Permanent disability: the legacy of tort litigation

The therapeutic alliance essential during the long process between the injury and the final appeal in the resulting tort is discussed. The core thesis is that once the patient with orthopaedic problems initiates litigation, he or she starts to become invested in permanent disability, and the slide down the slippery slope of a lifetime of disability has begun. This is not a lament about the role of lawyers, courts, and litigation. They are facts, part of the working conditions of the orthopaedic physician. What happens after acknowledging these facts is the topic of discussion. How can one do the best job of damage control in the face of a totally toxic situation? How can the physician become a stabilizing force in the spin toward permanence in disability?