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From the point of view of planning surgical intervention, a diagnostic test must be sensitive, specific, and reproducible. The patient's clinical findings must be precisely supported by the results of the diagnostic intervention. A well-studied surgical procedure to treat the specific pathology must be identified. Clearly, in many of the diagnostic regimens reviewed, the very nature of the tests (especially those involving pain provocation or ablation) may preclude the achievement of full sensitivity. Thus, the practical utility of a particular study in the matrix of clinical evaluation and subsequent surgical planning is of crucial importance. Appropriate patient selection and education about expected outcomes are vital to identify patients who will have a successful surgical outcome. Ideally, the indications and expectations should be identical in the minds of the diagnostician and the surgeon.

Finally, in many instances, more rigorous study of both diagnostic and surgical procedures is required. It is perhaps the greatest temptation of the clinician scientist to utilize promising techniques or procedures in an effort to alleviate patients' suffering for apparent problems before the techniques have been completely evaluated. Thus the exercise of compassionate restraint may be the greatest challenge facing clinicians today.


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