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Open Letter to AARP President



April 13, 2009



Jennie Chin Hansen, RN, MS, FAAN

AARP President-Elect Class 2008



Desmond Allen, PhD, MBA, RCP

AARP Member


Dear Jennie,

Given your nursing background, I am excited to hear of your new appointment.  Hopefully you can be a voice against the medical community’s increasing miss-treatment of our elderly population.  As a respiratory therapist with a PhD in health administration, I have firsthand knowledge of the medical industry's fleecing of America’s pocketbook with the lucrative yet misallocated diagnostic testing and hospitalization of generally healthy geriatrics whose only problem is having shown up for a routine doctor’s visit on a day their doctor had a few beds to fill in the local hospital; and, conversely, the similar unwarranted diagnostic tests and hospitalization of those with various end stage illnesses. 

Daily, across the nation, it is routine practice to admitted such patients to acute care hospitals with embellished diagnoses such as weakness, “supposed” dehydration, shortness of breath, etc.  And perhaps most upsetting is the multitude of patients suffering severe and chronic altered mental status admitted for various normal progressions of their end stage dementia.  Not only are these acute care hospitalizations medically unwarranted, these patients (both those in generally good health and the severely demented) will endure a series of unnecessary tests; tests that require a physician’s interpretation, which, of course is a billable item.  Maybe it is just me but the routine practice of ordering daily EKGs on a 92 year old admitted for altered mental status seems a little over-the-top.  Although the physician only gets $10.00 for each EKG interpretation, when you consider that even in a small rural hospital he/she may interpret 30 to 50 tests a day you realize this is a handsome sum.  Especially once you know that he/she will merely dictate the interpretation already supplied by the EKG machine.  I once timed a physician as he interpreted/dictated 33 EKGs in less that three minutes.  That translated into $330.00 for less than 3 minutes of reading.  Later that day he had another stack to “interpret.”  This happens daily in virtually every hospital and clinic in America; and EKG’s are the least lucrative interpretations of the several types of tests requiring interpretation.  Other studies such as PFTs, EEGs, ultrasounds, cardiac catheterizations, MRI’s, sleep studies, CAT scans and certain other x-rays command hundreds of dollars, especially when a consultation fee is tacked on to it.

This problem of routinely providing medically unwarranted procedures to our geriatric population is a two-fold issue: one an ethical matter, the other a fiscal.  Ethically, in the case of the end stage diseases, physicians are too pathetic to speak frankly with the patient and/or family to tell them the truth; to tell them that even our advanced technologies cannot cure their terminal condition; nor will such technologies improve their quality of life.  They are too pathetic even to tell the patient that although the application of such heroic procedures may prolong life for a few days, a few weeks, or even a few months, their remaining days are likely to be filled with extreme misery and pain; which, in truth, is often nothing less than torture.  Fiscally, for the generally healthy hospitalized geriatrics given a slew of tests, both the physicians and the hospitals make a proverbial killing by providing these superfluous services, which they market as quality healthcare.    

Herein lays the single most important issue for resolving America’s healthcare crises: putting an end to the unwarranted hospitalizations, the over-utilization of pharmaceuticals, and the misallocation of advanced technologies (including test interpretations); not merely for the elderly but for all age groups.  The physicians -- not the trial lawyers and not the insurance companies -- are the primary culprits in this mess.  Purely for the sake of filthy lucre modern medicine has duped America into believing all of its services are necessary.  While a fraction of modern medical services are effective the far majority of allocated services are unwarranted and even useless; so that American healthcare is largely little more than a scam; a societal leach; the modern snake oil salesmen of yesteryear.



Desmond Allen, PhD, MBA, RCP



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