The Five Enemies of Unity in Direct Primary Care By Someone Who’s Been There
If you’re in Direct Primary Care, you already know this model depends on more than just good medicine. It depends on people. Your team. Your leadership. The way you communicate. No matter how small your team, even if it’s just you and your significant other or if you have a dozen people in your office, working together is key!
And in the Direct Primary Care model—where relationships matter more than reimbursement codes, where autonomy fuels excellence—unity isn’t a luxury. It’s a necessity. Without it, you’re paddling against the current with a crew that’s rowing in opposite directions.
It has often been said that a business grows at the speed of trust. Not only is that the trust? Between, in our case, the practice and the patient, but the trust within your practice. It also said if you want to go far, go together. Unity isn’t just a nice-to-have—it’s the foundation if you intend “to go far”. Without it, even the most talented people will underperform. With it, ordinary teams can accomplish extraordinary things.
But there are obstacles to unity that we need to be aware of. And most of the time, they don’t show up with a big warning sign. They creep in quietly. They show up in conversations that don’t happen, in standards that slip just a little, in the habits that get overlooked.
Here are the five most common enemies of unity —and how to deal with them before they cost you more than you realize:
1. Poor Communication
If you’re not communicating clearly and consistently, your team will fill in the blanks. That usually leads to confusion, assumptions, and avoidable problems.
Good communication means more than sending a message—it means making sure the message lands. That people understand what’s expected, what matters, and what to do when something goes wrong.
Start here: Make communication a regular discipline. Clarify priorities. Be honest when something isn’t working. And always ask: “What are we not saying that we need to?”
2. Gossip
Gossip is a symptom of a culture where people don’t feel safe being direct. It’s easy, it’s emotional, and it spreads fast. But it destroys trust.
The moment people start talking about each other instead of to each other, you’re losing alignment.
Address it early. Be clear about your expectations. Build a culture where feedback goes up and across—not behind someone’s back. Gossip doesn’t just waste time—it erodes belief in the team.
3. Unresolved Disagreements
Conflict is normal. What matters is how you handle it.
Too often, disagreements go unspoken. People shut down, distance themselves, and start assuming the worst. That’s how resentment grows.
If you want a strong team, you’ve got to create space for resolution. Don’t avoid hard conversations. Model respectful dialogue. And when something feels “off,” talk about it sooner rather than later.
Clarity always beats avoidance.
4. Lack of Shared Purpose
People don’t just want to be told what to do—they need to know why it matters.
When your team forgets the purpose behind the work, motivation drops. Engagement fades. You might still hit the day-to-day tasks, but you won’t see long-term momentum.
Keep the purpose visible. Talk about it in meetings. Tie it to decisions. Celebrate moments when your mission shows up in real ways. A shared goal is what keeps people going when things get hard.
5. Sanctioned Incompetence
This one might be the most damaging of all.
When someone consistently underperforms and it’s ignored, the message to everyone else is clear: “It doesn’t matter.” And that lowers the standard across the board.
You don’t have to be harsh to be clear. But you do have to address performance. You owe it to the team—and to the person struggling.
Leadership isn’t about avoiding discomfort. It’s about protecting what matters.
Unity doesn’t happen by accident. It’s engineered. It’s created through effort, intention, tenacity and a focus on your mission to help the community. Don’t let these five enemies destroy the trust, momentum, and excellence you’ve built.
Lead with purpose. Lead with love.
Damn. That’s really good.
This is an excellent article! Thank you so much!
Amazing! I will be hopefully hiring my first employee in the next 6 months and these are great words of wisdom (experience) and I can relate to all of them over a 25 year career in the other world!