10th Chapter of Surgeons' Lecture: the challenges in surgery--past, present and future, and in search of the 4Cs.

Challenges facing surgical practice in the immediate future will not only be in the fields of clinical and operative surgical techniques, but will also involve a new complexity of clinical, para-clinical and economical issues. The impact of casemix, clinical carepaths, evidence-based medicine, high-technological advances, minimally invasive surgery, teleconferencing, robotic surgery, etc will transform the scene of surgical advancement in a dynamic way. Whatever the winds of change may be, ultimately patient's good and welfare must be uppermost in our minds. The challenge is how to maintain and achieve the 4Cs in this age of medical and surgical revolutionary changes. Commitment, Continuing medical education, Consistency, Compassion and a Caring spirit are the Cs we must always keep alive in our clinical practice.