ADVICE TO PATIENTS ON SECOND OPINIONS UNDER THE NHS

An area where conflict may arise between the patient's desire to exercise choice and the doctor's clinical judgement, concerns requests from patients for a second opinion.

Within the Isle of Man Health Services, there is a well-established agreement between the Department of Health & Social Security and the Medical Profession with regard to second opinions, which gives patients the right to be referred to a Consultant acceptable to them, when their General Practitioner thinks such a referral is necessary, and to be referred for a second Consultant opinion if both agree that this is desirable.

This arrangement recognises that, in many cases, second opinions have to be sought from Consultants practising in the United Kingdom and, therefore, should only be authorised on the recommendation of the patient's family doctor, usually after discussion with the Consultant whose opinion was first sought. In specialties with more than one Consultant locally, second Consultant opinions should initially be obtained on the Island, again where the General Practitioner considers this is justified.

Whilst, therefore, patients do not have an automatic right to a second medical opinion, there are certain ethical obligations placed upon doctors when considering the specialist care needs of their patients. The General Medical Council's Code of Practice states that to establish and maintain trust between doctor and patient, doctors should respect the rights of patients to a second opinion. The basis of this statement is to ensure that doctors act reasonably and do not take a request for a second opinion as a criticism of their own competencies. However, this does not mean patients have a inalienable right to a second opinion, as the determination of the treatment required is the ultimate responsibility of the doctor, and not the patient.

It is clear therefore, that the question of a referral, either for a initial or second medical opinion, is a matter for joint consideration between a General Practitioner and his patient to determine if such a referral is desirable. In all circumstances, it would be helpful for patients to discuss options with their General Practitioner.

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