Do General Practitioners Recognize Cases of Lyme Borreliosis in the Netherlands?

To assess knowledge and recognition of Lyme borreliosis, two photographs of erythema migrans and two written
cases of Lyme borreliosis were presented to 51 local general practitioners. The photographs and cases were tested,
among 10 other dermatological and rheumatic cases, using 2 different formats: open-ended questions, prompting
for the most likely diagnosis, and multiple-probability estimate questions. Each case served as its own "golden"
standard, but cases were also presented to a panel of "experts," 13 dermatologists and 23 rheumatologists. In the
open-ended questions, the two photographs of erythema migrans were recognized by 16 and 45% of the general
practitioners and by 92 and 54% of the dermatologists. In the multiple-probability estimates, 14 and 14% of the
general practitioners and 77% and 46% of the dermatologists rated these two photographs as highly probable for
erythema migrans. The first case of Lyme borreliosis was correctly diagnosed by 55% of the general practitioners
and 96% of the rheumatologists in the open-ended questions. In the multiple-probability estimates, 61 % of the
general practitioners and 87% of the rheumatologists rated this case as highly probable for Lyme borreliosis. The
second case of Lyme borreliosis was never recognized in the open-ended questions, whereas only two general
practitioners rated Lyme borreliosis as highly probable in the multiple-probability estimates. General practitioners,
as well as dermatologists and rheumatologists, had difficulties recognizing Lyme borreliosis. Better instruction and
education in recognizing the manifestations of Lyme borreliosis seems indicated.