Personal Awareness and Effective Patient Care

To the Editor. —The article by Dr Novack and colleagues¹was more personal opinion than scientific article. Therefore, it is not surprising that the authors comment, "For instance, Pakistani and Indian residents often come to the United States without formal training in pelvic... or testicular... examinations." This statement is biased. I can assure the authors and the readers ofJAMAthat the undergraduate curriculum in most Indian medical schools has structured programs for training in detailed clinical examination, including pelvic and scrotal examination. In fact, unlike US training (where emphasis is more on sophisticated laboratory and other investigations), in developing nations the emphasis is much more on clinical medicine. My personal experience in the United States is that patients undergo scrotal ultrasound or pelvic ultrasound without prior clinical examination by the ordering physicians. On many occasions in my surgery-urology practice, I have been called to see a patient with