Abstract: Objective　The study was conducted to analyze the first medical care seeking of new smear-positive pulmonary TB patients and the impact on TB case finding. Methods　Non-probability sampling method were used to select Guiyang, Yizhang, Yongxin and Beihu districts in Chenzhou city, Hunan province as the survey sites, and questionnaires were used to collect the basic information, including initial symptoms, first-visiting medical agencies and the first test results of the new smear-positive pulmonary TB patients seeking medical care from mid April to mid October, 2007. Results　A total of 186 new smear-positive patients were surveyed. The patients who first visited non-professional anti-TB agencies accounted for 97.8% and 22 patients were diagnosed as TB by visiting pharmacies and private clinics for 3 times or more. The patients who chose nearby medical agencies for convenience accounted for 58.6%. The referral rate was 67.1% in general hospitals above county level (47/70). And the daily recommendation rate of village clinics /township health centers was 26.5% (13/49). The patients who received no examination on their first visit accounted for 50.5% (94/186); only 2.9% (2/68) of general hospitals above the county level tested the sputum samples. Non-awareness rate of TB-related knowledge was 47.3% (88/186). Conclusion　High proportion of patients went to see doctor in non-professional anti-TB agencies for the first medical care. Low referral rates were found in village clinics and township health centers, and low sputum test rates were found in general hospitals. Therefore, it is important to improve the health education about TB-related knowledge and encourage patients to seek medical care in professional anti-TB agencies for the timely discovery of TB cases. In addition, consideration shall be given to further improve the current anti-TB system, such as the inclusion of pharmacies and private clinics into the system and the provision of professional training under the guidance of health department to improve the detection of TB patients.