I read with interest the 'Viewpoint' on this subject and would like to suggest addition of one more field to those given in the last paragarph "Exposure to Different Fields". This could be called as 'Existing Local (both traditional and modern) Practices Field." I illustrate this point with two examples based on our experience of work in Mumbaiurban slums:

1. Management of chronic otitis media: Any number of antibiotic regimens would not cure this condition unless the (well-known to community, but unknown-to-doctors) bad habit of mothers spitting water into-child's ears ostensibly for the purposes of cleaning the ears during bath of the child, is stopped through proper and friendly advice. This therapy is unlikely to be a part of any western text book or systematic reviews such as Cochrane collaboration(2).

2. Etiologic diagnosis of uterine prolapse in urban slum women: A detailed analysis of the reasons responsible for a high incidence of this entity in urban slum women revealed that a major contributing factor was the habit of chronic constipation developed by young and middle aged slum women due to lack of toilets and lack of privacy for defecation on streets or open areas in cities.

Many clinicians must be using their knowledge and observation of such local practices to make their diagnosis and management better. It may be worthwhile providing a platform for such experiences in the journal so that due notice is taken of by authors of textbooks.
 

Ramesh Potdar,
69, D. V. Pradhan Road,
Dadar, Mumbai 400 014,
India.