Rapid responses are electronic letters to the editor. They enable our users to debate issues raised in articles published on thebmj.com. Although a selection of rapid responses will be included online and in print as readers' letters, their first appearance online means that they are published articles. If you need the url (web address) of an individual response, perhaps for citation purposes, simply click on the response headline and copy the url from the browser window. Letters are indexed in PubMed.
Healthcare is a profound process that alters both physician and patient. Medical education is a demanding, exacting, life-altering process that trains physicians to alter the patient's anatomy (surgery) and physiology (medicine). Anatomical alterations are the exclusive domain of surgeons, whose training is the longest and most demanding of all specialties. Surgeons require not just knowledge, but also strength, stamina, speed, dexterity, and acuity. Surgery is so central to healthcare that the history of surgery is the history of healthcare.