Dear Editor

This scholarly article has been a fine example of what a fresh approach and interdisciplinary overview can do.

We work with illness explanatory models of patients from various outpatient clinics who suffer from biomedically unexplained fatigue and weakness for six months or more. Also, in private practice of clinical psychiatry compliance is the pivotal issue. We find that cultural epidemiology plays a significant role in understanding and managing patients' compliance and outcome. Either intentional error or violation, or unintentional slip or lapse, patients do always have subjective explanation for their behaviour. The antecedents of compliance or non- compliance can be found:
(1)in patient's illness experience, different variables of which include stigma of illness or treatment, anticipated outcome, perceived seriousness of the symptoms, and many other sociocultural contextual factors;
(2)in subjective meaning of the illness as exemplified by the perceived causes of the illness and their linkages among each other; and
(3)his experiences with the help seeking behaviour and the agencies of help, with their meeting patient's perceived needs.

Patient's explanatory models (emic) and its match or otherwise with the explanatory models of the professional care giving agencies (etic) is an important determinant of the patient's compliance toward the prescribed treatment. Careful attention to the patient's emic is facilitated by cultural epidemiological approach with the use of Explanatory Model Interview Catalogue(EMIC), a tool that can be used in research as well as in clinical practice. It focuses on patient's experience, meaning, and behaviour while retaining the qualitative as well as the quantitative aspects. Ratings on predetermined codes facilitate comparison and analysis apart from crystallizing the salient features of the explanatory model. Reliability of this effective tool has been documented in studies on leprosy and depression.