Diagnostic pathways of patients consulting at the infectious diseases ward for presumed Lyme disease : a qualitative descriptive study
Résumé
Objectives: Media coverage of Lyme disease (LD) has led to an increase in consultations for presumed LD in Europe. However, LDis confirmed in only 10-20% of patients, with a significant number remaining in a diagnostic dead-end.The objective of our study wasto understand the genesis of theLDhypothesis in care pathways.Methods:In spring 2019, we recruited for semi-structured interview the first 30 consecutive patients from a prospective cohort consulting in the infectious diseases department at University Hospital in Marseillefor presumed LD.The inclusion criteria were: age ≥18 years, subjective symptoms for ≥six months, no clinical or paraclinical argument suggesting current LD. The patients’ medical trajectories were collected using a biographical approachby combining sequences from the interviewee’s life and developing themes related to the medical history.
Results: The average duration of symptoms was 8.5 years.A majority ofparticipants were convinced they had LDdespite the lack of medical evidenceand the scepticism of their referring GP. The diagnosis of Lyme disease was primarily triggered by identification with clinical stories circulating in the media. Most ofparticipants had conducted the diagnostic investigationthemselves.
Conclusions:Patient empowerment in the diagnostic process suggest a failure of modern medicine to propose solutions for medically unexplained symptoms. Cliniciansshould systematically explore patients’ etiologic representationsin a patient-centred care approachin order to create the conditions for a therapeutic alliance.
Origine : Fichiers produits par l'(les) auteur(s)
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