Patients requesting a second opinion
Guidance for consultants prepared by the Central Consultants and Specialists Committee in conjunction with Ethics department and the General Practitioners Committee
September 2002
The BMA has been receiving an increasing number of public enquiries regarding requests for second opinions for NHS patients. General guidelines are available from the BMA Ethics department, but consultants may find these additional notes of some help in dealing with what can be a contentious issue.
These notes are primarily designed as advice for working consultants, but we hope that patients and managers will also find them helpful.
What is meant by a “second opinion”?
The CCSC finds it more helpful to use the term “further opinion” to cover all circumstances. Consultants often ask for a further opinion from their colleagues when a case is unusually complex or difficult. The patient should always be kept informed and, unless the patient objects to this, the consent is implicit.
Where a patient, relative or carer requests a further opinion, this may be because that person has some doubts about the consultant’s diagnosis and/or proposed course of treatment and would like confirmation by another consultant or the possibility of alternative diagnoses or treatment to be explored.
Respecting the patient’s request
When the Patient’s Charter was in existence, it made clear that within the NHS referral for a further opinion was dependent upon agreement between patient and doctor. However, although it is generally acknowledged that patients do not have an automatic right to a further opinion, doctors should always respect a patient’s wish to obtain one unless there are justifiable reasons for refusal, e.g. it is perceived that the patient might come to harm as a result.
Such requests for a further opinion should always be handled sensitively and wherever possible dealt with by the consultant rather than any other doctor on the team. The patient should not be made to feel a nuisance or a ‘bad patient’. The patient may feel unable to share the reasons leading to the request and such a request sometimes reflects a previous failure in communication. The doctor should attempt to assess objectively whether this is the case and, if so, whether anything can be done to rectify it.
Obligation to find a consultant willing to give a second opinion
The responsibility for finding a suitable consultant to give a further opinion rests, strictly speaking with the referring General Practitioner. However, it is often helpful for the consultant to suggest a name which the patient may wish to discuss with their GP. The consultant being asked to give a further opinion in these circumstances should be agreeable to this and should be fully informed of the situation.
When a referral is made for a further opinion, there may be particular questions which can be best dealt with by a consultant-to-consultant letter, always keeping the GP informed. All relevant x-ray, scan, pathology and histopathology reports and material should be forwarded as soon as possible.
Responsibility for further care of the patient
When the opinions concur
If both the original and the second consultant are capable of carrying out the treatment the patient should be asked for a preference, which may depend on geographical convenience, waiting time etc. The second consultant may not be able to undertake the care because of NHS purchaser-provider contracts. If the patient has seen the second consultant under private arrangements, the patient may not be able to afford to progress with the recommended treatment in the private sector.
When the original consultant disagrees with the further opinion
If the original consultant disagrees with the further opinion, that consultant should discuss the difference in views with the patient. If the patient then prefers to follow the further opinion, it is appropriate for the first consultant to suspend treatment of the patient and to refer him/her to the new consultant for further treatment. (However, there may remain an obligation on the first consultant to continue to give some treatment to the patient, particularly if the treatment required is urgent and cannot be provided promptly by the second consultant or if the patient is currently an in-patient.)
