A 67-year-old woman came to the surgery center for a scheduled diagnostic arthroscopy of her right shoulder because of constant pain on the rotation of the shoulder. Prior to entering the operating room she told the nurse, "I have been feeling weak, depressed, and tired ever since my last visit." The surgeon performs a reexamination with a detailed history, expanded problem-focused physical, and moderate-complexity decision-making prior to the surgery. The findings were negative and the procedure was performed uneventfully.