Table 5:

Theme 3—Health care practitioners have challenges and disagreement toward chronic Lyme disease

Categories of themes	Subcategories of themes	No. HCPs	Representative quotes
General agreement that diagnosing and treating chronic LD is controversial and frustrating for HCPs and patients, resulting in diverse diagnosis and treatment decisions across Canada	There is controversy between HCPs and patients around the symptoms, manifestations, and existence of chronic LD	7 FP 2 ID 1 EP 1 NP	“…there's the question of chronic Lyme disease… which is like a bit controversial in terms of type of manifestations, chronic fatigue, chronic pain, things like that…” (Participant 19, FP)
	HCPs indicated that the controversy about whether or not chronic LD exists is due to limited research evidence and information	4 FP 1 NP 1 ID 1 EP	“Well chronic Lyme, we have problems with that… there is [no consensus] and great controversy right now among specialists… to know if chronic Lyme exists and … how we have to treat it here… I don't think there is much evidence at the moment, so there are very varied practices.” (Participant 43, FP)
Diversity expressed by HCPs with regard to the existence of chronic LD and treatment options	HCPs indicated they tend not to believe in chronic LD, resulting in a resistance to providing antibiotics	6 FP 4 ID 1 NP 1 EP	“For me, there isn't a chronic Lyme (laughs)… there is this conspiracy theorist's movement both within the chronic Lyme patients and also within some medical practitioners and naturopathic practitioners that make my job quite difficult.” (Participant 39, ID)
	HCPs indicated they tend not to believe in the efficacy of American diagnosis and treatment for chronic LD	3 FP 4 ID 1 NP 1 non-ID	“I know some our patients are like running around going to these Lyme clinics in the States and they get in these massive courses of antibiotics, and doing all these things that are really bad for their health, but… they're invested in it, so they spend all their money.” (Participant 5, FP)
	HCPs indicated they tend to believe in chronic LD and are willing to discuss long-term and chronic symptoms with patients	7 FP 2 NP 2 ID 1 non-ID	“So chronic disease, of course, tends to be more [patient stigma]. I mean people, some people, some medical professionals, I would say think that it doesn't exist um as an illness, which is silly, because of course it does.” (Participant 1, FP)
	HCPs indicated they are neutral or unsure about existence of chronic LD and therefore base their treatment off other physician or specialist's suggestions	5 FP 1 NP 1 EP 1 ID	“Sure, so I have one patient who specialists from the States says she has chronic Lyme. I, again, I'm not an expert, and so I'm going based on this physician's opinion. And so – and so, this patient, I give her antibiotics…” (Participant 10, FP)

EP = Emergency physician(s); FP = Family physician(s); HCP = Health care practitioner; ID = Infectious disease physician(s); LD = Lyme disease; non-ID = Non-infectious disease specialist physician(s); NP = Nurse practitioners(s)