The multidisciplinary medical team is now a prominent feature of our modern medical care system. Over the last 40 years the ‘medical team’ or ‘firm’ has changed in many ways resulting in a way of working which can be deeply satisfying for the team members and beneficial to patients they care for. However, if the team does not function well as a unit the reverse can apply, with much dissatisfaction among staff, and substandard treatment of patients. This short article is a personal view of how things go wrong and how to improve matters based on personal experience of dysfunctional teams.