January 21, 1998

Expert Advice and Patient ExpectationsLaboratory Testing and Antibiotics for Lyme Disease

Author Affiliations

From the Departments of Medicine and Microbiology, University of California, Irvine.

JAMA. 1998;279(3):239-240. doi:10.1001/jama.279.3.239

The reported incidence of Lyme disease, an arthropod-borne infection, is about the same as another spirochetal infection, syphilis.1 But Lyme disease receives far more public and media attention than the sexually transmitted infection does.2 However, this attention is not hard to understand: Lyme disease is primarily a disorder of suburban, educated middle- and upper-class people. Lyme disease can be as disabling as syphilis, but there usually is not a stigma to having Borrelia burgdorferi infection. The demographics of Lyme disease also make it likely that those at risk of infection would be comparatively knowledgeable about the disease and may even have opinions about how to manage it. Does this level of interest—a set of patient expectations and perhaps even demands—influence care itself? In this issue of THE JOURNAL, the article by Fix and colleagues,3 while not directly answering that question, does reveal a possible consequence of patient expectations. The article also demonstrates that laboratory tests and antibiotic therapy—whatever the driving force behind them—often are not consonant with expert advice about Lyme disease care.

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