What is the prestige of hierarchy in medicine?” a bald friend of mine asked, when I referred him to a general surgeon to remove an annoying sebaceous cyst on his sparkling scalp. “Brain surgeons don’t deal with such paltry problems,” I said with jolly arrogance, dismissing the puffiness on his head. “I’ve had it removed twice before and it keeps coming back, which is why I want you to do it,” he said, massaging my ego.

“Neurosurgeons are on top of the medical totem pole,” I said to answer his question. “We do the most sophisticated and precise work. Also, our job has the maximum potential to harm and hence, the stakes are very high—because the brain and spinal cord control everything,” I explained. Just then, quite coincidentally, my cardiac surgery colleague peeked his head into my office to see if I was free to discuss a case. “Cardiac surgeons come a close second, but their job is essentially plumbing, knowing how to bypass faulty pipes!” I said, to humour him. “But we do the plumbing when the tap is running or while the toilet is being flushed,” he interjected, justifying his position at second, “Everyone else languishes at the other end of the spectrum!” My poor friend now looked quite baffled by our banter. “The general surgeons, urologists, and gynaecologists are quite literally furthest away from the top,” we explained.