Seeking a second opinion

Sometimes, a family wants to seek a second opinion from a clinician or clinicians at another healthcare organisation.

The General Medical Council, which regulates doctors, state that all doctors must ‘respect the patient’s right to seek a second opinion’.

This page explains what a second opinion is, the process for requesting a second opinion, and who to contact if you want to know more.

This page does not cover Martha’s Rule, which is a new patient safety initiative that specifically applies to when there are concerns of rapid clinical deterioration of the patient.

Visit the NHS England website for more information about Martha's Rule.

A second opinion involves getting the views of an independent specialist clinical team or healthcare professional about your child’s treatment. This team or healthcare professional may be based in the UK or internationally. Second opinions can be very helpful in the care of children with complex and rare diseases.

Many children at GOSH routinely benefit from expert advice from healthcare professionals at different hospitals as a standard part of their care.

Second opinions can be requested by the team treating the child or young person, by the child or young person themselves, or by their parents or carers (with parental responsibility).

We can help families with this process – please speak to your child’s consultant or clinical team or the Patient Advice and Liaison Service (Pals).

Pals can be contacted Monday to Friday from 10am to 5pm:

Email: pals@gosh.nhs.uk

Telephone: 0207 829 7862.

A relevant clinical specialist who is a member of a professional medical body can provide a second opinion.

A second opinion provider may be an individual healthcare professional or a multi-disciplinary team (healthcare professionals from different specialties with various skills and expertise) from another healthcare organisation.

International specialists, especially in rare diseases, can also be very helpful. They must be clear if their opinion involves difference in law or ethical norms between countries. In these situations, GOSH must abide by national law.

Second opinions can be helpful:

• When there is diagnostic uncertainty.
• Where there are several treatment options to choose from.
• When there are limited curative treatment options and a poor outcome is likely.
• When there is no clear evidence-based pathway – this means that there is no standard treatment.
• When there is disagreement about treatment – this can be between different clinical teams, between parents, between parents and an older child, or between the family and the clinical teams.
• If innovative and compassionate treatment (used with seriously ill patients with no other treatment options) is being considered, for example before a Paediatric Bioethics Team review.
• Sometimes before the courts consider a case, in the rare situations when an agreement about treatment cannot be reached.

Your child’s clinical team will discuss who is well placed to perform the second opinion. Usually this is someone independent of the GOSH team(s) and any other teams who have treated your child. If you want to have input into the questions that are put to the second opinion provider, please ask your child’s consultant.

We recommend a second opinion provider who can visit your child if they are an inpatient. This means they can talk to the entire GOSH multi-disciplinary team, but also to you and (where appropriate) your child. Ideally, they can examine your child. For outpatients, we recommend a second opinion provider who is willing to see your child in an outpatient setting and provide a letter giving their opinion to the GOSH multi-disciplinary team.

We can support the process by providing them with your child’s medical records, investigation results, and copies of scans that we hold. Such information will be sent securely.

Urgent life-saving treatment will not be delayed to seek a second opinion. However, should the situation stabilise, this could then be explored.

Any second opinion must be from an acknowledged medical expert in the relevant specialty.

Any discussion about involving non-expert views needs to be discussed with your lead consultant, who may direct you to Pals, the Chaplaincy team, or the Paediatric Bioethics team.

Sometimes a visiting specialist will tell you and the clinical team their opinion during their visit, but usually they will send a report. This report will be put in your child’s medical notes, and you will have the opportunity to read it and discuss it with the clinical team.

If a second opinion is requested, your child’s care will usually remain at GOSH. Seeking a second opinion does not mean the visiting team will necessarily take over your child’s care, and even if this is offered, it needs the clinical team’s agreement and your/your child’s consent.

If you want transfer to a different hospital, your clinical team will discuss this with you and explain the process. Transfer of care is not always possible, but it can be arranged if both teams agree that it can be done safely and is in your child’s best interests.

Possible questions for the second opinion provider include:

• Do you think the diagnoses (there might be more than one) made, and the GOSH teams’ views about it, are correct?
• Do you think the current GOSH treatment plan is reasonable?
• Are there any other treatments you know of that are available or in development that could help?
• In this situation, what would your team do? Please describe the risks, benefits, and burden of care associated

For any questions or if you require this information in a different format or language, please contact Pals:

Email: pals@gosh.nhs.uk

Paediatric Bioethics Team: clinical.ethics@gosh.nhs.uk

Alternatively you can contact your child’s clinical team.

1. Larcher V, Brierley J. Second medical opinions in paediatric practice; proposals for a framework for best practice. Arch Dis Child. 2020 Mar;105(3):213-215.
2. Royal College of Paediatrics and Child Health. 2022. The second opinion process - External second opinions in paediatrics. Accessed: 1 February 2024
3. Nuffield Council on Bioethics. Disagreements in the care of critically ill children 2023. Accessed: 1 February 2024