Naming Prestige

I recently came across a brilliant badass health care professional from New England. She went on and on about how she was at one prestigious hospital, asked about the one I was at, and then berated the fact that it was part of some other seemingly “inferior” hospital chain: “They’re good, but they’re no [insert her namely hospital here].” It was funny to me, because as a non-New Englander, my first question was, “Oh… What’s that hospital? I’ve never heard of them before.” Her silence, was deafening, even among a text message. “…. What? HOW do you not know this hospital?… [My City] is like one of the top centers for medicine in the USA and the WORLD.” “I mean, I’ve never heard of it, and actually in my world of Pediatrics, it’s OK, I guess…” Obviously we didn’t really talk a whole lot after that.

But it made me think about so much in my life as to what the idea of Prestige is and what it means; moreso, WHY is this important and WHAT does it actually implicate.

Once upon a time I was in an airport and i heard the man behind me discussing with another elderly gentleman about how one hospital in the midwest of the US was “Top Tier” and “Simply the Best.” Each year US News Health ranks hospitals for various metrics as to which one is “The Best.” There are multiple things that go into this and I imagine outside of subjective measurable content, there are a multitude of feedback loops from consumer reports to customer satisfaction surveys that go into play. Implicitly, we all like to focus on hearsay and rumors, it’s impossible not to and absolutely human nature to make choices off of these things. What we’re told we often believe, what we see is often what others show us and what we feel is often guided so much by society and peer pressure. But, I’ve always felt that Prestige at the end of the day means so little in the bigger scope of life.

When you leave Prestige and Ego behind, It gets to the heart of genuine important factors. The NAME of a hospital doesn’t matter to me. The CARE provided to me as a patient, to my family member as a patient, or to my patients as patients, is what matters. Outcomes and statistics factor in to good practices and are bigger reflections of overall administration and practices; however, even smaller lesser known places can offer adequacy in this regard.

I have been lucky enough to work in some hospitals with great public names, and some with not so well-known or supported names, and I have seen efficiency and system success based on individual endeavors and truthful team efforts. Not everywhere in the country is going to be performing critical cardiac surgeries for rare or nearly fatal conditions, but some places are going to be able to hold their own by continuing to follow successful protocols on the wall that are up to date with best practice guidelines.

In Maine, I was honored to meet one of the most academic Pediatric Hospitalists i have ever met, in a community hospital; and, she changed forever my perception of how the world of Medicine functions and also what perceptions by patients and onlookers matter and don’t matter. I will never forget when I asked her, as she gave me homework, why she didn’t do academic medicine, “Well… I didn’t want to. You can work in academics, or you can make your practice academic.” Her and myself are the same doctor, regardless of which hospital we work at. We are supported or broken down by the administration, logistics and the knowledge and experience of our support staff, among obvious needs of resources; but, you never know when you’re going to be resuscitating a preterm baby in the countryside with a nurse that just transferred from a “high class” Neonatal Intensive Care Unit. Name means so little in times of necessity and higher focus on superb team work.

On a global scale… My mother’s husband was hospitalized for COVID in June/July of 2022… In Guatemala, while on a service trip. She was nervous, because it was simply a resource-limited country. He did fine and when he came back to the US showed her his hospital discharge paperwork. All in Spanish, I read over it and realized he had received the standard of care for treatment that we would have given him at almost any up-to-date hospital in the United States. The walls were dirt, the X-ray machine was facing a stool you’d sit on and the wires needed to be watched carefully when you showered, but he got great care and ultimately did well.

At the end of the day… I always wonder about Name and Prestige. Throughout my life, I have been fortunate to train at prestigious names – my high school is a nationally acclaimed college preparatory trend, my college internationally recognized, etc. Places that are known throughout the country for this or for that.

As I apply for work, I realize the help that a name can have in job seeking – I’m not oblivious to the fact that while I hold Name and Prestige with a grain of salt, not everyone does. But, there is so much more that is important in life and I intend to be the best no matter where I go. I have never once been asked where I did my medical training by patients nor most of my peers other than out of curiosity for why i wear cowboy boots or why my accent is “Californian.” And ultimately, when it comes down to it, my thoughts about Name and Prestige and why i never brag about where I’m from, culminate in this:

My patients have never asked where I trained. They have only asked that I care.

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