Citation frequencies are commonly interpreted as measures of quality or impact. Yet, the true nature of citations and their proper interpretation have been the center of a long, but still unresolved discussion in Bibliometrics. A comparison of 67,578 pairs of studies on the same healthcare topic, with the same publication age (1–15 years) reveals that when one of the studies is being selected for citation, it has on average received about three times as many citations as the other study. However, the average citation-gap between selected or deselected studies narrows slightly over time, which fits poorly with the name-dropping interpretation and better with the quality and impact-interpretation. The results demonstrate that authors in the field of Healthcare tend to cite highly cited documents when they have a choice. This is more likely caused by differences related to quality than differences related to status of the publications cited.