Today's Medicine

Why Complete POLST Forms? Early Conversations Can Make Tough Decisions Easier

Published: June 22, 2023

When it comes to providing the best care, communication between a patient and health care provider is absolutely essential. And when it comes to receiving the care you’d want if you’re unable to speak for yourself, it’s crucial to have your loved ones know your wishes.


A Way to Express Your Desires

More often than we realize, life-threatening problems occur suddenly or leave you unconscious or otherwise unable to make your own decisions.

But patients and providers have a valuable tool in POLST, a nationally recognized portable treatment order that conveys your wishes in a time of crisis. POLST is valid outside of the clinic or hospital setting and can quickly communicate the most important medical decisions to all medical providers – whether it be emergency responders or hospital personnel. One of the advantages of a portable medical order is the coordination of care decisions by first responders that honor your wishes outside of the hospital.

When a crisis occurs, you may be faced with some difficult questions. But having your desires in writing can ease ambiguity and help your medical team honor your wishes.

The POLST is usually completed during a visit with your primary care provider, but it can also be completed with providers in a hospital setting. This order becomes a standardized declaration of your treatment choices that health care providers and your family can follow. 

As a primary care provider, I know firsthand that we all need to do a better job at completing these portal treatment orders with patients prior to crisis events.


Standardized Care Starts at the Time of Crisis

Many people fail to plan because they don’t know what to plan for. Since they’re preparing for a situation that hasn’t yet happened, it can be difficult to know what questions to ask. Some people may be overwhelmed by the complexity of the decisions, so they’re left without a plan at all.

POLST recognizes that not every patient wants everything medicine has to offer and allows them to control the length and intensity of treatment. It uses four treatment questions to provide clarity about your wishes in a time of medical crisis:

  • Do you want cardiopulmonary resuscitation (CPR) performed if you stop breathing or don’t have a pulse?
  • Do you want invasive treatments such as intubation to help you breathe?
  • Are there certain treatments and procedures that you would want to limit?
  • Have you ever considered being kept alive with medically administered nutrition?  

Because the questions are standardized and recognized nationally, their answers convey complex medical information quickly and efficiently to providers across the entire spectrum of care.

POLST is just one part of advanced care planning – an umbrella term that encompasses legal documents and medical orders. While we accept the legal documents – and those are very valuable – they have different purposes than medical orders. A power of attorney and living will are usually done in a legal context, whereas portable medical orders like POLST and do-not-resuscitate (DNR) orders are medical orders that are used by health care providers in multiple settings.

While it’s important to complete both legal documents and medical orders, a living will may not be helpful in an emergency outside of a clinical setting. Portable medical orders like POLST are becoming more universal and the language is very standard, which means they’re more useful in emergency settings when quick decisions are essential.

It’s important to note that POLST is intended for individuals with a serious illness or frailty and not people who are healthy. I understand that this is the most confusing part about POLST or any advanced care document, which is why having conversations with your primary care provider can help determine if a POLST is right for you. I believe that it’s something to consider for anyone wishing to limit care in any way.


Plan for Today and Revise as Your Life Changes

Advanced directives provide guidance and offer autonomy when you’re are unable to speak for yourself. Many patients have already completed legal documents in the form of living wills and power of attorney. These documents are important and should match the decisions on a portable medical order, but it’s important to have both completed.

POLST and other medical treatment orders such as Nebraska Emergency Treatment Orders (NETO) can and should be be modified as your health changes. As Methodist transitions from NETO to POLST, previous documents can be a great starting place to update your wishes and standardize your medical decisions. Your primary care provider or medical team can help make sure your choices are updated and align with your current health situation.

You might wonder why we’re transitioning as a health system from NETO to POLST. The main reasons are for the ability of your portable medical order to be recognized in other states and to standardize our approach to advanced care planning.


Getting Everyone on the Same Page

Putting these few decisions in written form can make all the difference to your family at the time of an emergency.

Following your wishes and respecting your choices is every health care provider’s goal – even when you’re unable to speak for yourself. Having the conversation early and often is the best way to help ensure that your health care plan is understood.

If you have questions at any time throughout your health care journey, don’t hesitate to reach out to your primary care provider because we want to work with you each step of the way.

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About the Author

Dr. Gregory Hutteger attended medical school at A.T. Still University Kirksville College of Osteopathic Medicine (Kirksville, Mo.), prior to completing his family medicine residency in Michigan. Board-certified in family medicine, Dr. Hutteger cares for patients at  Methodist Physicians Clinic as well as Methodist Hospital.

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