ABEM Patient Safety & Ethical Practices 4 — Questions and Answers
Question 1: A patient with HIV is referred for EMG. The most appropriate safety approach is to:
- Apply standard precautions consistently, as with any patient (Correct answer)
- Double-glove and use a dedicated needle set labeled for HIV patients
- Refuse to perform the study due to transmission risk
- Notify all clinical staff of the patient's HIV status before the study
Correct answer: Apply standard precautions consistently, as with any patient
Standard precautions are designed to protect against bloodborne pathogens for all patients regardless of known infection status.
Question 2: Which of the following scenarios represents an inappropriate billing practice in electrodiagnostic medicine?
- Billing for nerve conduction studies not performed during the session (Correct answer)
- Billing for both the technical and professional component when both are performed
- Combining nerve conduction studies with needle EMG in a single encounter
- Billing at the appropriate code level based on documented findings
Correct answer: Billing for nerve conduction studies not performed during the session
Billing for services not rendered constitutes fraud and violates federal and state laws as well as medical ethics.
Question 3: Documentation in an electrodiagnostic report should include which of the following to meet ethical and legal standards?
- All muscles and nerves tested, waveform measurements, and clinical interpretation (Correct answer)
- Only the final diagnosis with no supporting data
- The technician's raw data without physician interpretation
- A summary written by the referring physician
Correct answer: All muscles and nerves tested, waveform measurements, and clinical interpretation
Complete documentation of all tested muscles and nerves, measurements, and interpretation is required for clinical, legal, and billing accountability.
Question 4: A patient expresses significant anxiety about needle EMG and asks if there is an alternative. The most appropriate response is to:
- Explain what information needle EMG provides and discuss whether the clinical question can be answered without it (Correct answer)
- Insist on needle EMG because it is the gold standard
- Perform surface EMG without informing the patient of its diagnostic limitations
- Sedate the patient to proceed with needle EMG
Correct answer: Explain what information needle EMG provides and discuss whether the clinical question can be answered without it
Respecting patient autonomy requires honest discussion of what information needle EMG provides and whether an alternative approach can meet the diagnostic need.
Question 5: In electrodiagnostic practice, the duty to maintain patient confidentiality may be ethically overridden when:
- The patient poses an imminent credible threat of serious harm to an identifiable third party (Correct answer)
- A colleague requests information out of professional curiosity
- A family member insists on knowing the patient's diagnosis
- The patient has a condition that is socially stigmatized
Correct answer: The patient poses an imminent credible threat of serious harm to an identifiable third party
Confidentiality can be breached to protect identifiable third parties from imminent serious harm, consistent with the Tarasoff principle and public safety obligations.
Question 6: Which of the following electrode application practices BEST reduces the risk of patient burns during nerve conduction studies?
- Ensuring adequate gel contact, avoiding current flow across compromised skin, and checking equipment regularly (Correct answer)
- Increasing stimulator output to ensure supramaximal responses are obtained quickly
- Using metal surface electrodes without gel to improve conductance
- Placing electrodes over bony prominences to stabilize them
Correct answer: Ensuring adequate gel contact, avoiding current flow across compromised skin, and checking equipment regularly
Proper gel application, avoiding damaged skin, and equipment maintenance minimize the risk of electrical burns during nerve conduction studies.
Question 7: An electrodiagnostician is asked to perform studies on a patient who is also their personal friend. The BEST ethical approach is to:
- Disclose the relationship, consider referring to a colleague, and document the decision (Correct answer)
- Perform the study without disclosure because friendship does not affect objectivity
- Refuse all studies on anyone known personally
- Ask the friend to sign a waiver of conflict of interest
Correct answer: Disclose the relationship, consider referring to a colleague, and document the decision
Personal relationships create potential conflicts of interest that should be disclosed and ideally managed by referral to a colleague.
ABEM Patient Safety & Ethical Practices 4
A patient with HIV is referred for EMG.
The most appropriate safety approach is to: