ABEM Patient Safety & Ethical Practices 2 — Questions and Answers
Question 1: A patient with a pacemaker is referred for nerve conduction studies. Which precaution is MOST important?
- Avoid stimulation near the pacemaker generator and leads (Correct answer)
- Cancel the study entirely
- Use only needle EMG and avoid all electrical stimulation
- Increase stimulus intensity to compensate for interference
Correct answer: Avoid stimulation near the pacemaker generator and leads
Electrical stimulation should be kept away from the pacemaker generator and lead pathways to prevent inappropriate inhibition or triggering.
Question 2: During EMG, a patient discloses they are currently taking warfarin. Which needle technique modification is MOST appropriate?
- Use smaller gauge needles and minimize needle passes (Correct answer)
- Refuse to perform needle EMG until anticoagulation is reversed
- Proceed without modification as EMG needles pose no bleeding risk
- Use only surface electrodes for the entire study
Correct answer: Use smaller gauge needles and minimize needle passes
Smaller gauge needles and fewer passes reduce bleeding risk in anticoagulated patients while still allowing a diagnostic study.
Question 3: Informed consent for electrodiagnostic studies should include all of the following EXCEPT:
- The interpreter's opinion on the likely diagnosis (Correct answer)
- Risks such as discomfort, bruising, or rare infection
- The purpose and nature of the procedure
- The right to withdraw consent at any time
Correct answer: The interpreter's opinion on the likely diagnosis
The interpreter's diagnostic opinion is not a required element of informed consent, which focuses on procedure details, risks, and patient rights.
Question 4: A referring physician requests an electrodiagnostic report that emphasizes findings supporting a specific diagnosis he has already given the patient. The most ethical response is to:
- Report all findings objectively regardless of the referring physician's preference (Correct answer)
- Include only findings consistent with the requested diagnosis
- Decline to perform the study
- Contact the patient's insurer before proceeding
Correct answer: Report all findings objectively regardless of the referring physician's preference
Electrodiagnosticians have an independent professional obligation to report findings accurately and objectively.
Question 5: Which of the following best describes the principle of beneficence as applied in electrodiagnostic medicine?
- Performing only those studies that are likely to benefit the patient clinically (Correct answer)
- Disclosing all information to the patient regardless of harm
- Maximizing the number of tests billed per encounter
- Allowing the patient's family to make all medical decisions
Correct answer: Performing only those studies that are likely to benefit the patient clinically
Beneficence requires the clinician to act in the patient's best interest by performing clinically indicated studies.
Question 6: An electrodiagnostician discovers incidental EMG findings suggesting ALS in a patient referred only for carpal tunnel evaluation. The most appropriate action is to:
- Inform the patient and referring physician and recommend appropriate follow-up (Correct answer)
- Omit the findings from the report to avoid alarming the patient
- Immediately tell the patient they have ALS
- Only report the carpal tunnel findings as requested
Correct answer: Inform the patient and referring physician and recommend appropriate follow-up
Incidental clinically significant findings must be disclosed to the patient and referring physician with appropriate guidance for follow-up.
Question 7: A patient refuses needle EMG after consenting to nerve conduction studies only. The electrodiagnostician should:
- Respect the refusal and complete only the nerve conduction studies, documenting the limitation (Correct answer)
- Proceed with needle EMG because it is medically necessary
- Cancel the entire study and reschedule
- Ask the referring physician to override the patient's refusal
Correct answer: Respect the refusal and complete only the nerve conduction studies, documenting the limitation
Patient autonomy requires respecting refusal; the study is completed as permitted and limitations are documented in the report.
ABEM Patient Safety & Ethical Practices 2
A patient with a pacemaker is referred for nerve conduction studies.
Which precaution is MOST important?