The POLST Form

Tom Bagwell: I’m Tom Bagwell the Director of Fund Development for the Visiting Nurse Association Hospice & Palliative Care of Southern California. It’s a mouthful but what we are done here today is inviting in the community every month to come hear from our experts. It’s called Meet the Experts and today they can hear from Dr. Timothy Dauwalder who will be talking to them about the POLST.

The VNA has been around for 62 years and has been serving the community for you know quite a long time and so we decided it was time to use modern technology and the modern sharing aspects of Facebook and Google plus and other things to really get our word out so we wanted a whole monthly meeting where we could create content to better serve our community.

Today Dr. Dauwalder will be presenting on the POLST which is the Physician Orders for Life Sustaining Treatment and it’s a very important presentation and there is a form that you can fill out that way you can have it ready for your doctor so when the stressful times come for Hospice our home health care and when decisions need to be made. They are usually made when you have your POLTS form on hand.

Dr. Dauwalder: Hi, I’m Dr. Timothy Dauwalder. I’m the Medical Director for VNA Hospice & Palliative Care of Southern California. I’m a Palliative Specialist been certified for some years. It’s a relatively new sub specialty and which I absolutely love. One thing that we deal with is advanced disease processes, the very ill and what that means and in general people with advanced long term diseases that are progressive need a plan for their life and to understand there disease thoughtfully and thoroughly. And as soon as you have a great understanding of the disease process at least, you try to figure out how can you facilitate what you want especially if your very sick.

In the past you just would call 911 or call your doctor you would end up in the hospital, and you may or may not have a care plan that you wanted so there is no voice for those that were very ill.

So today the topic really is POLST which is a legal document that was passed through the legislature of California. POLST stands for Physician Orders for Life Sustaining Treatment. It’s a form on cardboard stock or whatever you print it on that is meant to initiate a discussion with your doctor and your loved one regarding patient care plans for the very sick. In the past as I was mentioning, there weren’t a lot of options if you were very sick other than going to the hospital and whatever overset was thoughtfully derived by the doctor would be the overset. This is a very unique opportunity for the very sick or those with advanced disease or those that have a clear outline of how they wanna be treated when they are very sick.

To have an overset that directs the doctor with how they wanna be treated. So it’s very relevant for advanced disease processes That’s why myself as a Palliative Care Specialist or a Hospice Patients or those with very advanced disease, this is a great adjunct to the advanced health care directive. It doesn’t trump it, it is a complement to it but it allows you to carry a form with you and physician overset which in the past never would happen if you were outside the hospital or outside of skilled nursing, you couldn’t carry and overset with you. So this is a directive order for physicians to treat you in a specific way.

In the past that might be true only for the concept of do not resuscitate or CPR or allowing natural death, these types of singular decision. This form is far more nuance than its great, because you can pick degrees of support that are relevant to your own disease process to minimize suffering and not shorten life expectancy.

The decision to not have CPR and to allow natural death is often confused with ideas of shortening life or hastening death or giving up which is farther from the truth than anything in medicine that I can say it is a falsehood. Certainly people can give up, certainly people can hasten death but decisions they make. This form does not do that it allows freedom of choice to be treated in a way that is dignified that you choose. It can include full treatments, modified treatments, specifically to your disease. An addendum is made specifically with legal right to be treated a certain way and I think that’s a great thing. Nothing is perfect but the point of the form is to be carried with you so if you have an advanced disease if you have an elderly grandmother or mother or person that you love they can have this in the home, if not when one is called so It’s there, they can take it with them to nursing to the hospital and their level of care will be respected as that order says or determines.

You can look up on the web POLST, just that alone and click it and there will be discussions, dialogues, videos, video conferencing, all sorts of things for you to review what the POLST is. But the pint I would say first cause this is a new form, because it is a new form, your doctors may not even know what it is. So you have the opportunity to help move an advance the practice of medicine by being an advocate for your own medical care in advanced disease through this form.

So I would take this form, you can print it out on the internet or ask your doctor if he has one and it is was meant to be in discussion with your doctor to be an educated decision that is set to best help you live your life with the greatest quality. To not cause suffering through actions that even though might be technically accurate and adequate may actual be the source of suffering itself.

And I think we all have examples of that, that even though it seems sound it’s a source of suffering. So I just wanna encourage you to take charge of your medical care, to reach out to the resources that are available to you and don’t hesitate to ask questions and expect the answers that are thoughtful and accurate based on who you are as a patient and as a human on earth.

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