c) Involvement of Private Practitioners
AU : Uplekar MW & Sheela Rangan
TI : Private doctors and tuberculosis control in India
SO : TUBERCLE AND LUNG DIS 1993, 74, 332-337
DT : Per
AB :

Over three quarters of the 8 million registered doctors in India are engaged in private medical practice. In urban and rural areas alike people prefer private doctors to public health services for their health care needs. A majority of patients and those with suspected TB also report first to private doctors. A study on ‘private doctors and TB control in India’ was conducted in Dharavi a shanty settlement of Bombay metropolis to assess their knowledge and practice as regards the diagnosis and treatment of pulmonary TB, their awareness of the NTP and their impression of public health services. A population of 200,000 people was randomly selected. Among a total of 207 private allopathic and non-allopathic doctors serving the population, 143 were interviewed on a semistructured interview schedule on various aspects of TB, its diagnosis and treatment; 31 doctors refused and 10 could not give time. The completed schedules were obtained from 102 (70%) of doctors (48 allopaths and 54 non-allopaths). All of them stated to have come across TB patients in their practice and 25 stated correctly that it is not a notifiable disease. All the doctors were aware of the symptoms of early manifestation of TB, about 20% replied that they would first investigate the patient before starting treatment, 60% would give antibiotic, 10% with cough mixture and 10% treat for eosinophilia. In response to confirm clinical diagnosis of TB all the doctors would subject the patients to X-ray, ESR & CBC, and 38% of them said they relied on sputum examination. All except 2 doctors employed 80 types of regimens containing SCC drugs, most of them were expensive, inappropriate and non-standard. Cost of drug treatment ranged from Rs.1500/- to Rs.5000/-, cost of diagnosis from Rs.50/- to Rs.200/-. Compliance by patients was reported to be in the range of 25% to 50%. The private doctors’ perceptions for treatment default by TB patients were illiteracy, lack of funds, carelessness, relief of symptoms and ignorance.

The nearest government facility providing free diagnosis and treatment to TB patients with all the facilities was a Municipal Clinic with an OPA of 35 per day. About 500 TB patients were under treatment at that point of time. All anti-TB drugs were available in the clinic. A large majority of the private doctors referred those patients who could not afford treatment, to this clinic. Their opinion about public health service was as follows: half of them found unsatisfactory, 40% average, 10% would never refer their patients due to bad treatment. About 70% of private doctors were aware about NTP but could not elaborate on the activities of NTP. About updating their knowledge on TB, 65% mentioned medical representatives of drug companies, 25% through books, 5% through CMEs and 5% did not reply.

Although private practitioners are the first points of contact by the patients, few attempts have been made to involve them in the important national disease control programmes. As a result, although they treat the TB patients in their clinics, but poorly. The importance of notification is well known, yet none of the private doctors ever reported a case of TB. As a result, private doctors seem to be alienated from national efforts towards control of TB, there being no well-defined role for them in the NTP. It is evident from this study that private doctors cannot be wished away, as the people opt for their services, but at the same time they must not be granted total freedom to act as they see fit without caring for the consequences. There is a need for better communication between the private doctors and those implementing disease control programmes so as to enable them to follow appropriate clinical and public health practices.