True or False? “There’s no process in place to revisit the POLST if and when a person’s physical status changes.”
Hopefully, you know this is False: A POLST Paradigm Form is meant to be updated so that it always reflects your current wishes about what medical treatments you want during an emergency given your current medical condition.
While many of Dr. K’s remarks about POLST were accurate and we appreciate his clearly patient-centered approach to medicine, we were concerned about this fundamental element of a POLST Paradigm Form not being shared.
We agree with Dr. Komaroff that, “One important issue to consider is this: POLSTs can dictate very specific treatment that’s based on a person’s needs when he or she signs the form.” But we disagree with his statement that “there’s no process in place to revisit the POLST if and when a person’s physical status changes. Suppose your husband no longer agreed with the instructions in his POLST, but was not able to communicate with physicians. In that situation, the POLST could be a problem.”
To help educate him — and hopefully those who saw that column — the National POLST Paradigm Office responded to Dr. Komaroff, explaining:
A POLST Paradigm Form (called different things in different states) can be changed or voided at any time. Since it is a set of medical orders, as a clinical matter, the National POLST Paradigm Task Force recommends POLST Paradigm Form orders be reviewed periodically and specifically when:
• The patient’s goals of care and/or treatment preferences change, or
• A patient is transferred from one care setting or care level to another, or
• There is a substantial change in the patient’s health status.
Additionally, a POLST Paradigm Form is a medical order, so it serves a different purpose than an Advance Directive or Living Will, which are legal documents. Legal documents cannot be honored by emergency medical staff (EMS) at the scene of an emergency — EMS are legally required to do everything possible to attempt to save a patient’s life, unless a medical order providing otherwise is available. In contrast, POLST Paradigm Forms are medical orders that are followed by EMS. Additionally, POLST Paradigm Forms help reassure EMS personnel that the medical treatments being administered are consistent with the patient’s wishes.
Please contact the National POLST Paradigm Office for help in clarifying questions or misinformation about POLST. We are here to help!