We thank Vincent Richman for bringing to our attention the work of Edgar Rice Burroughs, who wrote about effective medical performance evaluation systems back in 1932.1 Although we agree that physicians have an important role to play in quality improvement,2 we believe it would be difficult in the current climate to expect busy clinicians to be solely responsible for reporting on the course of treatment and outcomes for every patient to a central agency. Such a system could raise concerns about the accuracy of the data, because clinicians would have an incentive to overestimate the severity of their cases and underreport the frequency of adverse outcomes. Nevertheless, the idea of physician performance evaluation systems is not a new one, and all suggestions for developing a better system are most welcome.