You would think that in the 21st century, a second opinion from a third party would be simple, but you’d be wrong. You’d also be wrong if you believed that patients have a right to a second opinion.
I speak from personal experience when I tell you that neither of the two are correct.
Two incidents in the last 4 years have led me to believe that:
(a) The right to a second opinion; and
(b) Verification of the information passed to the physician conducting a second opinion;
must be enshrined in the patients rights (scotland) act 2011.
And some might question why this is necessary, but when these things go wrong, they go catestrophically wrong.
In 2017, I was denied surgery on a technicality. I first requested and was granted a second opinion but due to asking the wrong question, it was subsequently revoked. It took two years for the Scottish Public Services Ombudsman to rule on the complaint and then the board remained non-compliant with the ruling that a second opinion should be rendered until two years later. For those counting, that’s four years of fighting over a second opinion.
In 2018/2019, my mother was admitted to hospital. She has advanced multiple sclerosis. In November 2018 she was diagnosed with cancer. She was prepared for surgery to remove the tumour and mere hours before that surgery was due to be conducted, the hospital stopped it citing risk of anaesthesia. But with NHS staff telling me to keep pushing, I did, because what was being said to me was that they did not have the empirical evidence to support the assessment they made. They had disregarded one scan, they had relied solely upon another and the refused all other testing.
It took 5 months to get a fair unbiased second opinion and it transpired that she did not require the surgery – because she didn’t have cancer. Doctors receiving the second opinion evaluated the original scans, found inconsistent results and ordered two tests which I, as my mothers guardian had been requesting over that time. The local board had misdiagnosed her.
These situations proved one thing. That there are way too many patients being denied second opinions for spurious reasons. A second opinion, particularly where there is a lack of trust can restore that trust, but can also put patients and their families at ease. They are key to ensuring that the information at hand is checked and verified. It should not take up to four years for one to be conducted and there should be an automatic mechanism by which to facilitate an outside second opinion which is free from interference.
The second thing I learned is that the entire referral system within NHS Scotland is a game of chinese whispers. It relies solely on a physician to properly report matters pertinent to clinical status to receiving physicians; and it relies solely upon that receiving physician being provided with all pertinent information.
There is far too much latitude for error, omission and unfortunately, coverup where the previous physician may have made an error.
I’m fighting for an unbiased second opinion to be an automatic right within our NHS, and for new checks and balances to ensure that information passed from one physician to another is wholly accurate.
The second of the two can be done using technology. An automated process where current medications and pertinent information at all levels of the patients healthcare are syncronised to ensure they are up to date. The introduction of a “crib sheet” which is effectively a summary attached to the front of each referral which is automatically generated by the system listing significant medical matters in timeline form.
I also want to see all referrals internal to a board and external being lodged on a centralised referral platform, rather than emails and calls which often get lost and mean patients records are incomplete. This is to ensure accountability. Where there is contention, I want to see a double signature system whereby the accuracy of referral paperwork being double checked to ensure that the information contained there-in is accurate and properly reflects the patients circumstances.
It beggars belief that such mechanisms don’t already exist. But in life-threatening situations especially, accurate information is key. A medication or symptom missed could result in misdiagnosis or the wrong treatment being applied.
These changes are not also good for the patient. They should have a net positive effect on the NHS as a whole because less mistakes mean less accidents which ultimately mean less claims for medical negligence.
A patient should not have to fight for months or years to garner a second opinion about their own healthcare.