Friday, February 01, 2008

Chump time

I was listening to a talking head on MSNBC explain for the 100th time this week that Rudy Gulliani is an idiot, when my wife received a phone call from a friend whom she was to transport to the hospital the next morning for some surgery. After she hung up she tried to explain to me over all of te political noise that her friend's surgery time had been changed from 10:00 to 9:00 a.m., and they now wanted her at the hospital at 7:00 instead of 8:00. "Why so early ? " she asked. "Chump time" I replied without taking my eyes off of the talking head who was now comparing Gulliani's expenditure of $30 million to acquire one delegate as the worst record since Phil Graham, who once spent $23 million to get no delegates (what with the current value of the dollar, I was thinking, Graham still looked worse). " Oh yeah, chump time" she replied.

I had first stumbled onto the theory of chump time when I was in college and having to have some oral surgery which required an overnight hospital stay (today they would not let you stay an hour for this procedure after you woke up). The hospital administrator person/looks like nurse person, told me that I needed to be at the hospital two hours before the surgery. I dutifully got to the hospital two hours early. Checked in in under three minutes, and spent the next hour and fifty seven minutes pissed of about the wait. Following that experience I began to carefully track the times people were asked to come to the hospital for surgery and the times the surgery was scheduled.After several years I had confirmed the thoery of chump time.

Chump time is an agreement between surgeons and hospitals (some might say a conspiracy) to get patients to the hospital for any given procedure as early as that person will tolerate without canceling the surgery. The "chump" in "chump time" is the patient. The "time" in chump time is the agonzing and unecessary hours you have to wait in a waiting room for any given surgical procedure.Now before you get too upset over this waste of your valuabale time, the theory behind chump time is actually benign, at least for the perpetrators of the act. Unlike the offices of a general practicioner, who will keep patients waiting in rooms full of coughing,vomiting and generally contagious people for hours on end, surgeons and hospitals need some kind of order.A general surgeon can schedule operating rooms for only 24 hours a day, and can work only about 16-18 of those hours.People, especially those about to be sliced up, can not be relied upon to show up to the hospital on time. There are many reasons for this which you can well imagine on your own, without me detailing them. So to keep operating rooms from backing up like waiting rooms at a G.P.'s office, the concept of chump time was invented. The Dr. thinks, if I tell this guy I am going to cut him at 8:00 there is only a 50/50 chance that he will make it on time. We will tell him to be there at 7:00 the odds go up to about 75% and if we tell him to be at the hospital at 6:00 I have a 95% chance of bilking medicare or some hapless insurance company for at least a portion of my fee.

In reality, without chump time, surgeries would become like a trip to the G.P. and you would have no earthly idea when, if ever, your procedure would be performed. But the problem with chump time is that it is, by its very definition, set up for chumps, something which you and I are not, or at the very least, I'm not. Why should I (and maybe you) have to suffer the indignity of chump time when I (and maybe you) are chumpless, completely without chump ?Well you don't.
If you, like me can be trusted to get to the hospital on time, ignore what they tell you about check in. Now I do recommend that you get there a half hour ahead of schedule, but only because if you don't, they will call you at home and make you think you are letting down the entire practice of medicine by you recalcitarance. But whatever you do, don't let the hospital, or your surgeon know that you know about chump time. Just act accordingly.

Some years ago, my former law partner and stil great friend Rick Reed managed to develop a disk problem in his back. By the time he got around to doing something about it he had lost about 50-75% of his arm strength and was in terrible pain.Rick does not trust western medicine and actually got a consult with some eastern swami who looked at his x-rays and told him "Go get the surgery". It was that bad. Well, because Rick had to start fasting the day before surgery, he had me take him out for a few after work drinks 24 hours earlier, to talk about the problem and screw up his courage.Upon refelection, I was the wrong guy to take out. Our conversation went like this.

Me: When you going in ?
Rick: I see the surgeon again tomorrow and then I go in for 8:00 surgery the next day.I have to be there at 6:00.
Me: Yeah, chump time
Rick: chump time ?
Me:yeah, the average Joe can't get to the hospital on time so that tell us all to be there extra early. It really sucks. Just get there when you want to.
Rick:gee, thanks

Well the problem was, of course, that Rick saw his surgeon between when he saw me and when he checked into the hospital. By way of background, Rick had the finest, but meanest general surgeon in Austin. Believe it or not, this guy had a picture on his wall of a triple amputee plowing a field with a mule (or maybe gathering a harvest in a combine, my memeor is hazy) with a note to his patients underneath the picture stating " Now this is a handicap". Translation, "stop your whining you lousy pussy and let me fix your back, then get to hell back to work."I mean, I am positive that this guy would have performed surgery without the anastehsia is they would have let him.

At any rate, Dr Atilla asks Rick, "They tell you what time to be there tomorrow'? " The doctor never tells the patient the chump time, he/she leaves that to the hospital or one of his/her office minions, that way there is deniability. " Yeah" said Rick, "about that, that time they told me to be there is 'chump time', right?" At this point the doc flew into a rage (as most people do when they are caught). "Chump time ?" he is said to have screamed. "Who in the hell told you that, listen, I'm going to be VERY disappointed in you if you are not there on time." Again, notice the wording, he just said "on time" not at the time Rick had been told to be there. But Rick,wary now of a scalpel wielding maniac, checked in exactly when the hospital had told him to, and sat and worried for two full hours when he could have been making calls to the real estate criminals he represented and helping Austin add anothe big box or hideous strip mall to the landscape.

Fortunately, Rick never told his doctor who had spilled the beans about the chump time scam. If he had, I would have been hearing from the AMA and perhaps been the subject of a restraining order. So chump time has continued unabated. It is an interesting pheneomen to study. It is not perfectly predictable, like say 9:00 Eastern, 8:00 Central. Chump time is more an art than a science. for instance, my wifes' friend had her surgery moved up and she had her chump time changed from an hour and a half to two hours. That is actually known as the chump time corrollary which states that the earlier your surgery, the more chump time you are given. In something that works very much like police profiling of criminals, patients ar given chump times based on stereotypes. A hippie, like I was was given a huge chump time. A physician getting surgery for himself or his family is givcn only the amount that is required to cover up the fact that there is such a thing as chump time

One last thing. Chump time is not for everyone. When American pop star (and subject of the new English ballet "Meltdown")Brittney Spears decided she wanted to go to the psychiatic hospital, again, yetserday, they let her checkin whenever she wanted and the City of Los Angeles detailed twelve policemen on "motor cycles, in cars and in helocopters" to get her there. That is hardly chump time, although I'd have to say that the citizens of L.A. who paid for that may feel somewhat chumplike. When one of the most dangerous and crime ridden cities in America details that kind of police power to get one nutcase back to the hospital, it begins to look like we are all chumps. Everyone except Brittney that is.


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