Sarah’s Health Notes: Your right to a second opinion
I had one of those weeks recently when several people asked the same question: this time it was all about whether NHS patients have the right to ask for a second opinion. Plus add-ons like: can I change my GP? (Interestingly, an old colleague of mine who’s a Health Editor on a national didn't know the answer…)
People usually want a second opinion because they have doubts about the diagnosis or treatment. Examples I know of include a patient with epilepsy who was clearly getting worse under their consultant’s care so moved to a specialist NHS clinic where the drug regime was changed and their condition improved. A teenager with a foot problem who did not get a second opinion early on and got much worse before she did talk to another doctor. A middle-aged architect suffering intense fatigue which he discovered was likely due to the side effects of long-term medication; a second opinion confirmed that and the medication was changed. He also received non-drug support in the form of i/v supplementation for nutrient deficiency caused by the drug. A patient with advanced cancer who was told by one oncologist to make his bucket list; he consulted a second in a different hospital who offered treatment options for longer term survival. (In some other cases, patients have chosen to pay for a second opinion.)
In terms of your right to a second opinion, the bottom line is:
The General Medical Council (GMC) states that a medical professional ‘must recognise a patient’s right to choose whether to accept your advice, and respect their right to seek a second opinion’. Find more information here.
It’s worth noting that this is not an absolute legal right so while you have a right to ask/request a second opinion, doctors do not have to comply. However, they generally will because not doing so could lead to complaints or negligence claims. And to be fair, most doctors welcome another point of view.
In hospitals the biggest change for patients’ families came with Martha’s Rule. Martha Mills, 13, died in hospital from sepsis after she had a bike accident, which injured her pancreas. The hospital staff ignored her parents’ repeated concerns and the coroner ruled her death was probably preventable had she been moved to intensive care sooner. Martha’s Rule gives patients and families the right to a rapid second opinion for worsening conditions. (Each hospital should have a dedicated Martha’s Rule phone number for patients, families and staff to call.)
In primary care, there are things to consider before asking for a second opinion. Key factors with any doctor/patient consultation are the processes of ‘shared decision making’ (SDM) and ‘informed consent’. The opposite of the old ‘doctor God’ philosophy where patients accepted that what the doctor said must be right. Sadly, while that should be a thing of the past, it’s not always - as I know first hand from many people.
It’s important that doctors, however pressed they are, discuss treatments (and non-medical options if relevant) with patients (SDM). The acronym to remember is B.R.A.N., which stands for: Benefits, Risks, Alternatives, do Nothing. If a doctor does not go through these steps when prescribing a drug or recommending surgery, the patient is wise to ask so they can exercise informed consent.
And yes, you do have the right to change your GP, without giving a reason, and register with a different one if you are within their catchment area. When you register with a new practice, that automatically notifies your old GP to transfer your medical records.
You do, by the way, have a legal right to access your medical records from GPs and hospitals, also dentists and opticians, via a Subject Access Request (SAR), under the Data Protection Act 2018. More from the Information Commissioner’s Office. However, a friend who tried to do this recently was told by a GP she knew well not to bother because it was such a lengthy and tricky process.
Organisations like The Patients Association and your local Citizens Advice Bureau can help and advise you on options.
