over lunch.  When I worked in Utqiaviq (the Inuit village formerly known as Barrow) we met every weekday for an hour.  In more than one place, I got to see the dysfunction that results from eliminating weekly doctors’ meetings.

Today I joined the medical staff for their Tuesday meeting. We started at 3:00PM.  The laughter and warmth that filled the room for the next hour could only come from a group with extremely high morale.  I didn’t have much to add; as a locums I could genuinely say that I don’t have a dog in the fight.  But I got to ask a number of questions.  One of which followed the use of 20 as a verb.

A “20” refers to involuntary hold when psychiatric factors render a patient dangerous to themselves or others. I learned about the process of how to make it happen.

All societies have an obligation to take care of their mentally ill, those disabled by a dysfunctional thought process.   Free societies must balance personal rights against the need to protect people from the psychotic.  Most states limit the time the physician can hold a person against their will to 48 hours, this part of Canada allows for 72 hours.


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