There is an increasing interest in medical professionalism, both within the medical community and in the larger public domain. Understanding the professionalism of surgery requires a thoughtful examination of the phenomena of surgery, including features that make it unique among the professions. Surgical care typically begins with a problem–solution encounter, with the initial question from the surgeon to the patient, ‘‘How may I help you?’’ This is a voluntary promise of confidentiality and trust that obligates the surgeon to apply his or her requisite and assumed knowledge and skills within the context of a human–human interaction, one in which a power differential exists between the surgeon and the patient. This places the surgeon in a fiduciary relationship with the patient, and the surgeon’s values, attitudes, and behaviors—professionalism—should reflect such. This is a surgeon’s responsibility, even at personal, professional, and financial sacrifice.