The shock team employs an immediate, team-based response. "The focus is on patients not responding well to therapy, and these patients have a high risk for readmissions. It takes a multidisciplinary team to take care of these patients," Dickinson says. "In some ways, the system has not worked for them. These are complicated patients."
Running a smooth multidisciplinary team is no easy task. "It's really hard to do," Dickinson says of the team-based concept. "It's not something that comes naturally [for physicians]," he says. "Most physicians would migrate off and make decisions on their own. Most physicians develop passive-aggressive personalities, and are not good at being collaborative."
In some cases, it's clear that the physicians don't embrace the team concept and won't ever be a fit. Sometimes, however, there are doctors who just need some guidance to become part of a multidisciplinary group.
Dickinson describes a situation in which a physician leader worked with a specialist who "nobody liked" because that person did not adhere to the multidisciplinary style. The doctor in question "would implement plans and put in orders and go in the opposite direction of what we were doing," Dickinson says. It became clear that the other doctors did not want this physician rounding in the ICU.