This scenario presents a professional challenge because it involves balancing the candidate’s desire for efficient preparation with the ethical obligation to ensure the integrity of the examination process and the credibility of the fellowship. The fellowship exit examination is designed to assess a candidate’s comprehensive understanding and readiness for advanced orthodontic practice, and the resources and timeline recommended must reflect this rigor. Careful judgment is required to avoid recommending shortcuts that could compromise learning or create an unfair advantage. The best approach involves a structured, comprehensive, and ethically sound preparation strategy. This includes a detailed review of the fellowship curriculum, engagement with recommended academic literature, participation in practice case analyses, and consistent self-assessment using a variety of resources. A realistic timeline should be established, allowing ample time for in-depth study, reflection, and skill refinement, rather than focusing on rapid completion. This approach aligns with the ethical principles of professional development, ensuring that candidates are genuinely prepared and that the fellowship maintains its high standards. It respects the learning process and the commitment to excellence expected of advanced practitioners. An approach that prioritizes speed and superficial coverage of material is professionally unacceptable. This might involve relying solely on condensed study guides or focusing only on memorizing exam formats without deep understanding. Such a strategy fails to uphold the ethical responsibility to acquire and demonstrate true mastery of the subject matter. It risks producing practitioners who are inadequately prepared, potentially compromising patient care and the reputation of the orthodontic profession. Furthermore, it undermines the purpose of a rigorous exit examination, which is to validate competence. Another professionally unacceptable approach would be to exclusively seek out “insider” information or past examination materials that have not been officially sanctioned for practice. This circumvents the intended assessment process and introduces an element of unfairness. It deviates from ethical guidelines that emphasize honest and merit-based evaluation. Relying on such methods suggests a lack of confidence in one’s own learning and an attempt to gain an advantage through questionable means, which is contrary to the principles of academic integrity and professional conduct. Finally, an approach that neglects to engage with current research and evolving clinical best practices, instead relying solely on outdated knowledge, is also ethically flawed. The field of orthodontics is dynamic, and advanced practitioners are expected to be abreast of the latest evidence-based treatments and technologies. Failing to incorporate this into preparation demonstrates a lack of commitment to lifelong learning and professional growth, which is a cornerstone of ethical practice. The professional decision-making process for similar situations should involve a commitment to thoroughness, integrity, and continuous learning. Professionals should always prioritize approaches that foster genuine understanding and competence over those that offer superficial gains. This involves consulting official fellowship guidelines, seeking advice from experienced mentors, and developing a study plan that is both comprehensive and realistic, ensuring that all preparation activities are aligned with ethical standards and the overarching goal of providing excellent patient care.

This scenario presents a professional challenge due to the inherent conflict between a practitioner’s desire to advance their knowledge and the ethical imperative to avoid misleading or deceptive marketing practices. The pressure to remain competitive in a specialized field, coupled with the potential for increased patient referrals, can create a temptation to overstate qualifications or the uniqueness of services offered. Careful judgment is required to ensure that all professional communications are truthful, accurate, and do not exploit patient trust. The best professional approach involves accurately and transparently representing one’s qualifications and the scope of services offered. This means clearly stating that the fellowship is an advanced training program focused on a specific area of orthodontics, without implying it confers a distinct specialty recognized by regulatory bodies or professional associations beyond its stated scope. It requires avoiding any language that could be interpreted as creating a new, unrecognized specialty or suggesting a level of expertise that is not demonstrably supported by established standards. This aligns with ethical principles of honesty, integrity, and patient welfare, and adheres to guidelines that prohibit misleading advertising and the misrepresentation of professional credentials. An incorrect approach would be to market the fellowship as establishing a “new sub-specialty” in orthodontics. This is ethically problematic because it misrepresents the nature of the fellowship, potentially creating a false impression of a recognized, distinct area of expertise that may not be acknowledged by professional orthodontic boards or regulatory authorities. Such a claim could mislead patients into believing they are receiving treatment from a uniquely qualified specialist when the training, while advanced, may not meet the criteria for a formally recognized sub-specialty. This violates principles of truthfulness in advertising and professional conduct. Another incorrect approach would be to imply that completion of this fellowship automatically grants a higher level of certification or licensure than is officially recognized. This misrepresents the value and standing of the fellowship, potentially deceiving patients about the practitioner’s credentials and the regulatory oversight of their practice. It undermines the established pathways for professional recognition and certification within the orthodontic field. Finally, an incorrect approach would be to use vague or ambiguous terminology that suggests superior or exclusive treatment capabilities without concrete evidence or established recognition. This can create an unwarranted perception of advantage for patients and is a form of deceptive marketing, as it relies on implication rather than clear, verifiable information about the practitioner’s skills and the nature of their advanced training. Professionals should employ a decision-making framework that prioritizes transparency, accuracy, and patient well-being. This involves critically evaluating all marketing materials and professional communications to ensure they are factually correct, avoid exaggeration, and do not create misleading impressions. When in doubt, consulting with professional ethics committees or regulatory bodies for guidance is a prudent step. The focus should always be on providing patients with accurate information to make informed decisions about their care.

This scenario presents a professional challenge due to the inherent conflict between patient well-being, the financial implications of material choices, and the ethical obligation to provide the highest standard of care. The orthodontist must navigate the temptation to use less expensive materials that may not offer the same long-term benefits or biocompatibility, while also adhering to professional standards and patient trust. Careful judgment is required to prioritize patient outcomes and safety above all else. The best professional approach involves a transparent discussion with the patient about the available material options, clearly outlining the advantages and disadvantages of each, including their respective costs and long-term performance. This approach prioritizes informed consent and patient autonomy. By presenting evidence-based information and allowing the patient to make a decision based on a full understanding of the implications, the orthodontist upholds their ethical duty of beneficence and non-maleficence. This aligns with the principles of patient-centered care, ensuring that the chosen materials are not only effective but also suitable for the individual patient’s needs and circumstances, while respecting their financial considerations. An approach that involves unilaterally selecting the less expensive material without full disclosure to the patient is ethically flawed. This constitutes a failure to obtain informed consent, as the patient is not privy to the full range of options and their consequences. It also risks violating the principle of non-maleficence if the chosen material proves to be less effective or poses a higher risk of adverse reaction compared to superior alternatives. Furthermore, it can erode patient trust and potentially lead to professional repercussions if the patient later discovers the lack of transparency. Another professionally unacceptable approach is to insist on the most expensive material without adequately considering the patient’s financial constraints or exploring more cost-effective, yet still high-quality, alternatives. While aiming for the best possible outcome is commendable, an inflexible stance can be perceived as paternalistic and may create an undue financial burden on the patient, potentially leading to non-compliance with treatment. This fails to balance the pursuit of optimal clinical results with the practical realities of patient affordability and accessibility of care. Finally, an approach that involves using materials of questionable quality or origin to reduce costs, even if presented as equivalent to standard options, is a grave ethical and regulatory breach. This directly compromises patient safety and the integrity of orthodontic treatment, potentially leading to treatment failure, adverse biological responses, and significant harm. Such actions undermine the profession’s commitment to evidence-based practice and patient welfare. Professionals should employ a decision-making framework that begins with a thorough assessment of the patient’s clinical needs. This should be followed by an exploration of all clinically appropriate material options, considering their evidence-based efficacy, biocompatibility, and potential risks. A transparent and open dialogue with the patient is paramount, where all options, including their respective costs and benefits, are clearly explained. The final decision should be a collaborative one, respecting the patient’s informed choice within the bounds of safe and ethical practice.

The scenario presents a common challenge in academic and professional development programs: balancing program integrity with candidate support. The Advanced Mediterranean Interdisciplinary Orthodontics Fellowship Exit Examination, like many rigorous assessments, must maintain high standards to ensure the quality of practitioners. However, the fellowship also has a vested interest in the success of its candidates, who represent the program’s reputation and future contributions to the field. The challenge lies in defining a retake policy that is fair, transparent, and upholds the program’s commitment to excellence without being unduly punitive. This requires careful consideration of the blueprint weighting, scoring, and the rationale behind retake decisions. The best approach involves a clearly defined, pre-established policy that prioritizes objective assessment and developmental feedback. This policy should outline the specific criteria for passing, the weighting of different blueprint components, and the conditions under which a retake is permitted. Crucially, it must include a structured process for candidates who do not meet the passing threshold, offering constructive feedback based on their performance against the blueprint. This feedback should highlight specific areas of weakness, allowing for targeted remediation. The justification for a retake should be based on a demonstrated need for further development in specific, identified areas, rather than a simple failure to pass. This aligns with ethical principles of fairness and professional development, ensuring that retakes are opportunities for growth and that the examination remains a valid measure of competence. An approach that focuses solely on a predetermined number of retakes without considering the candidate’s performance against the blueprint is problematic. This fails to acknowledge that some candidates may require more support or that a single retake might not be sufficient if the underlying issues are not addressed. It can lead to a perception of arbitrariness and does not foster a developmental mindset. Another flawed approach is to allow retakes based on subjective appeals or extenuating circumstances without a clear, objective framework. While compassion is important, relying on subjective judgment can undermine the perceived fairness and consistency of the examination process. It opens the door to bias and can dilute the rigor of the assessment. Finally, an approach that does not provide specific, actionable feedback after a failed attempt is ethically questionable. Candidates have a right to understand why they did not pass and what they need to do to improve. Without this, a retake becomes a guessing game, and the program fails in its duty to support professional growth. Professionals should approach such situations by prioritizing transparency, objectivity, and fairness. This involves developing and communicating clear policies in advance, ensuring that assessment criteria are well-defined and aligned with the program’s learning objectives, and providing constructive, evidence-based feedback to candidates. The decision-making process should be guided by the principle of promoting competent practitioners while upholding the integrity of the fellowship.

The evaluation methodology shows that managing complex patient cases involving potential interprofessional referrals requires a nuanced approach that prioritizes patient well-being, informed consent, and adherence to professional ethical standards. This scenario is professionally challenging because it involves a patient with a potentially serious underlying condition that may fall outside the orthodontist’s primary scope of practice, necessitating collaboration with other specialists. The orthodontist must balance the patient’s immediate orthodontic concerns with the urgent need to address the suspected systemic issue, all while maintaining patient trust and confidentiality. The best approach involves a comprehensive assessment that acknowledges the limitations of orthodontic expertise in diagnosing and managing systemic conditions. This includes a thorough clinical examination, review of patient history, and consideration of any presenting symptoms that suggest a broader medical issue. Upon identifying a potential systemic concern, the orthodontist should engage in open and transparent communication with the patient, clearly explaining the observed signs, the potential implications for their oral and overall health, and the necessity of further investigation by a medical specialist. This approach is correct because it upholds the ethical principle of beneficence (acting in the patient’s best interest) and non-maleficence (avoiding harm) by ensuring the patient receives appropriate medical evaluation. It also respects patient autonomy by providing them with clear information to make informed decisions about their care. Furthermore, it aligns with professional guidelines that mandate collaboration and appropriate referral when a patient’s needs exceed the practitioner’s expertise. An incorrect approach would be to dismiss the observed signs as unrelated to the orthodontic treatment or to proceed with orthodontic treatment without addressing the potential systemic issue. This fails to act in the patient’s best interest and could lead to delayed diagnosis and treatment of a serious medical condition, potentially causing significant harm. Another incorrect approach would be to refer the patient to a medical specialist without adequately explaining the reasons for the referral or the potential implications of the observed signs. This undermines patient trust and autonomy, as the patient may not understand the necessity of the referral or may feel coerced. Finally, attempting to diagnose or manage the suspected systemic condition without appropriate medical qualifications or consultation would be a clear violation of professional boundaries and ethical practice, potentially leading to misdiagnosis and inappropriate treatment. Professionals should adopt a decision-making process that begins with a thorough clinical assessment, followed by a critical evaluation of whether the patient’s needs fall within their scope of practice. If there is any doubt or indication of a condition requiring specialized medical attention, the professional should prioritize patient safety and well-being by initiating a timely and appropriate referral. This process must always be underpinned by clear, honest, and empathetic communication with the patient, ensuring they are fully informed and empowered to participate in their care decisions.

The scenario presents a common challenge in orthodontic practice: balancing patient autonomy and informed consent with the clinician’s professional judgment and ethical obligations, particularly when a patient’s wishes diverge from recommended treatment. The complexity arises from the need to ensure the patient fully understands the implications of their choices, the potential risks and benefits, and the long-term consequences, while also upholding the standards of care expected within the orthodontic profession. This requires a nuanced approach that prioritizes clear communication and shared decision-making. The best approach involves a thorough and documented discussion with the patient and their guardian, if applicable, detailing the rationale for the recommended treatment plan, outlining alternative options (even if less ideal), and clearly explaining the potential risks, benefits, and limitations of each. This includes discussing the prognosis with and without the recommended treatment, and ensuring the patient comprehends the potential for suboptimal outcomes or the exacerbation of existing issues if their preferred, less evidence-based, approach is pursued. This aligns with the ethical principles of beneficence (acting in the patient’s best interest) and autonomy (respecting the patient’s right to make decisions about their own care), as well as the professional guidelines that mandate comprehensive informed consent. The documentation of this discussion is crucial for professional accountability and patient safety. An approach that proceeds with the patient’s preferred, but less optimal, treatment without fully exploring the implications or ensuring complete understanding fails to uphold the clinician’s duty of care. This could be seen as a breach of the principle of non-maleficence, as it may lead to a worse outcome for the patient. Furthermore, it bypasses the essential process of informed consent, where the patient must be empowered to make a decision based on a clear understanding of all relevant factors. Another unacceptable approach is to dismiss the patient’s concerns outright and insist solely on the clinician’s initial recommendation without engaging in a dialogue about the patient’s motivations or fears. This disregards the patient’s autonomy and can erode trust, potentially leading to non-compliance or dissatisfaction. It fails to acknowledge that patient preferences, while needing to be guided by professional expertise, are a valid component of the treatment planning process. Finally, agreeing to a treatment plan that is clearly detrimental to the patient’s oral health, even if requested, would be ethically indefensible. This would violate the core principle of beneficence and could expose the clinician to significant professional liability. The clinician’s primary responsibility is to provide care that is in the patient’s best interest, based on their professional knowledge and ethical obligations. Professionals should approach such situations by first actively listening to and understanding the patient’s perspective and concerns. This should be followed by a clear, jargon-free explanation of the clinical findings and the evidence-based treatment recommendations, including the rationale behind them. The clinician must then present and discuss all viable alternatives, transparently outlining the pros and cons of each, and ensuring the patient (and guardian) fully comprehends the information. The decision-making process should be collaborative, with the clinician guiding the patient towards the most appropriate course of action while respecting their ultimate right to choose, provided that choice does not lead to significant harm. Thorough documentation of all discussions and decisions is paramount.

Scenario Analysis: This scenario presents a professional challenge due to the inherent conflict between a patient’s expressed desire for a specific, potentially non-evidence-based treatment and the orthodontist’s ethical and professional obligation to provide care that is in the patient’s best interest, supported by current scientific understanding and regulatory guidelines. The challenge lies in navigating patient autonomy while upholding professional standards and avoiding potential harm or ineffective treatment. Careful judgment is required to balance patient wishes with the orthodontist’s duty of care, ensuring informed consent is truly informed and not merely acquiescent. Correct Approach Analysis: The best professional practice involves a thorough diagnostic assessment, followed by a detailed discussion with the patient about all viable treatment options, including their respective risks, benefits, and limitations, based on current orthodontic evidence. This approach prioritizes patient understanding and shared decision-making. The orthodontist must clearly articulate why the proposed non-evidence-based treatment is not recommended, explaining the scientific rationale and potential negative consequences, while also presenting evidence-based alternatives that can achieve the patient’s aesthetic goals safely and effectively. This aligns with the ethical principles of beneficence (acting in the patient’s best interest) and non-maleficence (avoiding harm), as well as the regulatory requirement for informed consent, which necessitates a comprehensive understanding of treatment alternatives. Incorrect Approaches Analysis: Proceeding with the patient’s requested non-evidence-based treatment without a robust discussion of alternatives and risks is ethically problematic. It fails to uphold the orthodontist’s duty of care and could lead to suboptimal outcomes, patient dissatisfaction, and potential harm. This approach disregards the principle of non-maleficence and undermines the integrity of informed consent by not ensuring the patient is fully aware of the implications of their choice. Agreeing to the non-evidence-based treatment solely to satisfy the patient’s immediate request, without adequately exploring and presenting evidence-based alternatives, constitutes a failure to act in the patient’s best interest. This prioritizes patient appeasement over professional judgment and scientific evidence, potentially leading to ineffective treatment and wasted resources. It also fails to meet the standard of care expected in orthodontic practice. Refusing to discuss any treatment options beyond the patient’s initial request, without first attempting to understand their motivations and presenting evidence-based alternatives, can be perceived as dismissive of patient autonomy. While the orthodontist has a duty to recommend evidence-based care, a complete refusal to engage in a dialogue about the patient’s desires and concerns, before offering alternatives, can damage the patient-provider relationship and may not ultimately lead to the patient accepting the most appropriate care. Professional Reasoning: Professionals should approach such situations by first actively listening to and understanding the patient’s concerns and motivations for their desired treatment. This should be followed by a comprehensive diagnostic workup. Subsequently, a transparent and detailed discussion should occur, outlining all evidence-based treatment options, including their potential benefits, risks, limitations, and expected outcomes. The orthodontist must clearly explain why any requested treatment that deviates from established evidence-based protocols is not recommended, providing scientific justification. The goal is to empower the patient with sufficient information to make a truly informed decision, in collaboration with the orthodontist, that aligns with their aesthetic goals and is supported by sound clinical practice.

This scenario presents a professional challenge due to the inherent complexity of diagnosing and managing craniofacial anomalies, which often involve intricate anatomical variations, subtle histological changes, and potential pathological processes. The clinician must navigate these complexities while adhering to ethical obligations of patient care and professional conduct. The challenge is amplified by the need to integrate knowledge from multiple disciplines – orthodontics, anatomy, histology, and pathology – to formulate an effective treatment plan. The best professional approach involves a comprehensive, multidisciplinary assessment that prioritizes accurate diagnosis and patient-centered care. This includes a thorough clinical examination, detailed radiographic analysis, and, where indicated, histological evaluation of relevant tissues. The clinician must then synthesize this information to develop a treatment plan that addresses the underlying anatomical and pathological issues, considering the patient’s overall health and aesthetic goals. This approach aligns with the ethical imperative to provide competent care, act in the patient’s best interest, and maintain professional standards. An approach that relies solely on a superficial clinical examination without considering underlying histological or pathological factors would be professionally unacceptable. This failure to investigate thoroughly could lead to misdiagnosis, inappropriate treatment, and potentially adverse outcomes for the patient, violating the duty of care. Another professionally unacceptable approach would be to proceed with treatment based on assumptions about the craniofacial anatomy without confirming these assumptions through appropriate diagnostic imaging or, if necessary, biopsy. This disregard for diagnostic rigor risks treating symptoms rather than causes and could lead to ineffective or harmful interventions. Finally, an approach that prioritizes a specific orthodontic technique over a complete understanding of the patient’s craniofacial anatomy and oral pathology would be ethically and professionally flawed. This narrow focus neglects the holistic nature of patient care and could result in a treatment plan that exacerbates existing problems or fails to address the root cause of the patient’s condition. Professionals should employ a systematic decision-making process that begins with a thorough patient history and clinical examination, followed by the judicious use of diagnostic tools (radiographic, histological, etc.) to establish an accurate diagnosis. Treatment planning should then be based on this diagnosis, considering all relevant anatomical, histological, and pathological factors, and always prioritizing the patient’s well-being and informed consent.

This scenario presents a professional challenge due to the inherent conflict between immediate patient comfort and long-term oral health outcomes, particularly when dealing with a child’s developing dentition and parental expectations. The orthodontist must balance the immediate need to address caries with the broader orthodontic treatment plan, ensuring that any intervention is minimally invasive, evidence-based, and aligns with the ethical principles of patient welfare and informed consent. Careful judgment is required to avoid compromising future orthodontic treatment or causing unnecessary distress to the child. The best professional approach involves a comprehensive assessment of the carious lesions in conjunction with the orthodontic treatment plan. This includes determining the extent and depth of the caries, their impact on enamel and dentin, and their potential to progress during orthodontic treatment. Based on this assessment, the orthodontist should collaborate with a pediatric dentist or cariologist to develop a minimally invasive treatment strategy. This might involve early remineralization therapies, conservative restorations, or sealants, prioritizing the preservation of tooth structure and minimizing interference with orthodontic mechanics. The rationale for this approach is rooted in the principle of “do no harm” and the ethical obligation to provide the highest standard of care. Furthermore, it aligns with the professional guidelines that advocate for integrated oral health management, where orthodontic treatment is not viewed in isolation but as part of a holistic approach to oral well-being. This collaborative and conservative strategy ensures that the orthodontic treatment can proceed effectively while safeguarding the long-term health of the teeth. An incorrect approach would be to proceed with orthodontic bracket placement without a thorough assessment and management of the active carious lesions. This failure to address active disease prior to initiating orthodontic treatment poses a significant risk of exacerbating the caries, leading to more extensive tooth decay, demineralization around brackets, and potential pulpal involvement. Ethically, this neglects the primary duty to protect the patient’s oral health. Another incorrect approach would be to recommend aggressive, irreversible restorative procedures for minor carious lesions solely to expedite orthodontic treatment. This violates the principle of minimally invasive dentistry and could lead to unnecessary loss of healthy tooth structure, potentially compromising the long-term prognosis of the teeth and the orthodontic outcome. It also fails to adequately consider the child’s developmental stage and the potential for remineralization. Finally, an incorrect approach would be to delay orthodontic treatment indefinitely due to the presence of carious lesions without a clear, evidence-based plan for their management and subsequent orthodontic intervention. This could lead to suboptimal orthodontic outcomes if the dental arches continue to develop unfavorably during the delay, and it may also cause undue anxiety for the patient and parents regarding the perceived inability to proceed with treatment. The professional decision-making process for similar situations should involve a systematic evaluation: first, a thorough clinical and radiographic examination to assess the extent of caries and its relationship to the orthodontic needs. Second, consultation with relevant specialists (e.g., pediatric dentist, cariologist) to determine the most appropriate, minimally invasive management plan for the caries. Third, clear and transparent communication with the patient and their guardians regarding the findings, proposed treatment options, risks, benefits, and the integrated plan for both caries management and orthodontic treatment. Fourth, implementation of the agreed-upon plan, prioritizing the patient’s overall oral health and well-being throughout the orthodontic journey.

This scenario presents a professionally challenging situation due to the inherent conflict between a patient’s expressed desires and the orthodontist’s professional judgment regarding the optimal course of treatment for long-term oral health and aesthetic outcomes. The challenge lies in balancing patient autonomy with the orthodontist’s ethical and professional responsibility to provide evidence-based care. Careful judgment is required to ensure the patient is fully informed, understands the implications of different treatment paths, and ultimately makes a decision that aligns with their best interests, even if it differs from their initial preference. The best professional practice involves a thorough and transparent discussion of all viable treatment options, including their respective risks, benefits, limitations, and long-term prognoses. This approach prioritizes comprehensive patient education and shared decision-making. The orthodontist must clearly articulate the rationale behind their recommended treatment plan, supported by diagnostic findings and established orthodontic principles. This ensures the patient understands why a particular approach is considered optimal for achieving stable, functional, and aesthetically pleasing results. This aligns with the ethical principles of beneficence (acting in the patient’s best interest) and non-maleficence (avoiding harm), as well as the professional obligation to provide informed consent, which requires a complete understanding of treatment alternatives. An approach that solely focuses on fulfilling the patient’s immediate aesthetic request without adequately addressing potential long-term functional compromises or stability issues would be professionally unacceptable. This failure to provide a comprehensive overview of risks and benefits, particularly concerning the stability of the proposed outcome and potential for future complications, violates the principle of informed consent. It also risks prioritizing patient preference over professional expertise, potentially leading to suboptimal outcomes and a breach of the duty of care. Another professionally unacceptable approach would be to dismiss the patient’s concerns or preferences outright and unilaterally impose a treatment plan. This disregards patient autonomy and can erode trust, leading to patient dissatisfaction and potential non-compliance. Ethically, this approach fails to respect the patient as an individual with the right to participate in decisions about their own healthcare. Finally, an approach that involves presenting only the orthodontist’s preferred treatment without exploring or explaining alternative options, even if less ideal, is also professionally flawed. This limits the patient’s ability to make a truly informed choice and may lead them to feel that their input is not valued, undermining the collaborative nature of the patient-provider relationship. Professionals should employ a decision-making framework that begins with a comprehensive diagnostic assessment, followed by the development of multiple treatment possibilities. Each possibility should be discussed with the patient in detail, using clear language and visual aids where appropriate, covering expected outcomes, treatment duration, potential discomfort, financial implications, and long-term stability. The orthodontist should actively listen to the patient’s concerns, values, and lifestyle factors, and then collaboratively arrive at a treatment plan that is both clinically sound and personally acceptable to the patient.