Journal of General Internal Medicine

, Volume 14, Issue 4, pp 243–248


Patients in the balance
  • David T. Stern
  • Catherine V. Caldicott
Original Articles

DOI: 10.1046/j.1525-1497.1999.00325.x

Cite this article as:
Stern, D.T. & Caldicott, C.V. J GEN INTERN MED (1999) 14: 243. doi:10.1046/j.1525-1497.1999.00325.x


OBJECTIVE: To examine the language of “turfing,” a ubiquitous term applied to some transfers of patients between physicians, in order to reveal aspects of the ideology of internal medicine residency.

SETTING: Academic internal medicine training program.

MEASUREMENTS: Using direct observation and a focus group, we collected audiotapes of medical residents’ discussions of turfing. These data were analyzed using interpretive and conversation analytic methods. The focus group was used both to validate and to further elaborate a schematic conceptual framework for turfing.

MAIN RESULTS: The decision to call a patient “turfed” depends on the balance of the values of effectiveness of therapy, continuity of care, and power. For example, if the receiving physician cannot provide a more effective therapy than can the transferring physician, medical residents consider the transfer inappropriate, and call the patient a turf. With appropriate transfers, these residents see their service as honorable, but with turfs, residents talk about the irresponsibility of transferring physicians, burdens of service, abuse, and powerlessness.

CONCLUSIONS: Internal medicine residents can feel angry and frustrated about receiving patients perceived to be rejected by other doctors, and powerless to prevent the transfer of those patients for whom they may have no effective treatment or continuous relationship. This study has implications for further exploration of how the relationships between physicians may uphold or conflict with the underlying moral tenets of the medical profession.

Key words

residency patient transfers turfing professional relationships professional values 

Copyright information

© Society of General Internal Medicine 1999

Authors and Affiliations

  • David T. Stern
    • 1
    • 2
  • Catherine V. Caldicott
    • 1
    • 2
  1. 1.the Division of General Internal Medicine, Department of Internal MedicineAnn Arbor Veterans Administration HospitalUSA
  2. 2.The Robert Wood Johnson Clinical Scholars ProgramUniversity of MichiganAnn Arbor
  3. 3.Ambulatory Care (11A)Ann Arbor