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Simon G. Kassabian, MD

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

The publication by Holmboe et al¹ titled "Association Between Maintenance of Certification Examination Scores and Quality of Care for Medicare Beneficiaries" provides a valuable insight. A few points, however, may be added in reviewing this matter.

The statement that "evidence-based processes of care" were used in this study seems to have applied in the time frame used, 2002 and 2003, when patient care was examined. Recent findings,^2-3 however, suggest an updated perspective^4-6 in the value of the practice examined in the study by Holmboe et al.¹ Though unknown at the time of the study, the updated perspective includes the risk-benefit ratio of treatments that may have resulted from extensive hemoglobin A_1c testing. The impact of effective diabetic control may have caused inadvertent harm despite well-intended care and stricter implementation. Even without this possibility, it supports compliance characteristics of physicians depending on standards of care, regardless of . . . [Full Text of this Article]

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