Champion of patient preferences

Dr. Susan Tolle

Dr. Susan Tolle selected for 2016 Esther Pohl Lovejoy Leadership Alumni Award

April 26, 2016

In 1991, a group of medical ethicists in Oregon made a troubling discovery that patient preferences for end-of-life care expressed in advance directives were not consistently honored.

Led by Susan Tolle, M.D. '77, director of the OHSU Center for Ethics in Health Care and professor of medicine, OHSU School of Medicine, and others, the group devised Physician Orders for Life-Sustaining Treatment, translating patient preferences into medical orders that are entered into an electronic registry.

The POLST Paradigm has been implemented in some form in 45 states. In 2014, the Institute of Medicine endorsed it.

That same year, Dr. Tolle was awarded the MacLean Center Prize in Clinical Ethics, one of the most prestigious national prizes in the field of ethics. She donated the $50,000 prize to the OHSU Foundation, acknowledging that it represented the work of hundreds of health care professionals in Oregon and across the country.

In 2015, Dr. Tolle was invited to write an essay in the New England Journal of Medicine discussing who should lead conversations with patients about their choices when facing advanced illness or frailty.

Who should have the difficult discussion of the goals of care with Anne, a 59-year-old woman with advanced illness?

That was the conversation prompt beneath a case vignette published Feb. 11, 2015, in the journal.

Dr. Tolle responded that patients and families need support and argued for primary care physicians to lead the conversations and provide support.

"Having conversations about the goals of care earlier in the course of an illness often affects satisfaction and the choices patients make," she said.

Read her essay on the NEJM website.

Dr. Tolle continues to make significant contributions to the national conversation on "difficult discussions."

Learn more about the Lovejoy award.