AMA Journal of Ethics^®

Safe discharge planning and execution require linkage to follow-up, patient engagement, and multidisciplinary teamwork.

This article summarizes AMA Code of Medical Ethics' guidance about patient transfer practices and discharge planning.

Dr Emma Cooke joins Ethics Talk to discuss her article, coauthored with Dr Holland Kaplan: “How Should Technology-Dependent Patients’ Care Be Managed Collaboratively to Avoid Turfing?”

Turfing is a colloquialism that refers to what clinicians do to patients whose needs do not fit neatly and tidily into typical clinical placement protocols.

Dr Kaarkuzhali B. Krishnamurthy joins Ethics Talk to discuss her article: “Should Physicians Be Able to Refuse to Care for Patients Insured by Medicare?”

This commentary on a case considers whether and to what extent refusal to care for patients insured by Medicare is a form of turfing.

Maya Roytman joins Ethics Talk to discuss her article: “AMA Code of Medical Ethics’ Opinions Related to ‘Turfing.’”

The language of “placement” is key in health care organizations’ admissions and discharge planning policies and practices. Where patients are thought to belong has substantial clinical and ethical heft in the everyday operations of the US health services sector. Turfing is generally regarded as an inappropriate reference to patients whose needs and vulnerabilities prompt us to want to make them someone else’s responsibility. Turfing can happen in inpatient settings when one care team looks to divert responsibility for a patient’s care to another team, in outpatient settings when clinicians refuse to take care of, say, patients insured by Medicare or Medicaid, and in discharge planning to rehabilitation or skilled care facilities. This theme issue investigates clinical and ethical criteria for determining what it means to be a person who belongs somewhere under a clinician’s watch in health care.

Constraints on hospitalists and surgeons and restricted orthopedic admission criteria can exacerbate patients’ distress that comes from clinicians’ disagreements.

Dr Catherine V. Caldicott joins Ethics Talk to discuss why turfing, despite being such a common, troublesome ethical issue, receives such little attention in the literature, how clinicians can ensure appropriate and safe transfers of care, and what health professions students and trainees can do to confront turfing when they see it.