Do you need a second opinion?
As a GP, I'd love to think that all my consultations are perfect - but they aren't. We all have times when we leave our doctor feeling dissatisfied. But when should you take the next step and ask for a second opinion?
Your GP is not a mind reader!
Patients often come in to my surgery convinced they have a certain condition, but they don't always tell me. A lady I saw last week had a brother who had died of lung cancer, and she was convinced she had it too. Everyone else I had seen that week with a cough wanted to know if they needed antibiotics, so that's what I assumed she was there about too. If she hadn't told me what she was concerned about (or I hadn't asked) she would have left without her fears allayed.
Why do you want a second opinion?
If you think you have something wrong but your GP says you don't (or that you have a different condition), ask why. Your GP should be happy to explain what symptoms and signs suggest you might have a given problem, and why they feel able to rule something out. Ask them for patient information leaflets about the condition they've diagnosed to back up their explanation
Do I have a right to a second opinion?
Although you don't have a legal right to a second opinion, you have a right to ask for one. Without a good reason, your doctor is unlikely to refuse to refer you for one. However, these days (with your consent) there are several ways of getting a second opinion without you necessarily seeing a second doctor in person. For instance, your GP may discuss your case with a colleague or colleagues at the GP practice. They may write to a second consultant with all the details of your case and your reasons for asking for a second opinion, and ask if the second consultant feels they would manage your case differently. Many areas of the country have direct access specialist advice lines where a GP can ring at certain times to discuss complicated cases with a different specialist.
If you want to see a different consultant, your GP would have to re-refer you. Because you've already seen a specialist, you may have to wait for an appointment. This in turn may delay you getting treatment, so it's important to take this into account if you're thinking of asking to be referred to a different hospital. The new consultant won't necessarily take over your care in the longer term (this would need to be arranged with the doctors and the hospital) and won't necessarily recommend a different course of action to the first. If you want to see a different GP, you can make an appointment with a different one in your surgery. Alternatively, you can register with another GP - but do talk to your GP first, as you may be reassured and no longer feel the need for a second opinion
Can I register with any GP I want?
A few years ago, the government announced plans to scrap GP catchment areas, which mean you can only register with a GP you live close enough to. Catchment areas vary hugely, depending on the density of the population.
Only taking patients from a limited area can mean that your choice of GP is limited, and many patients find it frustrating. They've heard about their friend's brilliant GP surgery, but they can't register as a patient. But changing the system isn't as easy as it sounds. Some of the possible problems include:
- If you are registered with a GP many miles from where you live, they may not be able to visit you at home if you need it because they need to be close enough to their other patients to deal with emergencies which might arise
- Many other services, like district nursing or social services, are limited to local catchment areas, so you may not be able to access these services if your GP doesn't have a contract with the district nursing team in the area in which you live.
Under new arrangements announced on 14th November, it will be easier for patients to register with a practice outside the area in which they live from October 2014. This means you may choose to register with a practice close to where you work, for instance. You won't necessarily be able to get home visits, but the NHS will have a duty to make sure you can still access medical care out of hours if you need it.
In the meantime, you can change the GP surgery you're registered with as long as you live within the boundaries the practice has agreed with the local commissioning body. Some practices close their lists to new patients if they have no spaces left, but if they refuse to register you, they must give a reason.
What if I want a medicine my GP or consultant won't offer?
Again, it's good to talk. Your doctor will be happy to explain why they've recommended a particular treatment. It may be that the treatment you want:
- isn't available because NICE (the National Institute for Health and Care Excellence) hasn't approved it
- isn't suitable for you because of your other medical condition or medication
- has more side effects than the one they're offering, so they want to see if their one works first
- has been approved by NICE as an 'option' for treatment and in your area there are rules about which patients should be prioritised to get one option rather than another treatment which is also approved.
Alternatively, your doctor may even agree with you!
Why do treatments offered vary depending on where people live?
Although there are nationally agreed guidelines on treatments for most medical conditions, they are just that - guidelines. That's because every patient is different and their particular combination of medical problems, medicines taken etc may be different to every other patient's. Most of the national guidelines state that the doctor has to take all these factors into account but use their clinical judgement to see which option is best for the patient.
However, it's impossible not to realise if you ever read the news or turn on the radio that the NHS is having to make major savings. Until 1st April 2013, GP practices were grouped geographically into Primary Care Trusts. Since 1st April, Clinical Commissioning Groups, or CCGs, have taken over. The theory is that GPs in an area are best placed to decide what the health priorities, in terms of commissioning (that's buying to you and me!) services for their patients, should be. But - and it is a big but - the money they've been given comes from an ever-shrinking pot. That means tough decisions are having to be made. For instance, in my area you can't be referred for cataract surgery unless your eyesight is below a certain threshold, and you can't be referred for your varicose veins, no matter how unsightly they are, unless you have signs that they're causing medical complications. In another part of the country, it might be easier to get cataract surgery but be harder to get your hernia repaired. You can't bypass these restrictions by asking for a second opinion - it's a harsh fact of the present financial climate.
With thanks to 'My Weekly' magazine where this article was originally published.