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Communications to the Editor |

Why Blame Private Practitioners? Why Blame Private Practitioners? FREE TO VIEW

Ashish Bhalla, MD
Author and Funding Information

Affiliations: Chandigarh, India,  Johns Hopkins University Baltimore, MD

Correspondence to: Ashish Bhalla, MD, House No.: 1032, sector 24-b, Chandigarh, 160023 (UT) India; e-mail: ashish_ritibhalla@yahoo.com



Chest. 2001;119(4):1288-1289. doi:10.1378/chest.119.4.1288
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To the Editor:

There is a tendency among academicians to blame private practitioners for everything that has gone wrong in the treatment of tuberculosis. There have been studies implicating private practitioners for wrong prescriptions that are blamed for emergence of multidrug-resistant tuberculosis, as highlighted in the article by Rao et al (March 2000).1In this study, the authors concluded that private practitioners make frequent errors in prescribing antitubercular therapy (ATT) in low-prevalence areas. There have been similar studies in India, a high-prevalence area for tuberculosis, with similar results.24 The point to ponder is, Who are these private practitioners, and whom do they look to for correcting their deficiencies? The answer is simple: their colleagues in the faculty positions at medical institutes. Is the knowledge of these teachers and residents working in the medical colleges and institutes adequate? We studied knowledge, attitude, and practice in 40 residents and faculty members from various departments prescribing ATT in one medical institute in India, and the results were surprising. Less than 50% knew what directly observed short-course treatment is, < 50% knew that the World Health Organization (WHO) has classified tuberculosis patients into four broad categories. Only 57% could answer that sputum-positive patients belong to category I; 47.5% could correctly categorize tuberculosis lymphadenitis to category III. Less than 25% could correctly write the exact drug schedule for category II patients. Only 50% could give the correct dosage of antituberculosis drugs.

This was introspection, and people were willing to learn from their mistakes. The observation that the knowledge regarding the treatment guidelines among the residents and consultants is low points to the fact that reeducation of faculty members regarding recent trends or guidelines is essential if we want this knowledge to percolate to the periphery. This kind of self-evaluation should be encouraged so that one is aware of one’s deficiencies and corrective measures could be planned. The WHO should also take up the task of going to the basic level for imparting knowledge regarding recent guidelines and not just publishing books of the same. Local initiative by faculty members in educating their colleagues will go a long way in preventing such problems.

Rao, SN, Mookerjee, AL, Obasanjo, O, et al (2000) Errors in treatment of tuberculosis in Baltimore.Chest117,734-737. [CrossRef] [PubMed]
 
Jain, RF Faulty prescriptions: an avoidable cause of multidrug-resistant tuberculosis.Indian J Tuberc1998;45,141-143
 
Madhur, G Private doctors in India prescribe wrong tuberculosis drugs. BMJ. 1998;;317 ,.:904. [PubMed]
 
Uplekar, MW, Rangan, S Private doctors and tuberculosis control in India.Tubercle Lung Dis1993;74,332-337. [CrossRef]
 

Why Blame Private Practitioners?

To the Editor:

Our study of errors in treating tuberculosis in Baltimore did not compare private doctors with academic doctors, but rather with the public tuberculosis clinic. In fact, physicians at academic medical centers who treated tuberculosis patients are considered private doctors in our analysis. Our main conclusion was that fewer mistakes occur in a comprehensive tuberculosis treatment clinic with expert staff than in individual doctors’ offices. We reasoned that a lack of experience with tuberculosis care was associated with incomplete knowledge of appropriate therapy, but noted that mistakes were frequently noted in a study in India, a high prevalence country.1 The correspondence from Chandigarh confirms that knowledge about appropriate tuberculosis treatment is low in an academic medical center in a high burden country. While the situations in Chandigarh and Baltimore are quite distinct, in both cities physicians require more training about treating (and preventing) tuberculosis. The survey done by Dr. Bhalla is a useful contribution to identifying the scope of the problem. We agree that additional educational efforts by tuberculosis experts are sorely needed by physicians in a variety of settings, including academic medical centers, and applaud the authors’ initiative addressing this problem.

References
Uplekar, M, Juvekar, S, Morankar, S, et al Tuberculosis patients and practitioners in private clinics in India.Int J Tuberc Lung Dis1998;2,324-329. [PubMed]
 

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References

Rao, SN, Mookerjee, AL, Obasanjo, O, et al (2000) Errors in treatment of tuberculosis in Baltimore.Chest117,734-737. [CrossRef] [PubMed]
 
Jain, RF Faulty prescriptions: an avoidable cause of multidrug-resistant tuberculosis.Indian J Tuberc1998;45,141-143
 
Madhur, G Private doctors in India prescribe wrong tuberculosis drugs. BMJ. 1998;;317 ,.:904. [PubMed]
 
Uplekar, MW, Rangan, S Private doctors and tuberculosis control in India.Tubercle Lung Dis1993;74,332-337. [CrossRef]
 
Uplekar, M, Juvekar, S, Morankar, S, et al Tuberculosis patients and practitioners in private clinics in India.Int J Tuberc Lung Dis1998;2,324-329. [PubMed]
 
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