Quick reference · Wardwise

Read

Identify the format and your role (a second-year Foundation doctor, or F2, unless stated otherwise).
State the central problem in one sentence.
Distinguish facts, reports and assumptions.
Identify who could be harmed and whether action can wait.
Read each option’s verb, recipient, timing and condition.
Expect every option to sound plausible; the best response is always present.

Rank

Judge actions independently by appropriateness, not chronology.
Sort into good, acceptable and poor, then compare within each group.
Compare adjacent options using a specific fact and consequence.
Do not invent an earlier action to rescue a weak response.
Use every rank once and check the scale direction.

Choose three

The three together should fully resolve the situation.
Identify what each action contributes.
Check that the set addresses the scenario’s important needs and that its actions are compatible.
Replace the weakest choice if another action addresses the situation better.
Select exactly three.

Separate close options

Ask: Which addresses the actual issue, in time, within the described role? Which relies on fewer unsupported assumptions? Which avoids unnecessary harm or loss of dignity while still being effective?

Try: “A is preferable to B because the scenario says ___, which means ___.”

Usual starting points and what could change them

Use the left-hand column as a starting point. The right-hand column shows facts that could change your response. Always check the exact scenario and options.

Usual starting point	What could change it
Address immediate patient risk before longer-term fixes.	No current risk is described; the question concerns recurrence or learning.
Speak to a colleague directly and privately about a non-urgent concern.	Harm is happening now, the concern is serious misconduct or impairment, or a power imbalance makes a private approach unsafe.
Escalate to the person who can act now (often the registrar or responsible clinician).	The issue is non-urgent and developmental, so a supervisor route fits better.
Clarify before acting when facts are uncertain and risk is low.	Clarifying would delay action on a clear danger.
Explore the patient’s concerns and wishes before persuading.	The patient lacks capacity for this decision, or an emergency changes the basis for acting.
Be honest, including about uncertainty; never falsify or conceal.	Nothing changes this. Consider only how and by whom honest information is given.
Keep information confidential unless sharing is justified.	Sharing is for direct care, the patient consents, or a lawful or serious-risk justification applies.
Work within your competence and seek supervision for what exceeds it.	Nothing removes this. In a true emergency, do what you safely can while help arrives.
Fulfil commitments (rota, teaching, deadlines) by legitimate means.	Doing so would leave patients unsafe or require you to work while unfit.
Look after your own fitness to work and seek independent advice about it.	Nothing removes this. Arrange safe handover rather than simply leaving.
Avoid treating yourself, family or friends, and keep personal and professional relationships separate.	A genuine emergency with no alternative.

Avoid rigid shortcuts

Shortcut	Better question
Always escalate	To whom, for what purpose, and with what urgency?
Always gather more information	Would clarification change the response, and can it safely wait?
Patient safety overrides everything	What specific risk exists, and how do consent and other duties apply?
Reassurance is always kind	Is it truthful and does it address the person’s need?
Taking all the work shows resilience	Can you do it safely, and is there a better supported plan?

If the terminology is unfamiliar, use the roles and terminology guide. If a comparison keeps going wrong, use the review template.