Turfing vs receiving a consult
Formal Definition
Two contrasting perspectives on inter-specialty patient care handoff: (1) "Turfing" — sending a patient to another team, often with the implication that the primary team is transferring full responsibility for care when they may be unwilling or unequipped to manage the case; can be appropriate (subspecialty expertise required) or problematic (unjustified transfer that fragments care or dumps unwanted work on another service). (2) "Receiving a consult" — accepting the patient for subspecialty input and recommendations (formal consult) or shared care (co-management); requires clear delineation of expectations and scope.
How It's Used on the Ward
"Turf" or "turfing" — pejorative term that describes transferring a complex or undesired patient to another team; inappropriate turfs divide care awkwardly and frustrate receiving services; "receive the consult" is the neutral term for accepting specialist input on a patient.
Example
""Internal medicine team on the receiving end of a late-day admission: 28-year-old admitted for vague abdominal pain, normal labs, normal imaging, no clear diagnosis, but some insurance coverage the medicine team doesn't take. Receiving resident: 'Did medicine just turf this admit? They didn't work it up, they've ordered nothing, and now it's after midnight on our service.' Genuine turfing example: patient needs a primary medical home for follow-up, but being told 'go to medicine' without appropriate setup leaves the patient with fragmented care.'""
Clinical Context
When turfing is appropriate: (1) genuine subspecialty expertise needed (rare genetic disease, specialized surgical procedure). (2) Patient's primary issues clearly belong to specialty domain (e.g., oncologic surgery to surgical oncology). (3) Patient/family preference for specialist care. (4) Access to care (academic center with specialty team not available elsewhere). When turfing is inappropriate: (1) Workup incomplete and responsibility transferred to receiving team. (2) Patient dumped because of complexity, social issues, insurance, or anticipating poor outcomes. (3) Transfer without communication with receiving team. Receiving a consult well: clarify scope of consult (specific question vs comprehensive management), communicate expectations with primary team, document clearly, provide helpful recommendation even if no further follow-up needed. Healthy cross-specialty relationships: mutual respect, clear communication, recognition that every service has expertise. Unhealthy turfing poisons working relationships and is a quality/culture red flag.