Getting a second opinion

There are two reasons why you, your family or friends or a clinician you are working with may want a second opinion

• You wish to have a second opinion about the diagnosis you have been given
  
• You would like a second opinion about the type of treatment you are on or what would be most suitable for your condition

Accepting your diagnosis also means that you can start to take steps to alleviate symptoms and begin to manage your condition. It is important for you to know what triggers can affect an illness you have been diagnosed with, for example if you need to avoid stress or using too much alcohol or street drugs. Most people would also find it useful to know what types of medication are available for a condition, or what alternative treatments are known to help and can be tried, like talking treatments.

This information allows them to take an active role in the management of mental health problems through allowing people to consider and choose from the options available to them. But, it is almost impossible to find the relevant information needed to make such as choice without having some idea of the diagnosis.

Second opinion reviews of the treatment plan
It is important that any treatment which has been prescribed should be regularly reviewed, especially for any negative side-effects it may be creating. Although newer (atypical) medications have become available, some doctors tend to rely on the older medications (typicals) and may have little experience of using more modern treatments. The need for older people to have their treatment reviewed is often neglected. Therefore, it can be very helpful to get an independent second opinion from a doctor who specialises in severe mental illness.

Have I got a right to a second opinion?

There is no legal or enforceable right to a second opinion. But the schizophrenia guideline produced by the National Institute for Clinical Excellence (NICE) states that a second opinion should be available to people newly diagnosed with schizophrenia if they would like one. 

National Institute for Health & Cinical Excellence (NICE)

How do I get a second opinion?

In the past, doctors had to worry about how the cost of a second opinion would be covered. This should not be a problem now as the cost is usually met by the Primary Care Trust in your area. A small number of doctors might be offended by a request for a second opinion, but this is not common. In most cases doctors will be more than happy to do what you ask and will be glad to get another view, especially from an independent expert. Obviously it is helpful to be polite and tactful, perhaps explaining why you would like to have a second opinion.

If you have already had a number of second opinions in the past then you may be told that a further opinion is not necessary. If your doctor refuses your request for a second opinion, you should first check that no misunderstanding has been made on the part of you or your doctor. You could try putting your request in writing, as it is less easy for a letter to be ignored. If the consultant psychiatrist disagrees, you could ask your GP instead (or vice versa). If both doctors refuse, you could discuss your situation with your local Patient Advice and Liaison Service (PALS), an advocate or the Rethink National Advice Service. Some people have found it very effective to get a solicitor to write to the Trust. You may not have to pay for this if you qualify for Legal Aid.

If you still get no success you may wish to use the NHS complaints procedure. The GP practice or hospital should be able to give you a leaflet about their complaints procedure. Alternatively you could try PALS, an advocacy service or the Rethink National Advice Service.

Should I see a private doctor?

In Rethink's experience, the best course of action for someone who is affected by the sort of problems we have described is to find a doctor who is a real specialist - you should not have to go outside the NHS to do this. If there is a particular reason why you feel you must consult privately, Rethink’s National Advice Service can tell you how to go about doing this.