Lyme disease: can 10 minutes make a difference?

Many patients are unaware of Lyme disease symptoms.
Many patients are unaware of Lyme disease symptoms.

It is a known fact that reported cases of Lyme disease are increasing. According to the U.S. Centers for Disease Control and Prevention (CDC), reported cases of Lyme disease increased by approximately 5,000 cases from 2012 to 2013.1 Each year, 96% of the reported cases come from 13 states in the Northeast and upper Midwest.1 Although health-care professionals may not find these data surprising, the general public is not as knowledgeable about the condition.

Many providers incorrectly assume that patients, especially those living in high-risk areas, are familiar with Lyme disease and its attendant symptoms. Recently, I had a patient tell me that she was tested for Lyme disease after being bitten by an unknown insect. When asked if she had experienced symptoms of Lyme disease, she replied, “I don't even know what the symptoms are.”

This was not an isolated incident, as I have been questioned by many people about Lyme disease. I have had people tell me that they do not know what a tick looks like. Others ask how to identify the classic “bull's-eye” rash, since many people have false ideas about the presentation of erythema migrans. I have been asked about vague symptoms that people have experienced, as well as what symptoms are associated with Lyme disease. Patients have also asked whether treatment is necessary and if all tick bites require treatment.

Health-care providers are often bombarded with patients calling and requesting office visits for unnecessary testing or treatment for Lyme disease. Many of these patients are not symptomatic, have symptoms not associated with Lyme disease, or are too early in the infectious process for accurate serum testing results. For accurate testing, sufficient time (approximately 4 to 6 weeks) is necessary for antibodies to reflect transmission from a tick. Most patients are unaware of this and frequently request that testing be performed immediately following a tick bite. Providers should use these opportunities to educate the general population about Lyme disease. However, it seems that many providers may simply comply with these requests to appease their patients. This results in lost opportunities for patient education and a disservice to our patients.  

The most effective method for preventing infection with Borrelia burgdorferi infections is avoidance of tick-infested areas. However, if avoidance is not possible, then there are a number of measures that can decrease the risk of a tick bite.2 Patients need to know when ticks are most active, where ticks are most active, what steps they can take to avoid these areas, and what measures may help decrease their risks when in these areas.

Without preventive patient education, avoidance measures will not be implemented. Brief, 5- to 10-minute educational discussions on Lyme disease during routine or annual visits have the potential to decrease exposure, unnecessary testing, and unnecessary treatment. Understandably, health-care providers are already very busy at these appointments and cover a large quantity of information. However, spending just a few more minutes once a year can improve patient safety and outcomes, which will help decrease the frequency of time-consuming phone calls and unnecessary office visits. Isn't the extra time worth the value it provides?

Lyme disease will continue to be the most common tick-borne infection in the United States, and the number of confirmed cases will continue to rise. As health-care providers, it is therefore our responsibility to educate our patients about this significant personal health issue.

References

  1. Centers for Disease Control and Prevention. Reported Cases of Lyme Disease by Year, United States, 1995-2013. March 4, 2015. Available at: http://www.cdc.gov/lyme/stats/chartstables/casesbyyear.html. Accessed June 27, 2015.
  2. Wormser GP et al. The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: Clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006; doi:43:1089-1134.
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