Many doctors in India miss TB signs: study

Many private sector doctors in India miss the signs of tuberculosis and therefore provide patients inadequate treatment, according to a new study published Tuesday involving people hired to act out the symptoms.

Tuberculosis or TB, an airborne infection, remains a major public health issue in India, China and Indonesia, among other countries.

It killed 1.7 million people in 2017, according to the World Health Organization, and a global health summit will be held at the United Nations on Wednesday to raise funds to eradicate the disease.

But the primary care physicians who see patients when they start coughing are the weak link in the fight against the pandemic -- at least in the two cities where the study took place, the metropolis of Mumbai and eastern Patna.

The experiment was financed by the Bill and Melinda Gates Foundation and led by a team of researchers from McGill University, the World Bank and Johns Hopkins University. The results were published in PLOS Medicine. It took place across 10 months between 2014 and 2015.

Twenty-four "simulated patients" went to 1,288 private sector doctors, presenting symptoms ranging from a simple cough to a cough presented as a possible relapse.

In 65 percent of interactions, medical practitioners -- which includes both qualified doctors, unqualified ones and those who practice traditional medicine -- responded in a manner inconsistent with Indian and international standards of care.

In some cases where a doctor suspected a problem linked to air pollution, they prescribed an antibiotic or syrup and asked the patient to return a few weeks later.

Doctors with formal medical training, particular in Mumbai, did slightly better, offering the correct course of treatment in roughly half of the cases, according to the results.

Doctors without formal training, who are very common in rural zones, are doing worse, as are those who provide traditional medicine including ayurveda, unani, and Siddha medicine, collectively known as "ayush."
Jishnu Das, a World Bank economist, explained that the problem wasn't so much that doctors were following one alternate treatment course as much as just doing "everything you can find."