To undertake peer review is to "evaluate professionally a colleague's work". In medicine, peer review is defined as "the objective evaluation of the quality of a physician's or a scientist's performance by colleagues". In peer review, physicians professionally and candidly, but confidentially, evaluate each other's performance, typically at the same institution, but quite often externally. The aim of peer review is not to spy on others, but rather to self-identify openly one's weakness in the presence of trusted colleagues. Peer review is one of the most respected activities in the circles of quality assurance and total quality management. Unfortunately, it is not an activity that is particularly favoured by many professionals; it is certainly not well accepted by physicians particularly in Eastern countries. Physicians have difficulty accepting evaluation of their performance by fellow colleagues even when given equal opportunity to monitor others. Peer review is generally more accepted, albeit often with reluctance and reservations, in the United States where it started and in some other Western countries. Being a professional can lead to certain types of behaviour and states of mind; thus some steps in the peer review process can be seen as threatening. Professionals are often not used to comparing given performance expectations with the achievement of their personal goals; neither are they used to collective responsibility and accountability versus autonomy and individualism.