Private practitioners approach to the diagnosis of Pulmonary Tuberculosis in southern India

Background: In India majority of patients with respiratory symptoms initially consult private doctor. Few studies have been performed on the role of private practitioners in TB control. The present study was planned to assess the private practitioners approach in the diagnosis of pulmonary tuberculosis. Method: A Cross Sectional study was conducted between September 2008 and October 2009 in rural and urban area of Udupi taluk. The study population included all modern medicine general practitioners and all the specialists practicing Internal Medicine, Chest Medicine, and Pediatrics. The non response rate was 8%. About 15 practitioners who were not in the list were interviewed during field visits. So, the total number of practitioners interviewed was 116. Results: The majority (67.4%) of general practitioners and physicians opted for sputum examination as the investigation of choice to diagnose pulmonary Tuberculosis. About 26.1% of general practitioners and physicians used both sputum and chest x-ray to diagnose pulmonary tuberculosis. About 6.5% used chest x-ray alone. However, about 58.3% of paediatricians preferred both sputum and chest x-ray to diagnose pulmonary tuberculosis. Conclusion: Relying only on chest x-ray to diagnose pulmonary tuberculosis may lead to over-diagnosis, over-medication and un-necessary utilization of resources. There is a need to improve the awareness among private practitioners regarding the importance of sputum smear examination to diagnose pulmonary tuberculosis.