Clinicians have difficulty identifying ticks


Welcome to another Inside Lyme Podcast with your host Dr. Daniel Cameron. In this episode, Dr. Cameron discusses findings from a recent study which examined the proficiency of clinicians at identifying ticks in the northeastern region of the United States.

The study by Laga and colleagues entitled “Proficiency at Tick Identification by Pathologists and Clinicians Is Poor” was published in The American Journal of Dermatopathology.¹

Using high-resolution photographs of ticks, the authors surveyed 115 health care providers, which included primarily medical students, medical residents, and physicians.


The survey was simple. Each health care provider was asked to look at high-resolution color pictures of ticks provided by the University of Rhode Island Tick Encounter Resource Center.  (The dimensions of each image were 1 5/8 inches by 2 inches.)

The participants were asked to select one of 5 possible answers for each photograph:

  1. American dog tick
  2. Deer/ blacklegged tick
  3. Lone Star tick
  4. Brown dog tick
  5. “I do not know”

Only 1 in 3 ticks were correctly identified.

The survey participants correctly identified 60% of the non-engorged black-legged ticks but only 34% correctly identified a partially engorged black-legged tick.

“Likely explanations are that texts and media rarely show partially engorged ticks,” the authors explain.

Additionally, “the color contrast seen between the scutum and abdomen in the blacklegged tick, for example, is lost after 2.5–3 days of engorgement.”

Participants had more difficulty identifying the other tick species:

  • 1 in 2 participants identified a non-engorged Lone Star tick;
  • 1 in 3 identified a non-engorged American dog tick;
  • 1 in 4 identified a non-engorged adult Brown dog tick.

The number of ticks correctly identified was worse for partially engorged ticks.

Medical students and non-physician health care providers (i.e., nurses, physician assistants) fared the worse with only about 1 in 4 correctly identifying the ticks.

In everyday practice, health care providers do not view high-resolution photographs of ticks. Their experience, instead, is with actual ticks which appear much smaller.

“In addition to choosing the easier-to-identify female ticks for our test, we also chose adult rather than nymphal ticks for the quiz,” the authors explain.

“Nymphal ticks, in addition to be being smaller, tend to have more muted colors and less distinctive markings on their scutums.”

In actual practice, it’s important that health care providers can identify engorged ticks. Yet, the survey shows that engorged ticks were more difficult for providers to identify.

The following questions are addressed in this podcast episode:

  1. How often is the tick seen?
  2. Have you found it difficult to identify a tick?
  3. What are a few tips to identifying ticks?
  4. What diseases does each tick carry?
  5. Why is it important to be able to identify an engorged tick?
  6. What is the risk of an engorged tick?
  7. What educational information should clinicians receive?
  8. What do Lyme disease patients know?
  9. What are treatment options for a tick bite?
  10. What are the risks and benefits of a single 200 mg dose of doxycycline for a tick bite?
  11. How effective is testing of ticks for diseases?

Please remember that the advice given is general and not intended as specific advice as to any particular patient. If you require specific advice, then please seek that advice from an experienced professional.

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  1. Laga AC, Granter SR, Mather TN. Proficiency at Tick Identification by Pathologists and Clinicians Is Poor. Am J Dermatopathol. May 11 2021.



As they say, “There’s no such thing as a good tick.”

That said, doctors are woefully educated on ticks, the diseases they spread, how to diagnose, treat, and recognize not just various ticks but the wide variety of symptoms patients struggle with.

This study partially reveals the many problems in Lyme-land.

Yesterday, I posted an article proposing guidelines by supposed ‘experts’ that call themselves the ‘Wilderness Medical Society.’  In the comment section I break down the various continually regurgitated myths used as talking points and the basis for all research and clinical guidelines. One of the things discussed is how the “wait and see” approach has been dooming patients for decades. This essentially means that rather than quickly treating known tick bites prophylactically, they simply wait and see if the person develops symptoms.

They also continue to push the one-dose doxy prophylactic treatment which doesn’t work. Neither does two pills. Unfortunately, researchers still believe the EM rash is some magical symbol.  The EM rash comes and goes at will and should never be a marker for effectiveness of treatment.

The catch with all of this is doctors can’t identify the ticks involved.

Ironically, if the doctor can’t identify the tick, or if attachment time is unknown, they still recommend the “wait and see” approach, even though that particular refrain has caused untold damage.

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