Intended for healthcare professionals

Rapid response to:


Lyme disease: time for a new approach?

BMJ 2015; 351 doi: (Published 03 December 2015) Cite this as: BMJ 2015;351:h6520

Rapid Response:

Re: Lyme disease: time for a new approach?

To the Editor:

In his comment about the perceptive Lyme disease editorial by Borgermans et al., Patrick Lacor states that the main issue for a physician facing a patient with possible Lyme disease is whether the physician can simply say, "I don't know". This situation is no different from a physician facing a patient with possible cancer, HIV/AIDS or hepatitis C virus (HCV) infection. The physician's answer should be, "I may not know, but I will ask someone who does”. That answer is a cornerstone of listening to the patient, as Professor Lacor acknowledges for patients with HIV/AIDS (1).

As stated in the editorial, Lyme disease has become a major epidemic with over 300,000 new cases diagnosed each year in the USA alone. Thus Lyme disease is six times more common than HIV/AIDS and 20 times more common than HCV infection (2). In the face of this epidemic, healthcare providers can no longer wash their hands of sick patients by saying "I don't know". These patients should be referred to medical professionals with a working knowledge of Lyme disease diagnosis and treatment, such as members of the International Lyme and Associated Diseases Society (ILADS).

For physicians who treat Lyme disease, the approach to sick patients with tickborne disease is usually clear-cut and logical based on the ILADS Lyme guidelines (3). For physicians who are content to say "I don't know" to Lyme disease patients, it is time to say "I want to learn more".


1. Arrey AE, Bilsen J, Lacor P, Deschepper R. “We listen to them”: A qualitative study of HIV provider-patient relationship in the management of care. BJESBS 2016;12: 1-10. DOI: 10.9734/BJESBS/2016/20582.

2. Stricker RB, Johnson L. Lyme disease: Call for a “Manhattan Project” to combat the epidemic. PLoS Pathog 2014;10:e1003796.

3. Cameron DJ, Johnson LB, Maloney EL. Evidence assessments and guideline recommendations in Lyme disease: the clinical management of known tick bites, erythema migrans rashes and persistent disease. Expert Rev Anti Infect Ther 2014;12:1103-35.

Competing interests: No competing interests

09 December 2015
Raphael B. Stricker
450 Sutter Street, Suite 1504, San Francisco, CA 94108, USA