Can patients tell when they are unwanted? "Turfing" in residency training

Objectives: When a physician believes that the troubles of caring for a patient outweigh the rewards, he or she can move-"turf", the unwanted patient from his or her own to another physician's territory. Physicians receiving such patients can feel burdened by, and resentful about, caring for those who are "turfed" to them by other physicians, yet little is known about the effects such "turf battles" have on patient care. This study aims to discover if "turfed" patients (TPs) experience their hospitalizations differently from patients whose admissions are perceived more favorably by their physicians. Design: Semi-structured, in-depth interviews. Population: Twenty Six English-speaking patients on a medical service in a tertiary care university hospital. Outcomes: Hospitalization experiences based on qualitative thematic analysis of interview audiotapes and transcripts. Results: The experience of patients perceived as "turfs" differed from patients deemed more appropriately admitted in two areas: mode of admission and tone of interview themes. TPs were admitted via the emergency department or intra-hospital transfer; unlike the "appropriate" patients (APs), none came from outside hospitals. Although patients in both groups voiced many similar themes, nearly all TP interview themes were unfavorable. AP interviewees, by comparison expressed both favorable and unfavorable themes. TPs were direct and explicit about their anger and frustration, while APs mixed humor with complaints. Conclusions: "Turfed" patients may have different care experiences from those of patients deemed appropriate for a medical service. Inter-specialty barriers to collegiality and relationship-centered care shape physicians' perceptions of patient appropriateness and desirability and merit further large-scale exploration. (C) 2004 Elsevier Ireland Ltd. All rights reserved.