By: SK Sahil
October in Amritsar is a month of seasonal change. The punishing heat of summer finally begins to relent, and the air bears a hint of the colder season ahead. It was in this weather that Gurneet, a 34-year-old homemaker, developed a light cough. She did what most others would do: assumed it was the weather, picked up a cough syrup from the neighbourhood pharmacist, and went back to her routine.
A week went by and the cough did not subside. It deepened over the following weeks and was accompanied by a high fever, malaise and profuse sweating at night as she struggled to sleep. She was also losing considerable weight and everyone around her started pointing out.
Over the next four months, Gurneet would visit eight different private doctors, hoping that the next one has a cure for her ailment. Each time, she would describe the same symptoms and come home with a prescription for flu medication or antibiotics. She was even administered saline drips by a doctor. She would religiously follow the treatment that was advised, but nothing changed and her condition continued to worsen. Despite the textbook presentation, the possibility of tuberculosis was never considered. Not once across those eight visits did any doctor suggest a sputum test or a chest X-ray.
When simple everyday tasks, such as cooking, climbing the stairs, getting through the day, became burdensome for a fairly young woman of 34, Gurneet asked her husband to take her to another doctor. This time they went to the local government hospital and the diagnosis was confirmed. It was pulmonary tuberculosis, a disease whose symptoms, including persistent cough, fever, night sweats, unexplained weight loss, are well-known and, in this case, had been visible for months.
Unfortunately, this isn’t a one-off lapse, it’s a deeper pattern. There is a wide arbitrary variation in how doctors order TB-specific tests even for patients with clear, persistent symptoms.1 Studies from across India consistently show that TB patients visiting private doctors tend to cycle through multiple providers before anyone arrives at the right diagnosis, leading to unnecessary expenses and increased risk of transmission.2 A recent research finds that patients who first visited private facilities were more likely to face prolonged diagnostic delay.3
Despite clear guidelines, with the International Standards for TB Care and India’s National TB Elimination Programme both laying out what practitioners should do, adherence in the private sector remains patchy. Majority of patients in India seek private care first, but with few checks and little consequence for deviation from protocols, the sector remains largely self-regulated.
In Gurneet’s case, private care translated to costs that went well beyond the medical bills, though those were significant too and paid out-of-pocket. Her husband also missed work on some days to accompany her to consultations, and household responsibilities had to be redistributed as her condition deteriorated. Thus, the delay in diagnosis affected not just her health, but the family’s daily routine and finances.
That’s not all. The effects in such scenarios ripple system wide. Every TB patient who goes undiagnosed is also a patient who is invisible to the surveillance systems that India’s elimination programme depends on to track and respond to the disease. This delay means the transmission continues unchecked. Small fractures in the system, like Gurneet’s delayed diagnosis, slowly compound into a public health issue, impacting health outcomes and disease containment at scale.
Gurneet is undergoing treatment now and on the path to recovery. But the conditions that delayed her diagnosis uncover an important gap, one that plagues the core of private healthcare in India. Why does a private practitioner not order a sputum test at the first visit for a patient presenting exactly as she did when guidelines and diagnostic protocols are in place? If this gap isn’t addressed, Gurneet’s story will continue to repeat in different homes, different cities, with different names but the same outcome.
Private practitioners in high-burden settings need to be meaningfully integrated into national care frameworks, with mechanisms that make adherence and accountability real. The goal is to create systems where a patient like Gurneet does not have to circle through eight doctors to arrive at a diagnosis this recognisable.i
Author bio:
Sk. Sahil is a public health enthusiast with over 5 years of experience in implementing large-scale health programs across multiple disease areas. At the Max Institute of Healthcare Management, Indian School of Business (MIHM-ISB), he worked as a Research Associate in 2025-26, where he was a part of an implementation research on the efficacy of pill-in-hand adherence monitoring for tuberculosis. This blog draws from his work focused on contributing to research outputs, supporting evidence generation, supporting data quality assurance processes, driving field-level insights, and coordinating field implementation teams to strengthen program delivery and improve outcomes. Currently, he is working as a Sr. Program Manager PMU at Rocket Learning strengthening ECCE through policy.