What about GPs in the fight against tuberculosis?

Dr Davies's article on tuberculosis (TB) is fascinating and I agree with many of his sentiments (June 2003 JRSM¹). But why were general practitioners (GPs) not mentioned in this fight against TB? I, too, have come across a patient in the past few months who almost died of meningeal tuberculosis. She was middle-aged, living with a family I had known for many years (but not registered with a GP). She developed a cough, weight loss, and sweats and finally ended up in intensive care with meningeal TB. Happily she survived and is now well. What is particularly galling is that, as a practice, we take an active interest in infectious diseases.² This brings me back to my main point.

Respiratory physicians cannot do all this alone; I don't know if some of Davies's comments are directed at GPs specifically (re-education of the medical and allied professionals), but general TB surveillance cannot be done without primary care. Let me say why.

I have heard it said many times that TB management should be totally within the remit of secondary care specialists. If the model of care is one that emulates HIV/AIDS care—hospital driven and directed—then please do not blame GPs for not identifying cases earlier.³ If you involve GPs in decisions regarding their tubercular patients, then primary care can be expected to work with specialists on early identification, management and most importantly, follow-up. Since January 2003 we have registered almost 400 patients from all five continents and including warravaged places such as Afghanistan, Iraq, Ivory Coast, Congo as well as those countries now recovering from the effects of war such as Albania and Kosovo. This is probably why up to 40% of new cases occur in London. With this in mind, it is incumbent on all health professionals to think about TB in cases where it might be a remote, or not so remote, possibility. Davies's article would have been more compelling if GPs had been mentioned at least once.