MDU issues advice on Lyme disease following announcement of government review
MDU reminds doctors about Lyme disease diagnosis as new guidelines awaited
Doctors are being advised to consider the diagnosis of Lyme disease in patients with suggestive symptoms, as the disease can often by mistaken for other conditions, according to the Medical Defence Union (MDU). Allegations about failure to diagnose Lyme disease are the most common reason for the condition to feature in complaints and claims reported to the MDU, with many cases involving GPs.
Numbers of cases of Lyme disease, which is a bacterial infection caused by infected ticks, have risen in recent years, and it is estimated there are around 2,000 to 3,000 new cases in England and Wales each year. The government announced a review of the diagnosis, treatment and transmission of the condition, earlier this week, including new NICE guidelines.
Dr Nicola Lennard, MDU medico-legal adviser said:
“We know our members often worry about missing a diagnosis of an unusual condition or mistaking patients’ symptoms for something more run of the mill. One such example is Lyme disease as initial symptoms may be non-specific and mistaken for other conditions.
“Doctors may see increasing numbers of cases of Lyme disease in the future so it is advisable to consider the diagnosis if a patient presents with suggestive symptoms and history. This is particularly important at this time of year when people are more likely to be walking in areas such as Scotland and the New Forest, where the tick which causes the disease is prevalent. With appropriate diagnostic tests and antibiotic treatment, Lyme disease can be managed effectively.
“Failure to diagnose Lyme disease is not necessarily negligent as this can be a difficult condition to spot, but it’s important to clearly document the consultation with the patient including the history taken, the examination performed, the differential diagnosis and management plan.”
In one typical case, reported to the MDU, a patient complained to their practice that their condition had been missed despite several visits to the nurse practitioner and various GPs. Another patient with a tick bite initially tested negative for the infection but was later found to have the disease. The patient claimed the practice should have repeated the blood test in the light of the symptoms.
The MDU’s advice on avoiding a delay in diagnosis of Lyme disease includes:
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Advise patients to take precautions against tick bites if they tell you they are visiting high risk areas, especially in Spring and Summer when ticks are most active.
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Be aware that there are various clinical manifestations of Lyme disease.
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Consider the diagnosis in patients with suggestive symptoms who have walked in areas where the disease is prevalent. NHS choices provides advice on preventing tick bites and a list of areas of known to have a high population of ticks.
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If the diagnosis is considered, arrange appropriate tests and where the diagnosis remains unclear, consider obtaining a specialist opinion from an infectious diseases consultant.
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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.
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Remember that Lyme disease is a notifiable disease in Scotland, but not in England and Wales.
