Scorecards are presented as reliable measures of medical outcomes. They are used as a means for measuring the quality of care provided and as a tool for negotiating fees for medical services. The existence of scorecards reflects our society's desire for openness and transparency in public affairs. The problem with scorecards and other publicly accessible ratings is that some of the recommendations they issue do not warrant the reliance of the public. In other words, scorecards that present ratings of medical professionals and medical institutions may themselves be untrustworthy. Scorecards are designed to encourage physicians to achieve "target rates" for health care interventions. Scorecards have been touted as a mechanism to improve patient care, advance patient decision making, and hopefully improve health outcomes. We need to be aware of how ratings of physician performance may affect your physician's clinical judgment, recommendations, and communication.