Scenario Analysis: This scenario is professionally challenging because it requires a fellow to navigate the complex and often unwritten expectations of operational readiness for a fellowship exit examination within the Indo-Pacific perioperative medicine context. This involves not only clinical proficiency but also an understanding of systemic preparedness, resource management, and interdisciplinary collaboration, all of which are critical for safe and effective patient care in diverse healthcare settings. The “operational readiness” aspect goes beyond individual skill to encompass the ability to function effectively within the broader healthcare ecosystem, which can vary significantly across the Indo-Pacific region. Careful judgment is required to balance individual preparedness with the systemic realities and expectations. Correct Approach Analysis: The best approach involves a comprehensive self-assessment and proactive engagement with program leadership and faculty. This entails a thorough review of the fellowship curriculum, learning objectives, and expected competencies, cross-referenced with the specific requirements and format of the exit examination. Crucially, it involves seeking direct clarification from program directors and mentors regarding the definition of “operational readiness” within their specific institutional and regional context. This proactive dialogue allows for the identification of any gaps in knowledge, skills, or experience that might impact performance on the examination and subsequent practice. This approach aligns with ethical principles of professional accountability and continuous learning, ensuring the fellow is not only prepared for the assessment but also for the responsibilities of independent practice. It also adheres to the implicit guidance within professional training programs to seek mentorship and guidance when navigating assessment milestones. Incorrect Approaches Analysis: Relying solely on the assumption that clinical proficiency alone constitutes operational readiness is professionally unacceptable. This approach fails to acknowledge the systemic and logistical aspects of perioperative medicine, such as familiarity with local protocols, equipment availability, and team dynamics, which are often implicitly assessed in exit examinations. It represents a significant ethical failure by potentially leading to an underestimation of preparedness and a risk to patient safety upon graduation. Focusing exclusively on memorizing theoretical knowledge without considering its practical application in diverse Indo-Pacific healthcare settings is also professionally inadequate. While theoretical knowledge is foundational, operational readiness demands the ability to adapt and apply that knowledge under varying resource constraints and cultural contexts, which are characteristic of the Indo-Pacific region. This approach neglects the practical realities of perioperative practice and ethical considerations of providing care in resource-limited environments. Waiting until the examination period to address any perceived deficiencies or seek clarification from program leadership is a reactive and potentially detrimental strategy. This approach demonstrates a lack of foresight and proactive professional development. It can lead to undue stress, compromised performance on the examination, and a failure to meet the expected standards of readiness, thereby posing an ethical risk to future patients. Professional Reasoning: Professionals should adopt a proactive and collaborative approach to preparing for fellowship exit examinations. This involves a multi-faceted strategy: 1. Self-Assessment: Critically evaluate personal strengths and weaknesses against program objectives and examination expectations. 2. Seek Clarification: Engage in open and direct communication with program directors, faculty, and mentors to understand the specific definition and components of “operational readiness” within the fellowship’s context. 3. Integrated Learning: Combine theoretical knowledge with practical application, considering the diverse clinical environments and resource availability within the Indo-Pacific region. 4. Simulation and Practice: Utilize available resources for mock examinations, case discussions, and skill-based simulations that mirror the expected examination format and challenges. 5. Mentorship: Actively seek feedback and guidance from experienced clinicians and program leadership throughout the preparation process. This systematic and engaged approach ensures not only successful completion of the examination but also fosters the development of a competent, adaptable, and ethically grounded perioperative physician ready to serve the Indo-Pacific community.

The performance metrics show a concerning trend in post-operative infection rates across several surgical specialties within the Indo-Pacific region. This scenario is professionally challenging due to the inherent complexity of perioperative care, which involves multiple disciplines, varying healthcare system infrastructures, and diverse patient populations across different nations. Ensuring consistent, high-quality care and accurate data collection for performance metrics requires meticulous attention to detail and adherence to established guidelines. Careful judgment is required to interpret these metrics and implement effective interventions. The best approach involves a comprehensive, multi-disciplinary review of the data, focusing on identifying specific contributing factors within each specialty and geographical area. This includes a detailed audit of adherence to established infection prevention protocols, such as hand hygiene, sterile technique, antibiotic stewardship, and environmental cleaning. Furthermore, it necessitates engagement with frontline clinical staff to understand local challenges and barriers to optimal practice. This approach is correct because it aligns with the ethical imperative to provide the highest standard of patient care and the regulatory requirement for continuous quality improvement in healthcare. By systematically investigating the root causes of elevated infection rates, healthcare providers can develop targeted, evidence-based interventions that are most likely to be effective and sustainable, thereby improving patient outcomes and meeting national and regional healthcare standards. An approach that focuses solely on punitive measures against individual practitioners without investigating systemic issues is professionally unacceptable. This fails to address the underlying causes of the problem, which may stem from inadequate resources, training deficiencies, or flawed protocols, and can lead to a climate of fear rather than a culture of improvement. Similarly, an approach that dismisses the data as unreliable without a thorough investigation into data collection methodologies and potential biases is also professionally unacceptable. This ignores the potential for serious patient harm and violates the principle of accountability in healthcare. Finally, an approach that implements broad, unspecific interventions across all specialties without granular analysis of the data is inefficient and may not address the specific drivers of infection in different contexts, leading to wasted resources and potentially failing to achieve the desired improvements. Professionals should employ a systematic decision-making framework that begins with data appraisal, followed by root cause analysis, development of targeted interventions, implementation, and ongoing monitoring and evaluation. This iterative process ensures that interventions are evidence-based, contextually appropriate, and effective in improving patient care and outcomes.

This scenario presents a professional challenge due to the inherent subjectivity in assessing candidate performance against a blueprint, the potential for bias, and the need to maintain fairness and consistency in the fellowship’s evaluation process. The fellowship’s commitment to rigorous standards, as outlined by its blueprint weighting and scoring policies, necessitates a structured and transparent approach to candidate assessment and retake decisions. Careful judgment is required to balance the need for high standards with the ethical obligation to provide fair opportunities for candidates to demonstrate their competence. The best approach involves a comprehensive review of the candidate’s performance data against the established blueprint weighting and scoring criteria. This includes a detailed analysis of their performance in all assessment domains, considering the relative importance assigned to each domain by the blueprint. The decision regarding a retake should be based on whether the candidate has demonstrated a significant deficit in a critical area, as defined by the blueprint, and whether there is a clear pathway for remediation and re-evaluation. This aligns with the principles of objective assessment and fair evaluation, ensuring that decisions are evidence-based and directly linked to the fellowship’s defined learning objectives and competency standards. Ethical considerations demand that candidates are provided with clear feedback and opportunities to improve, but only when the assessment data indicates a genuine need and a reasonable prospect of success. An approach that focuses solely on the overall pass/fail score without dissecting performance against the blueprint weighting is professionally unacceptable. This fails to acknowledge that the blueprint is designed to prioritize certain competencies, and a candidate might pass overall but still have critical weaknesses in high-weighted areas. This approach risks allowing candidates to progress who may not have mastered essential skills, thereby undermining the fellowship’s standards. Another professionally unacceptable approach is to grant a retake based on the candidate’s perceived effort or personal circumstances without a thorough review of their performance data against the blueprint. While empathy is important, the fellowship’s integrity and the safety of future patients depend on objective assessment. Decisions must be grounded in the candidate’s demonstrated competence as measured against the blueprint, not on subjective factors unrelated to their perioperative medicine skills. Finally, an approach that relies on anecdotal feedback or the opinion of a single examiner without consulting the comprehensive performance data and the blueprint’s scoring guidelines is also flawed. This introduces subjectivity and potential bias, moving away from the standardized and objective evaluation that the blueprint aims to ensure. It fails to provide a consistent and defensible basis for retake decisions, potentially leading to unfair outcomes for candidates. Professionals should employ a decision-making framework that prioritizes objective data, adherence to established policies, and ethical considerations. This involves: 1) Understanding the blueprint: Thoroughly familiarizing oneself with the blueprint’s weighting, scoring, and competency domains. 2) Data collection and analysis: Gathering all relevant performance data for the candidate and analyzing it systematically against the blueprint. 3) Objective assessment: Making judgments based on the evidence, not on personal feelings or external pressures. 4) Policy adherence: Ensuring all decisions are made in accordance with the fellowship’s stated policies on scoring and retakes. 5) Ethical review: Considering the implications of the decision for the candidate, the fellowship, and patient safety.

The control framework reveals a scenario where a candidate’s eligibility for the Integrated Indo-Pacific Perioperative Medicine Fellowship Exit Examination is in question due to a perceived discrepancy in their training duration. This situation is professionally challenging because it directly impacts a candidate’s career progression and requires a meticulous, evidence-based assessment to ensure fairness and adherence to established fellowship standards. The examination’s purpose is to certify competence in perioperative medicine within the Indo-Pacific region, and eligibility criteria are designed to guarantee that candidates possess the requisite foundational knowledge and practical experience. Misinterpreting or misapplying these criteria can lead to either the exclusion of a deserving candidate or the admission of an unqualified one, both of which undermine the integrity of the fellowship and the profession. Careful judgment is required to balance the need for rigorous standards with the principle of equitable assessment. The best professional approach involves a thorough review of the candidate’s submitted documentation against the explicit eligibility requirements outlined by the fellowship’s governing body. This includes verifying the accredited nature of their prior training institutions, confirming the duration and content of their perioperative medicine rotations, and cross-referencing these details with the fellowship’s defined minimum training period. If discrepancies arise, the appropriate step is to request supplementary evidence or clarification from the candidate and their training supervisors, maintaining open communication throughout the process. This approach is correct because it prioritizes objective evidence and procedural fairness, directly addressing the stated purpose of the examination and its eligibility criteria. It ensures that decisions are based on verifiable facts and established guidelines, upholding the integrity of the fellowship. An incorrect approach would be to immediately disqualify the candidate based on an initial, unverified perception of insufficient training duration. This fails to acknowledge the possibility of documentation errors or alternative interpretations of training equivalency, which might be permissible under specific fellowship guidelines. Such an action risks unfairly barring a qualified individual from the examination and demonstrates a lack of due diligence. Another professionally unacceptable approach is to waive the eligibility requirements without a clear, documented rationale or a formal process for exceptions. This undermines the established standards for the fellowship and could set a precedent for future inconsistent application of rules, potentially compromising the quality of certified perioperative physicians. Finally, assuming the candidate’s training is equivalent without a formal verification process, even if they appear competent, is also an incorrect approach. While perceived competence is important, the fellowship’s purpose is to assess candidates who have met specific, pre-defined training benchmarks. Relying on informal assessments rather than documented evidence deviates from the established control framework and compromises the standardization of the examination process. The professional reasoning process for similar situations should involve a commitment to transparency, fairness, and evidence-based decision-making. When faced with potential eligibility issues, professionals should: 1) thoroughly understand the specific requirements of the examination and fellowship; 2) meticulously review all submitted documentation; 3) proactively seek clarification or additional evidence when ambiguities exist; 4) consult relevant guidelines or committees if interpretation is complex; and 5) communicate decisions clearly and provide justification based on established criteria.

This scenario presents a common challenge in perioperative medicine: managing a patient with a complex chronic condition requiring acute intervention, where evidence-based guidelines may not perfectly align with individual patient needs or resource availability. The professional challenge lies in synthesizing current evidence, patient-specific factors, and ethical considerations to formulate the safest and most effective perioperative plan. Careful judgment is required to balance the risks of intervention against the risks of delaying or altering care. The best approach involves a comprehensive, multidisciplinary assessment that prioritizes patient safety and adherence to established evidence-based guidelines while acknowledging individual patient variability. This includes a thorough review of the patient’s chronic condition management, consultation with relevant specialists (cardiology, nephrology, and the patient’s primary care physician), and a detailed discussion with the patient and their family about the risks, benefits, and alternatives. The perioperative team must then collaboratively develop a management plan that integrates the latest evidence for both the chronic condition and the acute surgical need, ensuring appropriate monitoring and timely adjustments based on the patient’s response. This aligns with the ethical principles of beneficence and non-maleficence, as well as the professional obligation to provide patient-centered care informed by the best available evidence. An incorrect approach would be to solely rely on the most recent guidelines for the acute condition without adequately considering the patient’s underlying chronic disease and its current management. This fails to acknowledge the potential for interactions between the acute intervention and the chronic condition, increasing the risk of adverse events. Another incorrect approach would be to proceed with the planned surgery without obtaining specialist input on the management of the chronic condition, thereby neglecting a critical aspect of patient safety and potentially contravening best practice in integrated care. Furthermore, making decisions without a thorough discussion with the patient and their family about the risks and benefits, particularly concerning their chronic condition, would be ethically problematic, undermining informed consent and shared decision-making. Professionals should approach such situations using a structured decision-making framework. This begins with a thorough patient assessment, including a detailed history, physical examination, and review of investigations, with a specific focus on the interplay between acute and chronic conditions. Next, relevant evidence-based guidelines for both the acute and chronic conditions should be identified and critically appraised. This should be followed by multidisciplinary team consultation to gather diverse perspectives and expertise. Finally, a shared decision-making process with the patient and their family should be undertaken to arrive at a mutually agreed-upon management plan, ensuring that all ethical and professional obligations are met.

Scenario Analysis: This scenario is professionally challenging because it requires a candidate to balance the demands of a rigorous fellowship program with the need for effective, self-directed preparation for a high-stakes exit examination. The pressure to perform well on the exam, coupled with the existing clinical workload, can lead to suboptimal study habits, burnout, or a superficial understanding of the material. Careful judgment is required to select preparation resources and a timeline that are both comprehensive and sustainable. Correct Approach Analysis: The best professional approach involves a structured, multi-modal preparation strategy that integrates diverse, high-quality resources with a realistic, phased timeline. This approach prioritizes foundational knowledge acquisition through core textbooks and review articles, supplemented by active learning techniques such as practice questions, case study analysis, and simulated exams. The timeline should be phased, starting with broad topic review and gradually narrowing focus to exam-specific content and weak areas, allowing for regular self-assessment and adjustment. This method ensures a deep, conceptual understanding rather than rote memorization, aligning with the ethical imperative to provide competent patient care and the professional expectation of continuous learning and mastery. It also addresses the practical need to manage time effectively without compromising clinical duties or personal well-being, thereby preventing burnout. Incorrect Approaches Analysis: Relying solely on a single, comprehensive review textbook without incorporating active learning methods is an insufficient approach. This method risks passive learning, leading to a superficial grasp of complex perioperative concepts and a failure to develop critical thinking skills necessary for exam success and clinical application. It neglects the importance of applying knowledge to practical scenarios, which is a key component of assessing readiness for independent practice. Focusing exclusively on practice questions and past exam papers without a solid foundation in core knowledge is also professionally unacceptable. While practice questions are valuable for identifying knowledge gaps and familiarizing oneself with exam format, they cannot substitute for a thorough understanding of underlying principles. This approach can lead to memorizing answers without understanding the ‘why,’ which is ethically problematic as it does not guarantee true competence. Adopting an overly aggressive, condensed study timeline in the final weeks before the exam, while neglecting consistent preparation throughout the fellowship, is a high-risk strategy. This approach often leads to burnout, stress, and a lack of retention. It fails to acknowledge the cumulative nature of learning and the importance of spaced repetition for long-term knowledge consolidation, potentially compromising the candidate’s ability to perform optimally under pressure and their overall well-being. Professional Reasoning: Professionals should approach exam preparation as an extension of their commitment to lifelong learning and patient safety. A systematic, evidence-based approach to resource selection and time management is crucial. This involves: 1) Identifying learning objectives and exam scope. 2) Curating a diverse set of high-quality, peer-reviewed resources. 3) Developing a realistic, phased study plan that incorporates active recall and spaced repetition. 4) Regularly assessing progress and adapting the plan as needed. 5) Prioritizing well-being to ensure sustained cognitive function and prevent burnout. This methodical approach ensures not only exam success but also the development of robust, enduring clinical knowledge and skills.

Scenario Analysis: This scenario presents a professional challenge due to the critical nature of perioperative care and the potential for rapid physiological deterioration. The integration of foundational biomedical sciences with clinical medicine is paramount, requiring the clinician to interpret complex physiological data in the context of a patient’s underlying pathology and surgical intervention. The challenge lies in distinguishing between expected physiological responses to surgery and anesthesia, and signs of emergent complications requiring immediate, decisive action, all while adhering to established clinical protocols and ethical obligations. Correct Approach Analysis: The best professional practice involves a systematic, evidence-based approach to patient assessment and management. This includes a thorough understanding of the patient’s pre-operative condition, the specific surgical procedure performed, and the known physiological effects of anesthetic agents. The monitoring system’s data must be interpreted in conjunction with direct patient assessment, including vital signs, physical examination, and laboratory results. The correct approach prioritizes a differential diagnosis of potential complications, considering the most likely causes based on the clinical picture. Promptly initiating appropriate interventions, such as fluid resuscitation, vasopressor support, or airway management, based on this differential diagnosis and established clinical guidelines, is crucial. This approach aligns with the ethical principles of beneficence and non-maleficence, ensuring the patient receives timely and appropriate care to prevent harm and promote recovery. It also reflects adherence to professional standards of care, which mandate continuous patient monitoring and prompt management of adverse events. Incorrect Approaches Analysis: One incorrect approach would be to solely rely on the automated alarms of the monitoring system without integrating this data with a comprehensive clinical assessment. While alarms are important safety features, they can be prone to false positives or may not capture the full clinical picture. Over-reliance on alarms without clinical correlation can lead to unnecessary interventions or delayed recognition of true emergencies. This fails to meet the standard of care that requires active clinical judgment and patient assessment. Another incorrect approach would be to delay intervention while awaiting further diagnostic tests that are not immediately critical for stabilization. In a perioperative setting, time is often of the essence. While diagnostic workup is important, delaying life-saving interventions based on a clear clinical indication, even if a definitive diagnosis is not yet established, would be a failure to act in the patient’s best interest and could lead to irreversible harm. This violates the principle of beneficence. A third incorrect approach would be to administer treatments without a clear understanding of the underlying pathophysiology or the potential side effects of the medications. This could lead to iatrogenic complications, further destabilizing the patient. Effective perioperative medicine requires a strong foundation in biomedical sciences to understand how interventions will impact the patient’s physiology, especially in the context of anesthesia and surgery. This approach demonstrates a lack of critical thinking and a failure to apply foundational knowledge. Professional Reasoning: Professionals should employ a structured approach to perioperative patient management. This involves: 1) Situational Awareness: Continuously assessing the patient’s physiological status and the surgical context. 2) Data Integration: Synthesizing information from monitoring devices, physical examination, and patient history. 3) Differential Diagnosis: Systematically considering potential causes for observed changes. 4) Evidence-Based Intervention: Selecting and implementing interventions supported by clinical guidelines and scientific evidence. 5) Reassessment: Continuously evaluating the patient’s response to interventions and adjusting the management plan accordingly. This iterative process ensures that care is dynamic, responsive, and patient-centered.

Scenario Analysis: This scenario presents a professional challenge due to the inherent conflict between the immediate need for patient care and the strict requirements for informed consent, particularly in a perioperative setting where patient capacity can be compromised. The physician must navigate ethical obligations to act in the patient’s best interest while respecting their autonomy and adhering to regulatory frameworks governing consent. The urgency of the situation, coupled with the potential for rapid deterioration, necessitates a swift yet legally and ethically sound decision-making process. Correct Approach Analysis: The best professional practice involves obtaining consent from the legally authorized surrogate decision-maker when the patient lacks capacity. This approach is correct because it upholds the principle of substituted judgment, aiming to make decisions that the patient would have made if they were able. This aligns with ethical guidelines that prioritize patient autonomy even when capacity is absent, and it complies with regulatory frameworks that define who can provide consent on behalf of an incapacitated individual. The physician must ensure they have identified the correct surrogate and that the surrogate understands the patient’s known wishes or best interests. Incorrect Approaches Analysis: Proceeding with the surgery without any form of consent from a surrogate or a documented advance directive would be a significant ethical and regulatory failure. This bypasses the patient’s right to autonomy and exposes the healthcare provider to legal repercussions for battery or unauthorized treatment. Delaying the surgery indefinitely until the patient regains capacity, if that is not medically feasible or would lead to significant harm, is also an unacceptable approach. While respecting autonomy is crucial, the physician also has a duty to provide necessary medical care to prevent harm, especially in a life-threatening situation. This approach prioritizes a rigid interpretation of consent over the patient’s immediate well-being. Relying solely on the opinion of junior medical staff without verifying their understanding of consent laws or their ability to assess patient capacity would be professionally negligent. While junior staff are valuable members of the team, the ultimate responsibility for ensuring valid consent rests with the attending physician, who must ensure all legal and ethical requirements are met. Professional Reasoning: Professionals should employ a structured decision-making process that begins with a thorough assessment of the patient’s capacity. If capacity is lacking, the next step is to identify and engage the legally authorized surrogate decision-maker. This involves understanding the hierarchy of surrogates as defined by applicable laws and ethical guidelines. The physician must then ensure the surrogate is fully informed about the patient’s condition, the proposed treatment, its risks and benefits, and available alternatives, enabling them to provide consent based on the patient’s known wishes or best interests. Documentation of this process is paramount.

The audit findings indicate a potential disparity in perioperative care access and outcomes across different socioeconomic strata within the Indo-Pacific region. This scenario is professionally challenging because it requires the healthcare team to navigate complex ethical considerations, resource limitations, and diverse cultural contexts while upholding the principles of health equity. Careful judgment is required to ensure that all patients, regardless of their background, receive high-quality perioperative care. The best approach involves a comprehensive, multi-faceted strategy that directly addresses the identified disparities. This includes conducting a thorough epidemiological analysis to pinpoint specific areas of inequity, developing targeted interventions to improve access to pre-operative assessment and post-operative care for underserved populations, and implementing culturally sensitive patient education programs. This approach is correct because it aligns with the core ethical imperative of health equity, which mandates fair distribution of healthcare resources and opportunities. It also reflects best practices in population health management by using data-driven insights to inform targeted interventions. Furthermore, it acknowledges the importance of cultural competence in healthcare delivery, a critical factor in the diverse Indo-Pacific region. An approach that focuses solely on improving general perioperative outcomes without specifically targeting identified disparities fails to address the root causes of inequity. This is ethically unacceptable as it perpetuates existing disadvantages and violates the principle of distributive justice. Another unacceptable approach is to attribute disparities solely to patient non-compliance or lack of health literacy without investigating systemic barriers. This overlooks the responsibility of the healthcare system to provide accessible and understandable information and support, and it can lead to stigmatization of vulnerable patient groups. Finally, an approach that prioritizes resource allocation based on the highest volume of procedures rather than on the greatest need for equitable access is ethically flawed. This transactional model neglects the fundamental goal of ensuring that all individuals have the opportunity to achieve their highest level of health. Professionals should employ a decision-making framework that begins with a commitment to health equity. This involves actively seeking out and analyzing data on health disparities, engaging with affected communities to understand their needs and barriers, and collaborating with stakeholders to design and implement evidence-based, culturally appropriate interventions. Continuous monitoring and evaluation are essential to ensure that interventions are effective and that progress towards equity is being made.

This scenario presents a professional challenge due to the inherent conflict between patient confidentiality, the need for effective communication within the perioperative team, and the potential for perceived bias or undue influence on clinical decision-making. Maintaining trust with the patient while ensuring all relevant parties are informed and that care is delivered without external pressure is paramount. Careful judgment is required to navigate these competing interests ethically and in accordance with professional standards. The best approach involves a direct and transparent discussion with the patient about the proposed involvement of their spouse in the perioperative care discussions. This approach respects patient autonomy and confidentiality by seeking explicit consent before sharing any information or involving the spouse in decision-making processes. It aligns with ethical principles of informed consent and patient-centered care, ensuring the patient remains in control of their medical information and treatment choices. Furthermore, it proactively addresses potential concerns about undue influence by establishing clear boundaries and expectations for the spouse’s role, thereby fostering a collaborative yet patient-directed care environment. An approach that involves informing the spouse directly without the patient’s explicit consent before the discussion would violate patient confidentiality and potentially erode trust. This action bypasses the patient’s right to control their personal health information, a fundamental ethical and professional obligation. Another unacceptable approach would be to proceed with involving the spouse in discussions without any prior conversation with the patient, assuming their agreement. This demonstrates a lack of respect for patient autonomy and can lead to misunderstandings or distress for the patient, undermining the therapeutic relationship. Finally, dismissing the spouse’s desire to be involved without exploring the patient’s wishes or the potential benefits of their involvement would be professionally suboptimal. While patient autonomy is key, a blanket refusal without understanding the context or patient’s perspective might miss opportunities for beneficial support and communication, provided it is managed within ethical boundaries. Professionals should employ a decision-making framework that prioritizes patient autonomy and informed consent. This involves open communication, active listening to patient and family concerns, and a clear understanding of professional ethical guidelines regarding confidentiality and shared decision-making. When faced with requests or situations involving family members in patient care, the first step should always be to ascertain the patient’s wishes and obtain their explicit consent for any information sharing or collaborative discussions.