Prestige is a human construct, not natural consequence. As with most human construct, prestige has always involved elements of myth, partial fact, and make-believe. This is especially so in medicine. The defining features of prestige in medicine, as in most human pursuit, has historically been quite malleable with the times. What was prestigious in medicine at the time of the Aesciplia in ancient Greece, much different than prestige in medicine today. This despite the use by historians and physicians of altering historical facts in order to create the illusion of a single arc of noble intent and progress through the ages of medical endeavor in attempts at painting a prettier picture and to enhance contemporary prestige.
The bulk of prestige in medicine today is to be found in the halls of academia, or so the academics would have you believe. But academic prestige today is not based in the selfless caring for the in-firmed or in devotion to prolonging quality life and reducing suffering. Prestige in medicine today results almost entirely from pedigree, publication, and funding. Pedigree takes credit for historical accomplishment where credit is not due - William Osler did most of the heavy lifting resulting in prestige for Johns Hopkins University early on, that those that graduate from now lay claim to. Upon graduation and embarking on their academic careers, publication and research funding will be the yard sticks by which they are judged and promoted, not by how good of a clinician they are. I personally take pedigrees from Hopkins, Harvard, and the ‘good’ places as warning concerning clinical skill. In my experience no one cared how good my care of patients was in assessing my appropriateness for promotion. It was the number and quality of my publications and the amount of research funding I brought to the university that mattered, not how well I cared for your relative.
Of the two department of medicine chairs I have known, both had excellent pedigrees, publication and grant portfolios, but both were mediocre clinicians, and that is being generous. The problem? Mediocrity in medical care, kills.
