In the 21^st century, tuberculosis (TB) is still surrounded by fear and prejudice, making it both a medical and a social issue. Patients commonly become the center of attention because stigma delays their referral for aid, conceals the diagnosis and results in experiencing treatment failures [1]. According to the World Health Organization (WHO), key conditions for successful TB control include protection of human rights, equal access to aid and fighting discrimination [1]. The other side of the issue is rarely noticed. It consists of the stigmatization of phthisiologists, nurses, laboratory assistants, primary care physicians, pulmonologists, and infectious disease specialists.

Russian phthisiology has a distinct and mainly unique history. The State Tuberculosis Institute (which later became the Central Research Institute of Tuberculosis), established in Moscow on August 28, 1921, served as the organizational core of the tuberculosis control system. Around this institution, a widespread network of specialized dispensaries, hospitals, and sanatoriums was built [2]. In the USSR, the dispensary system, which organized medical care by nosology rather than by location, was the defining feature of healthcare [3]. In Russia and most post-Soviet nations (such as Ukraine, Uzbekistan, and Kazakhstan), phthisiology developed as an independent clinical specialty. It features its own residency training programs and dedicated phthisiologists who manage not only patient treatment but also long-term dispensary monitoring, health education, and social support. In most countries outside the post-Soviet space, tuberculosis care does not exist as a distinct medical specialty. Instead, tuberculosis treatment falls under the broader fields of pulmonology or infectious diseases. While physicians who treat TB are still referred to as phthisiologists, any related social or outreach work is managed by nurses and social workers rather than by a representative of a dedicated medical discipline. From an ethical standpoint, this institutional feature is crucial. As Russian specialists in tuberculosis handle everything from hands-on clinical treatment to community education and outreach, their high visibility makes them much more vulnerable to professional stigma than doctors who only treat the disease occasionally.

Professional stigmatization can be defined as a set of negative stereotypes, limitations, and discriminatory practices that a specialist is subjected to not because of the quality of their work, but simply due to their association with tuberculosis. According to a systematic review on tuberculosis stigma, the main driving force is the fear of contracting TB, and it affects not only patients but also those who treat them [4]. Moreover, one recent study showed that such biases are frequently mirrored within the medical community itself toward professionals working in tuberculosis control programs [5]. In foreign bioethical literature concerning tuberculosis prevention among personnel, it is noted that an adequate assessment of occupational risk should lead to improved working conditions, rather than to the exclusion of a specialist from their professional sphere [6]. At the same time, a domestic study on the perception of tuberculosis by primary healthcare physicians reveals a persistent gap between theoretical knowledge of transmission modes and the irrational fear of contracting the disease among certain clinicians when dealing with tuberculosis departments [7].

Several factors underlie professional stigma such as fear of infection due to insufficient infectious safety of the institution; the transfer of social stereotypes about tuberculosis as a disease of poverty and social maladjustment onto the specialist; underestimation of the complexity of phthisiology as a modern, high-tech field of medicine; and a deficit of organizational protection for personnel. It is important to distinguish between justified caution and stigma. Thus, a rational response to a professional risk is rather infectious control than social distancing from a specialist.

It is convenient to analyze this problem from an ethical point of view through several basic principles. The dignity of the individual implies that a phthisiologist should not be perceived solely as a “carrier of infectious danger” and that they deserve the same respect as any other doctor. The non-maleficence principle applies not only to patients but also to staff: stigma harms the psyche (anxiety, burnout, self-stigma), social connections (alienation from colleagues and loved ones), and career (underestimation of qualifications, missed growth opportunities). From the principle of justice, it follows that the risks faced by healthcare workers in tuberculosis services must be balanced by appropriate protection, compensation, and recognition of the complexity of their work. This same thesis is enshrined in the specialized WHO guidance on medical ethics regarding tuberculosis: an individual healthcare worker should not bear sole responsibility for the consequences of systemic organizational failures [8].

Furthermore, the concept of solidarity dictates that managing tuberculosis must be a unified institutional priority, rather than an isolated burden of a single specialty. It is entirely unacceptable to hold individual doctors solely accountable for infectious safety by using the dismissive argument that “they chose this profession themselves”.

An illustration of hidden forms of professional stigma can be seen in a situation where phthisiologists who are pregnant or postpartum frequently encounter intense domestic pressure, with relatives demanding they restrict contact with their newborns or cease breastfeeding due to fear of “infection”. Meanwhile, dealing with TB patients doesn’t mean that a healthcare professional has active tuberculosis, as TB is not transmitted through casual contact [9]. Moreover, the WHO does not recommend to separate a newly born from a mother with confirmed TB and advises continuing breastfeeding which is necessary for the early when the measures of infectious control are followed [10]. Such pressure replaces objective clinical assessment with professional stereotypes and can cause significant psychological harm during the most vulnerable period of motherhood.

A similar mechanism can be applied in relation to patients experiencing social vulnerability. When coworkers make comments about how tough or unpleasant your clients are, they are insulting both your patients and your skills as a professional. Poverty, homelessness, and history of imprisonment are social determinants and risk factors for tuberculosis, not moral characteristics of a person; increased incidence in closed institutions is explained by overcrowding, ventilation peculiarities, and other factors, not by patient “behavior” [11].

Particular attention must be paid to scenarios where clinicians face pressure directly from the patient rather than from broader society or colleagues such as instances of physical threats after non-compliance with medical protocols. It is more accurate to speak not of stigma in the strict sense, but of the victimization of medical personnel. However, the ethical logic is the same: the clinical duty to provide emergency care does not negate the employer’s duty to ensure the safety of workers, and threats should not be perceived as an “inevitable part of the job” in phthisiatric services [12].

The consequences of professional stigma affect several levels: chronic stress, decreased job satisfaction, and self-stigmatization for TB specialists; reduced attractiveness of phthisiology for young doctors; increased stigma of the disease for patients, if the medical system demonstrates fear and avoidance towards those who treat it; and deterioration of interdisciplinary interaction, which is essential for the early detection of tuberculosis and for the effective functioning of the healthcare system.

Prevention strategies should be multi-level. At the organizational level, real infectious safety is necessary. It includes early detection, separation of patient flows, availability of respiratory protection, as well as transparent guarantees for staff such as protection from violence and threats in the workplace, prevention of working alone with an aggressive patient, and incident documentation [12]. The expert and educational function of a phthisiologist requires recognition even against the backdrop of improving epidemiological indicators. Training for physicians of all specialties statistically significantly increases the detection of tuberculosis cases (pooled relative risk 1.60 with 95% CI 1.53–1.66) [13], therefore regular professional training on tuberculosis remains a mandatory, not an optional, activity [14]. At the organizational culture level, it is important to eliminate derogatory language and stigma-based humor, and to include phthisiologists in general professional processes such as consultations, scientific events, and management decisions.

Finally, labor rights of specialists must be protected as they require fair pay, transparent workload distribution, access to prevention and treatment of occupational diseases, and the ability to safely report infection control issues without the risk of being labeled “disloyal” [8]. Respect for the autonomy and professional judgment of the phthisiologist also means that treatment personalization within evidence-based approaches should not be perceived as a deviation from the standard as clinical guidelines are intended to support, not replace, clinical reasoning, and patient-centered tuberculosis care involves shared decision-making with the patient [15].

CONCLUSION

The stigma against doctors and nurses working with tuberculosis is not a private conflict, but an ethical and staffing issue of systemic proportions. The actual risk of infection does not justify stigmatization. A reasonable response to this risk is to improve infection control and protect staff rights, rather than alienating and devaluing the profession. Only a combination of measures can reduce the severity of the problem. The measures include information and educational programs, safe working conditions, confidentiality guarantees, protection from workplace violence, fair workload distribution, and recognition of phthisiology as a full-fledged, high-tech clinical discipline. Ultimately, this benefits not only the well-being and retention of tuberculosis service staff, but also patient trust, treatment quality, and achievement of overall public health goals in the fight against tuberculosis [1].