Primary hyperparathyroidism (PHPT) is the most common cause of hypercalcemia in outpatients, and the incidence of PHPT is on the rise, with a prevalence of approximately 0.86% in the general population. The diagnosis of PHPT has been mainly at the clinical level, with elevated blood calcium being the main diagnostic clue. Follow-up of patients’ serum parathyroid hormone (PTH) reveals that serum PTH is associated with elevated blood calcium in the majority of patients, except for some patients whose PTH may occasionally be within the normal range. In a review of a Cleveland Clinic cohort, Press et al. found that approximately 2% of individuals had hypercalcemia and unfortunately only 32% of patients were further examined for serum PTH despite clear evidence of hypercalcemia. The clinical diagnosis rate is only about 1.3%, of which only 0.3% are referred to surgery, even though many patients have biochemical findings that meet the diagnostic criteria for PHPT. This shows that the prevalence of PHPT is much higher than previously estimated, and it is even more incredible that even when patients are known to have hypercalcemia, there is no further clinical evaluation and treatment. Measurement of serum PTH is the most important step in identifying the cause of hypercalcemia, and a PTH test ratio of only 1/3 will result in many patients being missed and delayed in treatment. At this point it is easy to see how serious the knowledge gap or verbal knowledge disconnect is among the physicians involved in the face of unexpectedly discovered hypercalcemia patients. What is more, serum PTH is tested and the diagnosis of PHPT is established, but it is not recorded in the text of the patient’s medical record, let alone the patient is referred to surgery for treatment, indicating a very weak job responsibility of the first consulting physician involved. Although, more and more reports in the literature suggest the effectiveness of parathyroidectomy in patients with PHPT, the work profile of certain medical first-visit physicians remains unchanged. Therefore, as surgeons it is not only their responsibility to teach their patients about the dangers of PHPT and the importance of parathyroidectomy, but they also have an obligation to help internal medicine physicians become more aware and vigilant in this regard. For this reason better research is needed to learn how to assess patients for hypercalcemia and how to diagnose PHPT, which is not only a matter of knowledge and application of technical tools, but mainly a matter of knowledge and vigilance of the first consulting physician. So what should surgeons do to improve the diagnosis and treatment of PHPT? The first step is to promote the efficacy of parathyroidectomy and try to convince primary care physicians and endocrine surgeons of the excellent efficacy of this treatment, which is currently the most underdeveloped task. Are all patients really 100% satisfied after parathyroidectomy? Objective assessment data show that bone density improves and fracture risk is significantly reduced after parathyroidectomy, but it is difficult to show that patients’ subjective perceptions are necessarily significantly better. Quality of life surveys have shown improvements in overall quality of life indicators and significant reductions in pre-existing clinical symptoms, but a more scientific and rigorous approach to these subjective efficacy assessment indicators is an important safeguard to convince peers. Since randomized controlled trials are not yet clinically feasible, it is important to systematically and quantitatively analyze postoperative improvement prospectively with the help of validated instruments and controlled control designs. Both primary care physicians, endocrine surgeons, and head and neck surgeons have an obligation to identify more patients with PHPT from occult status and to provide timely surgical treatment, not only for the benefit of the patient but also for the benefit of society.