Traditionally most surgeons have paid little attention to the costs of healthcare treatments. With the increase in the number of efficacious surgical alternatives, a distinct scarcity of available resources has emerged. Since the Eighties, the impact of surgical expenditure has been increasing everywhere. The causes are: medical progress, increased life expectancy, escalating costs and decreasing revenues. The surgeon has been increasingly forced to weigh up theories, doctrines and techniques of economics and management. This created new problems of choice. In any event, the surgeon's decision-making could lead to negative consequences if the primary concern is with the financial constraints and he is prompted simply to act rather than to achieve his therapeutic goal. In conclusion, although the impact of economic considerations is inevitable in the choice of surgery, the terms and methods involved in the process are rather ambiguous. In other words, surgeons face with the dilemma of the patient to whom the economist denies treatment. To be aware of this issue is the first step, but there is still much more to do in order to define the terms of action.