Abstract
Objectives/Aims: To determine the challenges General Practitioners (GPs) face in management of patients with Tuberculosis (TB)
Method: Focus group discussions with 12 GPs
Setting: The study was carried out in Shifa College of Medicine (SCM) which is a private medical college in Islamabad, Pakistan. SCM has initiated a Professional development course for practicing GPs of twin cities of Rawalpindi and Islamabad attended by 22 GPs. The course is divided into modules and prior to initiating the Respiratory module we carried out this study.
Results: Numerous challenges are faced by GPs in terms of diagnosis and management mostly due to knowledge gaps. Physicians need education about appropriate diagnostic tests. Facilities for gold standard tests like sputum smear and culture were not available at all centers. Extra pulmonary TB poses a big diagnostic challenge because of lack of facilities for affected organ biopsies.
Regarding management, GPs mostly used fixed drug combination therapy, which is also promoted by latest WHO guidelines. Most participants did not calculate doses for their patients and none maintained a TB register. GPs were not aware of screening guidelines for close contacts. Knowledge about diagnosis of Multi-drug resistant TB (MDR-TB) was lacking. Treating pregnant and lactating women with TB is considered a major challenge. Counseling patients with TB needs attention because it is linked with issues like drug compliance and social stigmatization.
Conclusion: Knowledge gaps regarding management of TB should be filled with printed guidelines and protocols. Educational Seminars should be conducted by experts in the field of tuberculosis for General practitioners regularly to update them about standard treatment practices. Counseling workshops are needed for GPs in this regard.

Key words: General Practitioners, Tuberculosis diagnosis, Tuberculosis management