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GPs given warning over missing Lyme disease diagnoses

11 June 2007

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The Medical Defence Union (MDU) is warning its GP and hospital doctor members to ensure they consider a diagnosis of Lyme disease, which is most common in spring and summer. A number of complaints and claims have been reported to the MDU in recent years, which primarily allege a delay in the diagnosis of this condition.

Dr Claire Wratten, MDU senior medical claims handler, said: “The diagnosis of Lyme disesase can be difficult to make because initial symptoms may be nonspecific and mistaken for other conditions. While a delay or failure in diagnosis is not necessarily negligent, if the condition remains untreated, patients may develop serious symptoms affecting mainly the neurological, cardiac and musculoskeletal systems, many months to years after the initial infection.

“Doctors may see increasing numbers of cases of Lyme disease in the future, as recent news reports have indicated a rise in the tick population, some of which carry the disease and can spread it to humans by biting and attaching themselves. In England and Wales, 684 cases of Lyme disease were reported last year and Scotland has seen a 10-fold increase in the numbers reported 10 years ago with 177 cases last year – which is why we are warning our members to be alert to the possibility of the disease in their patients.“

Despite the increase in incidence of Lyme disease, the MDU says it is likely that an individual doctor will only rarely see a case. In view of this, the MDU has issued the following advice to its members, aimed at avoiding delay or failure in diagnosis:

  • Advise patients to take precautions against tick bites if they are visiting woods, heathland and parklands in high risk areas. Advice is available online at:
  • Be aware that there are various clinical manifestations of Lyme disease.
  • Consider the diagnosis in patients with suggestive symptoms who have walked in areas where the disease is prevalent, such as Scotland, the New Forest and North America. Be aware that only about 20% of patients are likely to recall the tick bite.
  • If the diagnosis is considered, arrange appropriate tests to exclude or confirm the diagnosis.
  • Be aware of the relevant guidelines on treatment of the condition, for example those from the Health Protection Agency and Centres for Disease Control and Prevention.
  • As with all aspects of patient care, it is important to keep accurate contemporaneous records, and to record both positive and negative findings.
  • Remember that Lyme disease is a notifiable disease in Scotland, but not in England and Wales.