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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.
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