FENTON’S WAY

The Two Baskets of Medicine

In FENTON’S WAY, all of medicine falls into one of two baskets:

1. Emergencies
   Where the mission is to survive the moment.
   This is governed by 5 Mission Essential Tasks (METs):
   Survive, Sort, Stabilize, Communicate, and Transport to higher level of care. When at higher level of care and stable patient transfers into Category 2.Everything Else

2. Everything Else
   The daily, ongoing, complex work of diagnosis, care, recovery, and support.
   This is guided by the Four Questions — the core of this book and this system.

Both are part of FENTON’S WAY.
The difference is the urgency.
The structure stays consistent.

FENTON’S WAY is a system that brings structure and clarity to the chaos of modern healthcare. It is nothing less than the process of the practice of medicine. Automating any activity without first defining the process and the goal of that process does not create a product — it creates expensive noise and dangerous mistakes.

Developed by Leslie H. Fenton, MD, PhD, FACP, FENTON’S WAY reflects decades of service as an Army Special Forces Medic and Navy physician, including multiple deployments with Special Operations Task Forces, service as Senior Medical Officer for Naval Special Warfare (SEAL Teams), and work in ERs, ICUs, home care, systems design — and as a patient and caregiver himself.

FENTON’S WAY Divides Medicine in to two categories (baskets) A) Emergencies B) Everything Else

Individual Issues in Each Category (Basket) are resolved by successfully accomplishing Defined Mission Essential Tasks (METs). built by accomplishing specific

(A) EMERGENCIES

5 Mission Essential Tasks for (Mass Casualty Scenario) Emergencies

  1. Survive - Situational Awareness (avoid or minimize additional injuries or worsening of the currently injured)

  2. Sort - 3 Categories

    A) Dying (3 categories, 1) Right Now: seconds-minutes; 2) Soon: minutes-hours 3) Eventually: Hours to Days);

    B) Alive (Would survive without Loss of function without care)

    C) Dead ( Have expired or will expire regardless of care available - Provide Comfort Measures)

  3. Stabilize - Dying Right Now > Soon > Eventually

  4. Communicate

  5. Transport

(B) EVERYTHING ELSE

4 Mission Essential Tasks for Everything Else

Ask and Answer Four Questions = Four Mission Essential Tasks (METs) for Everything Else (routine day to day medicine)

• Question #1: Who are you, and who are you becoming?

• Question #2: Why are you here right now? Why not yesterday? Why not tomorrow?

• Question #3: Do we know what we’re doing?
  - The PRODUCT OF VALUE: a prioritized, up-to-date, accurate, functioning Medical ISSUE List
  - Each ISSUE includes Specific Plan of Actions to
    - Achieve definition of the Issue at lowest level of abstraction that provides greatest quality of care at greatest Benefit/Cost Defined by Patient & Attending Physician
    - Provide greatest quality of care at greatest Benefit/Cost Defined by Patient & Attending Physician
    - definition of success - achieve highest level of function at greatest Benefit/Cost Defined by Patient & Attending Physician
    - Restore and Maintain optimal function as Defined by Patient & Attending Physician
    - Restore and Maintain highest quality of life Defined by Patient & Attending Physician

• Question #4: When are we leaving, where are we going, and who cares?

These Four Questions are the foundation of FENTON’S WAY. You’ll encounter them throughout this text — as prompts, reflections, and structural anchors. They are designed to be used in real time — by patients, physicians, and system leaders alike.

FENTON’S WAY delivers an up-to-date, accurate, and prioritized list of your active medical issues.

Each ISSUE is not just a diagnosis. It’s a mission statement.

This approach has been applied:
- In trauma bays and on battlefields
- In rural home visits and hospital command centers
- In quiet conversations with patients near the end of life
- In training sessions for students just beginning their journey

FENTON’S WAY is not just for emergencies. It’s for everything else.

It’s for every decision that must honor both life and purpose.

This is more than a method. It’s a mindset — a format for all communication.

Once you learn the Way, you’ll begin to see its power in every part of your healthcare.