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1. Should I ask for a second opinion?

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Second Opinions This factsheet explains why you might ask for a second opinion and how to ask for it. You do not have a right to a second opinion, but you can ask for one. This factsheet will also look
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Second Opinions This factsheet explains why you might ask for a second opinion and how to ask for it. You do not have a right to a second opinion, but you can ask for one. This factsheet will also look at what your options are if you ask for a second opinion and do not get one. If you disagree with your doctor about your diagnosis or treatment, tell them why. Give the doctor more information to see if they will change their mind. An advocate might be able to help you with this. Doctors can have different opinions, particularly in mental health. Second opinions can help you feel more certain about the right diagnosis and treatment for you. You can ask for a second opinion, but you have no legal right to one. If your GP or psychiatrist agrees that a second opinion will help, they will try to arrange one for you. If your doctor thinks you need a second opinion in a different part of the country, your local NHS Clinical Commissioning Group (CCG) will decide if they should pay for this. If you ask for a second opinion but get turned down, you can complain. There are some specialist NHS services that are experts in particular mental illnesses. You can ask for a second opinion from this sort of service if you feel you need it. Your local NHS will only agree to this if they think you really need one. 1 This factsheet covers: 1. Should I ask for a second opinion? 2. Have I got a right to a second opinion? 3. How do I get a second opinion on the NHS? 4. What can I do if my request for a second opinion is refused? 5. Do I need to see a private doctor? 6. Where can I get a specialist second opinion? Sample letters 1. Should I ask for a second opinion? You may want a second opinion if you feel there is uncertainty about your diagnosis or treatment. After a second opinion you may feel that there is some healthy debate about what options may be best for you, or the second doctor may agree about the best way forward. Some people ask for a second opinion because they would like a particular diagnosis or treatment. The most important thing is to give your doctor the most accurate information so they can make the best decision for you. The diagnosis or treatment you want may not be the one best suited to you. It is important to remember that having a second opinion may not lead to a different opinion. Uncertainty about your diagnosis If you have a mental illness, your recovery may be better if a doctor spots and treats your illness early. But sometimes it can be difficult for your doctor to decide. It can be hard to recognise early symptoms of mental illness. Drugs or alcohol can cause similar symptoms, and your doctor might not be certain about what has caused them. Sometimes people may ignore or play down their symptoms. This can make it harder for doctors to recognise them. Some symptoms may change as you get older. Your doctor may want to wait before they make a firm diagnosis. Symptoms of mental illness can also be caused by physical illness or medications. Your doctor might want to do some tests first. Your doctor may wait to make sure they do not give you a wrong diagnosis. A diagnosis stays on your medical records even if it changes later. Therefore, doctors may wait to diagnose you until they are certain. 2 Some people can recover from one or two episodes of mental illness. A doctor may want to see if this happens first. There are no scans or blood tests to help doctors diagnose mental illness. Doctors are trained to make decisions based on your history and current symptoms. It is not always a certain science, and different doctors may give you a different diagnosis. Even if a doctor is sure about your diagnosis, you or a carer, friend or relative may find it difficult to accept. Uncertainty about treatment You may feel that your treatment plan is not right. If you feel that a particular therapy or medication would help you but your doctor does not agree, you could ask for a second opinion. Although psychiatrists are specially trained in mental health, they may not be an expert in a particular condition. You may want to get a second opinion from a psychiatrist who is an expert in treating your mental illness. Your local NHS is only likely to agree to this if you have already tried the usual treatments they offer. Medication It is important that your doctor reviews your medication regularly. They should check that it is helping with your mental health and whether you are getting any side effects. Medications can work differently with different people. Trying to find the right medication for you might be a trial and error approach. However, if you feel your medication is wrong and your doctor will not change it you could ask for a second opinion. 2. Have I got a right to a second opinion? Unfortunately you have no legal right to a second opinion. But your doctor should not dismiss it if you bring it up. 1 They should think about your reasons for wanting another opinion and take them seriously. If they don t agree that you need one, ask for reasons. 3. How do I get a second opinion on the NHS? There are two types of second opinion in the NHS: a local second opinion, and an out-of-area specialist second opinion. 3 Local second opinion This is an opinion from another doctor in your local NHS. For example, if your psychiatrist has diagnosed you then the second opinion would be from another psychiatrist in their team or from a different local team. If your GP has diagnosed you but you disagree, you could ask them to pass your details to a psychiatrist. This is not the same as a second opinion. But if they won t offer this, you could ask for a second opinion from another GP. There may not be a formal procedure for asking for a local opinion. It is best to talk it through with your doctor. Make it clear what outcomes you are looking for. You could mention: why you feel the diagnosis or treatment option is uncertain, how this uncertainty makes you feel, how having a second opinion would make you feel more certain, and comfortable with treatment, and any problems you have had with treatment so far. It is generally best not to criticise your doctor s opinion if you can avoid this. You can acknowledge their opinion but say that you are aware that there are often differences of opinion and you would like to explore all your options before settling on long-term treatment. There may be a specialist mental health service in your area. In this situation, you may be able to get a specialist opinion more easily without having to go out-of-area. Out-of-area specialist second opinion The procedure for asking for an independent second opinion outside your local NHS depends on local policies. You may have to ask for details of the individual funding request policy. If your local NHS agrees that you should have a second opinion outside their area, they will have to pay for this. What happens when I ask for an independent second opinion? If your doctor agrees you need an independent second opinion, they will help you to apply to your local Clinical Commissioning Group (CCG). Applying directly to the CCG is called making an individual funding request (IFR). Your GP or healthcare professional has to send your IFR to the CCG. You can send a letter with the IFR about why you want a second opinion. The CCG looks after the money for your local NHS trust and decides what to spend it on. They will decide if they will pay for an independent second opinion for you. Your local CCG may have agreed to use a particular specialist service when people need expert opinions. 4 How hard is it to get an independent second opinion? It can be difficult to get an independent second opinion. This might be because: your doctor thinks you don t need one, or your CCG will not pay. It may be more likely that you ll be successful if: all the usual treatments have not worked for you. This is called being treatment resistant your mental health is not improving as quickly as your doctor expects. You may be in and out of hospital, or you may have been in hospital for a long time the side effects of your medication are seriously affecting your health and your doctor cannot find any answers or alternatives It is important to explain how your diagnosis or treatment is negatively affecting your life and why a second opinion might help. The stronger your reasons, the more likely it is that your CCG will agree. 4. What should I do if the second opinion is refused? If your doctor refuses a second opinion Ask again Ask your doctor why they think you don t need a second opinion. If you still feel that you need one, try to clear up any misunderstandings and ask again. Although this situation can be very frustrating, it is important to be polite. You will need to persuade the doctor to change their mind, so focus on the reasons why you think it will be helpful. If your doctor still refuses, you could ask in writing. It can be easier to get your point across in a letter. Contact PALS You could talk to your local Patient Advice and Liaison Service (PALS). PALS are there to help patients resolve problems with care and treatment. You could ask PALS if there is a local policy on second opinions. If there is, you can then mention the policy when asking your doctor to reconsider. You can find your local PALS by searching on the NHS Choices website or Rethink Mental Illness Advice Service could search for you. Use an advocacy service A community advocate could help you to ask for a second opinion. An advocate is someone independent from mental health services who can help to make your voice heard when you are trying to resolve problems. 5 There may be a local advocacy service in your area which you can contact for support. You can search online or Rethink Mental Illness Advice Service could search for you. Make a complaint If you still have no success you could complain using the NHS complaints procedure. If your complaint is about your GP, ask the surgery for details of the complaints procedure. Your psychiatrist will work for a particular NHS service. To complain, ask the service for details of their complaints policy, or talk to PALS. If the CCG refuses funding Clinical Commissioning Groups (CCG) have to make hard decisions about what they will pay for. This can make it harder to get funding for an independent second opinion. If you do not get funding for a second opinion, you could contact your local CCG directly. You can ask them to reconsider. There is information about how to find your local CCG at the end of this factsheet. Sometimes getting a community care solicitor could help. The costs of a solicitor vary. You might be entitled to legal aid but you would need to discuss your situation with a solicitor. You can find more information about: Advocacy Complaints NHS treatment your rights Legal advice at Or call and ask us to send you a copy. 5. Do I need to see a private doctor? A private doctor is one that you have to pay for yourself. You do not need to see a private doctor to get a second opinion. If you decide to, think carefully about your reasons for going outside the NHS and if you can afford private treatment. Bear in mind that the private doctor might agree with the NHS. If they don t, the NHS does not have to follow their decision about your diagnosis or treatment options. 6 Rethink Mental Illness does not have lists of private psychiatrists, and the advice service cannot make recommendations. If you would like to find one, you could ask your GP. You could also research online to see what services are available, and then ask them about the level of service they offer and their costs. 6. Where can I get a specialist second opinion? If you feel you need a specialist opinion, there are some NHS services that specialise in certain conditions. They can see people from all areas of England. There are details of some below, but this is not an exhaustive list. These services offer expert assessment and treatment. They are set up for people whose conditions are complex or where someone s correct diagnosis or treatment is unclear. Some mental health trusts also have specialist services for other mental health conditions such as obsessive compulsive disorder, eating disorders or trauma. There are also individual professionals throughout the country not linked with a specialist service. Psychosis Service This service specialises in expert, evidence-based treatment for people with complex psychosis or who have psychosis and another mental illness. They specialise in new treatments for people who struggle with other treatment options. Telephone: (Tel: (inpatients) or (outpatients) Address: Bethlem Royal Hospital, Beckenham, BR3 3BX Website: Mood disorder specialists There are three national specialist services that offer second opinions and treatment reviews for people who have mood disorders such as bipolar disorder and clinical depression. Affective Disorder Unit This service provides specialist assessment and treatment for people with complicated or treatment-resistant mood disorders, including depression and bipolar disorder. Telephone: /4696 Address: Bethlem Royal Hospital, Beckenham, BR3 3BX 7 Website: Specialist Services for Affective Disorders This Manchester Mental Health and Social Care Trust service provides specialist assessment, psychological treatment and help and advice for patients, relatives and referring clinicians on Affective Disorders. Telephone: (Switchboard number) or Website: The Regional Affective Disorders Service This Northumberland, Tyne and Wear NHS Foundation Trust service offers specialist outpatient and inpatient care for patients with difficult-to-treat mood disorders. Telephone: /6831 Address: St Nicholas Hospital, Jubilee Road, Gosforth, Newcastle upon Tyne, NE3 3XT Website: Clinical Commissioning Groups You can find your local Clinical Commissioning Group with the contact details below. Telephone: (Monday to Friday 8am to 6pm, excluding English Bank Holidays) Address: NHS England, PO Box 16738, Redditch, B97 9PT Website: 1 General Medical Council. Good Medical Practice. Manchester: GMC; Para 16(e). 8 Doctor s name Address of service Sample letter asking your doctor to review your treatment Your name Your address Your telephone number (optional) Your address (optional) Date Dear [doctor s name], My treatment [If you re asking on behalf of someone else, include their name and date of birth] [Include some background about your health] I am writing to ask you to review my treatment. As you are aware, I have been unwell for [5 years]. During this time I have had [3 hospital admissions] and have tried [5 combinations of medication.] I am currently taking [4mg risperidone and 40mg fluoxetine every day]. Unfortunately, [my] mental health is still having a big impact on my quality of life, and I feel that it is important for me to [try a different treatment] [reduce / increase the amount of medication I am taking]. Specifically, I have had problems with: [List the problems your health has caused you] In addition, I believe that my current medication causes the following side-effects: [List the side effects you think your medication has caused you] I hope that you will be able to review my medication in the hope that we can find a way to help me with these problems. Please get in touch with me by letter, telephone or to discuss this further. Yours sincerely, [Your signature] [Your name] 9 Psychiatrist s name Address of service Sample letter asking for a second opinion about treatment Your name Your address Your telephone number (optional) Your address (optional) Date Dear [psychiatrist s name], Second Opinion [If you re asking on behalf of someone else, include their name and date of birth] [Include some background about your health] I am writing to ask you to refer [me] for a second opinion about my treatment. As you are aware, I have been unwell for [5 years]. During this time I have had [3 hospital admissions] and have tried [5 combinations of medication.] [Have you already tried to resolve the problem with your psychiatrist? If so, say so here.] In my last consultation with you, you mentioned that you cannot think of any alternative treatment options for me, and that I should carry on taking the medication I am taking at the moment. I feel that my health is unlikely to improve on this medication, as I have already been taking it for a year and I have not noticed a substantial improvement. Unfortunately, [my] mental health has been having a big impact on my quality of life recently, and I feel that it is important for me to find the right treatment. Specifically, I have had problems with: [List the problems your health has caused you] I hope that you understand my reasons for asking for a second opinion and that you will support my request. Yours sincerely, [Your signature] [Your name] 10 Sample letter asking your doctor to review your diagnosis Doctor s name Address of service Your name Your address Your telephone number (optional) Your address (optional) Date Dear [doctor s name], My diagnosis [If you re asking on behalf of someone else, include their name and date of birth] I am writing because I am worried about my mental health, and I hope that you can help. I would like to give you a full picture about my problems so that you can make sure that I have the right diagnosis and treatment. [Include some background about your health] As you are aware, I have been unwell for [5 years]. During this time I have had [3 hospital admissions] and have tried [5 combinations of medication.] I have had problems with: Hearing voices that tell me to do things Feeling very low Crying Feeling anxious about my health, like thinking I have cancer I hope that you will be able take this information into account to make sure that I have the right diagnosis. Please get in touch with me by letter, telephone or to discuss this further. Yours sincerely, [Your signature] [Your name] 11 Sample letter asking your doctor for a second opinion about your diagnosis Psychiatrist s name Address of service Your name Your address Your telephone number (optional) Your address (optional) Date Dear [psychiatrist s name], Second Opinion [If you re asking on behalf of someone else, include their name and date of birth] [Include some background about your health] I am writing to ask you to refer [me] for a second opinion about my diagnosis. As you are aware, I have been unwell for [5 years]. During this time I have had [3 hospital admissions] and have tried [5 combinations of medication.] [Have you already tried to resolve the problem with your psychiatrist? If so, say so here.] In my last consultation with you, you mentioned that I have a diagnosis of schizophrenia. I feel that this is not the right diagnosis for me because: [Give the reasons why you disagree with your diagnosis] I respect your professional opinion about my health, but I understand that doctors often disagree about diagnosis. I want to make sure that my diagnosis is right because this is an important part of my recovery and treatment choice. I hope that you understand my reasons for asking for a second opinion and that you will support my request. Yours sincerely, [Your signature] [Your name] 12 Rethink Mental Illness 2016 Last updated February 2016 Next update June 2018 Version 6 This factsheet is available in Large Print Last updated 01/10/
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