"If they don't have scars, they haven't been on a team." - Balfour Mount (Larson, p. 198).

In new-employee orientation, I initially ask new hospice team members what Balfour Mount, internationally known expert in hospice and palliative care, meant in this statement about team membership. Often, they are puzzled, but seasoned hospice workers know the teamwork that is the pride of hospice/palliative care does not happen without much sacrifice and struggle by each team member.

Just as we encourage patients and families to analyze the risks and burdens of a treatment or intervention in order to decide its merit, we must examine the burdens and blessings of working as an interdisciplinary team member.

Is it worth it? Let's consider what is entailed. True interdisciplinary teamwork is unique because:

* the team is an integrated group able to overcome traditional discipline-specific boundaries;

* roles blend as required to meet the patient and family needs;

* the care plan is built upon collaboration among team members;

* team members share goals;

* the team, rather than a representative of a particular discipline, manages the care provided; and

* communication occurs frequently and is essential to the ongoing work of the team.

To participate on this level requires a willingness to become vulnerable and transparent with others because each team member's practice is exposed to colleagues' scrutiny. Personal agendas and turf issues must be replaced by openness and blending of roles. All members must be ready to constantly clarify the expectations each has on another or unmet expectations can become a source of resentment and conflict.

Just as professionals approach patients and families, team members must work with each other using a nonjudgmental attitude that respects the culture of each discipline without assigning blame when an intervention fails.

While this may sound great, the day-to-day rigors of maintaining such honesty and cooperation can be taxing. Interdisciplinary team members must be committed to learn through self-disclosure and respect individual personalities to avoid clashes. Such clashes can be disastrous if members are unwilling to work with each other's strengths rather than focusing on weaknesses.

Team members should be as accepting and supportive toward each other as they are to clients. The team must address members who:

* fail to "pull their own weight,"

* dominate meetings,

* are uncooperative with agreed upon care plans and interventions,

* refuse to share information, and

* are unwilling to be honest with peers and address conflict.

So, why bother?

Wouldn't it be much easier to conduct the assessment, develop goals based upon your specialized skills, and function independently without the communication and collaboration necessary for interdisciplinary care?

Those not on effective interdisciplinary teams would probably answer, "Yes!" However, successful teams know that great accomplishments are possible when interdisciplinary teams successfully deliver patient-centered care. As Dale Larson points out in his classic hospice work, The Caring Helper:

"Caregiving teams are able to respond to the complex human problems of people coping with terminal illness. An individual caregiver can't possibly meet all these needs; it requires the expertise of professionals from various disciplines working together to identify issues, problems and opportunities and obtain goals during the course of care" (p. 199).

There are also important outcomes for the team members:

* increased knowledge of self,

* acceptance of other professionals and their discipline's unique perspective on a problem or situation,

* development of conflict-management skills,

* constant evaluation of one's work seen by other professionals,

* ongoing learning through exposure to new ideas and approaches,

* support from other professionals that helps one to cope with the losses and intensity of hospice work, and

* shared failure (and hopefully, related learning) and shared success.

Not all professionals are candidates for interdisciplinary team membership. By exploring the blessings and burdens as described in this article, individuals can better decide whether membership on a hospice interdisciplinary team fits their style of practice.

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