Turfing: patients in the balance

Area of Science:

• Medical Education
• Sociology of Medicine
• Qualitative Research Methods

Background:

• Patient transfers between physicians, often termed "turfing," are common in internal medicine residency.
• The language used to describe these transfers can reveal underlying ideologies within medical training.

Purpose of the Study:

• To analyze the language of "turfing" to understand the ideology of internal medicine residency.
• To explore resident perceptions of patient transfers and their implications for medical ethics.

Main Methods:

• Direct observation and focus groups were used to collect audiotapes of residents' discussions about turfing.
• Interpretive and conversation analytic methods were employed for data analysis.
• A focus group validated and elaborated a conceptual framework for turfing.

Main Results:

• The decision to label a patient transfer as "turfing" hinges on the perceived balance of therapeutic effectiveness, continuity of care, and power dynamics.
• Residents view appropriate transfers positively but describe "turfed" patients with terms related to irresponsibility, burden, abuse, and powerlessness.
• Inappropriate transfers occur when the receiving physician cannot offer more effective therapy than the transferring physician.

Conclusions:

• Internal medicine residents experience anger, frustration, and powerlessness when receiving patients perceived as rejected or for whom they lack effective treatment options.
• The study suggests that physician relationships and communication surrounding patient transfers can conflict with core medical ethics.
• Further research is needed to explore how these dynamics impact the moral tenets of the medical profession.