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The Collaborative Care Sorting Hat: Gryffindor or Slytherin?

Posted By Randall Reitz, Thursday, September 01, 2011
Updated: Tuesday, May 08, 2012

A tangent to get us started. I'm one of the few people I know who is just getting started with Harry Potter. I read the first book about 7 years ago and loved it so much, that I knew that I would want to read the series with my, then, newborn daughter. We tried to start  reading them during our bedtime reading when she turned 6, but even the more vanilla "Sorcerer Stone” proved too intense for her. About 7 months ago we tried again and it has since consumed much of our daddy/daughter time. We started out with her reading 1 paragraph per page and me picking up the rest. We're now starting Year 5 with a combination of shared and individual reading.

One of my favorite characters from the book is the Sorting Hat. As each new first year student arrives at Hogwarts School of Witchcraft and Wizardry she or he is assigned to 1 of the 4 houses of the school: fearless Gryffindor, devious Slytherin, friendly Hufflepuff, and analytical Ravensclaw. Click here to see which house fits your temperament.

This ritual occurs to great fanfare in front of the entire school at a ceremonial dinner. 1-by-1 the first years sit on a chair and has a floppy, snaggle-toothed witch's hat placed on his/her head. The hat has a mind and a mouth. The mind analyzes the student and intuits fit between the student and the typology of the 4 houses. The child wearing the hat can hear the reasoning of the mind. Then, the mouth announces the assignment to the breath-bated mass in the banquet hall. You can see Harry's experience with the Sorting Hat here.

The Sorting Hat

Sorting through the hats. As a collaborative clinician employed as the Director of  Behavioral Sciences in a family medicine residency, I have developed my own Sorting Hat technology. Unfortunately, my hat's intuition is still foggy, its mind confused, and its mouth glitchy. Hopefully putting pen to paper will help to work out some of the bugs.

In this professional role I wear numerous hats—sometimes consecutively, but usually concurrently:

  • Educator—This is my primary role, either in didactic sessions or through staffing cases in the precepting room and exam rooms;
  • Evaluator—After supervised appointments or behavioral science learning days I prepare formal evaluations of the learner's skills and professional development;
  • Remediator—I serve on a committee that employs both carrots and sticks to assist residents struggling in identified areas (e.g. medical knowledge, professional behavior, curriculum completion, biopsychosocial health concerns);
  • Supporter—Residents are scheduled with me on a 1-to-1 basis about every 2 months and many residents pull me aside to discuss personal issues;
  • Colleague—I have the fortune of a psychologically-minded residency and my faculty colleagues will often seek me out to consult or to cathart;
  • Clinician—I carry a small individual caseload, co-facilitate group medical appointments, and see numerous patients on-the-fly when invited out of the precepting room by medical providers;
  • Supervisor—We have an integrated mental health team (therapists, case managers, doctoral interns) that I supervise clinically.
  • Patient—My family receives our primary care at the residency clinic.

I love being a faculty member and usually wearing the multiple hats is a great job perk. For example, about 6 months ago (hopefully not as a result of Harry Potter), my oldest had a seizure. I found her lying on the floor at 6 a.m. already in the post-ictal phase with no idea as to the etiology of her altered mental status. I put on the patient hat, drove to the residency clinic, found a favorite resident, and got her seen without appointment. Within minutes the team narrowed in on a seizure diagnosis, and rushed us off to hospital. We benefitted from excellent technical care from the ER doctor and compassionate and patient-centered support from a resident and attending physician throughout our inpatient experience. As a bonus, this attending physician is my personal doctor and her partner is one of Grand Junction's few neurologists. To this day, when I put on the patient's hat in the clinic our family doctor answers my questions and offers quick phone consults with the neurologist.

My Mind and Mouth. Despite these benefits, it is not hard to predict that wearing multiple hats often troubles my mind with double and triple role conflicts. For example, when I see patients with residents the clinical, teaching, supportive, and evaluative roles overlap: If the resident is struggling with behavioral patient skills do I leave on the teaching hat and only observe the difficulty, or do I switch to the clinician hat and take over care? When debriefing after the appointment do I approach it with the supportive hat or the evaluative hat?

This is exacerbated when a resident is referred to the remediation committee. My participation during the tense interactions with referred residents can blunt a resident's willingness to confide in me during supportive 1-to-1 sessions. And conversely, it is not clear to me how information that was shared with me in semi-confidence while wearing the supportive hat should affect the proceedings of the remediation committee. Or worse, how would it affect our relationship if a new resident made a mistake in offering care to my family and it resulted in a bad outcome or a referral to the remediation committee?

My mouth is the behavioral manifestation of my mind's hat sorting quandaries. When an ethical or inter-personal dilemma arises from a multi-role relationship, the first response that is usually expected comes through my mouth. In faculty meeting when we discuss a situation with a resident, all eyes will often turn to me to provide insight into the resident's emotional constitution, cognitive faculties, or behavioral eccentricities. When I'm brought in to meet a new patient I feel heightened need to provide a pithy intervention so that my teaching opportunities later in the week will seem credible.

Toggling between mind and mouth while fumbling numerous hats requires 2 under-appreciated skills: delay and vagueness. Delay helps by slowing down the discussion to allow my mind to offer a reasonable solution to my mouth (i.e. "Let me think about this and talk with Resident X before I weigh-in”). Vagueness allows me to wear multiple hats simultaneously without violating their competing ethics. For example, I can respect confidentiality by making a broad statement such as "I think Resident Y might struggle with self-doubt stemming from a difficult experience during her first year”).

My Blog Colleague: My guess is that Sorting Hats are ubiquitous in collaborative settings, especially in collaborative teaching settings. Rather than my idiosyncratic head ornament, Sorters are endemic to our field. How does your Sorter fit?

  • When is your Sorter comfortable? When does it provoke a rash?
  • How do you balance the competing aspects of collaboration?
  • Which aspects of your personal life do you bring to the professional setting, which aspects do you leave at home?
  • Is there any video clip that depicts dual-role relationships better than this one?


Randall Reitz , PhD, LMFT is the executive director of CFHA and the behavioral science faculty at St Mary's Family Medicine Residency in Grand Junction, CO. He and Ana Reitz have 3 children: Gabriela, Paolo, and Sofia.

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Ajantha Jayabarathan says...
Posted Sunday, September 11, 2011
I thoroughly enjoyed your multiple "Randalls" presentation....it rivals George Costanza's dilemma....since there are 8 Randalls present at any given time and in reaction to any situation....delay and vagueness....deployed as you have suggested, restore the balance between conflicting roles, while maintaining the respect for a maturing, evolving clinician...who deserves to grow through mistakes,challenges and real life experiences just like faculty in the professional sense and each of us as parents and human beings.....it is also interesting to note that you are in positions of more and less vulnerability when wearing each of those hats....however....your power within the clinic is assured.....personal and professional, by virtue of all that you bring to the professional relationships within your collaborative circle of support.....it is an interesting web.....
regards
AJ
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Randall Reitz says...
Posted Monday, September 12, 2011
AJ, thanks for your insightful comments. It's interesting that you mention parents. That has me thinking about how this process is shared in the parental role, but with it being more of a lifelong process, rather than just for a few years until graduation with residents.

You seem to be a hat sorting aficianado as well!
Permalink to this Comment }

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