(Maybe unintended is a better word than involuntary?)
Saw a guy in clinic yesterday for MRI follow up with shoulder exam concerning for rotator cuff tears. His MRI shows fully torn cuff tendons with moderate retraction and mild to moderate atrophy. This is a "repairable, but do it sooner rather than later" cuff tear in that recent data shows that delaying a retracting cuff repair can profoundly increase the risk of failure of the repair (the listed failure rate in the most recent meta analysis is anywhere from 10% to 94% depending on how you define the word "failure").
So, we need to get this guy into surgery in the relatively near future to grab those tendons and reattach them before they retract too far away, or the muscle atrophies - both of which push him more towards that 94% number. So I book the surgery and he mentioned in passing that he was frustrated with a recent encounter with a Pain Management physician because he didn't get any pain medication, only injections.
Cease fire. Freeze.
Brocephus got a steroid injection from pain management into his shoulders three days before being scheduled for a cuff repair. We now have to wait 90 days and he has a "statistically significantly increased risk of failure" even after 90 days. He tells me (I don't believe him) that he told the PM doc that he was being worked up for cuff tears, but the doc did the injections anyway. https://www.arthroscopyjournal.org/article/S0749-8063(18)30978-2/fulltext
I called the pain management guy, but he wouldn't talk to me. He was yelling across the clinic to his MA who was trying to explain his rationale over the phone to me as to why he did the injections. So, we're stuck. No cuff repair until February, new deductible, increased risk of failure, significant shoulder pain until then.
Might be that the PM guy had no understanding of the surgical implications of a recent steroid injection. Might be he was giving the patient what he considered to be a reasonable alternative in lieu of the narcotics he was asking for.
In your practice of medicine, what other pitfalls are there that a different specialty can dive into to screw up your treatment of a patient?