Getting a second opinion
I’ve heard general practice described as 'first opinion medicine', and if you have confidence in your GP a first opinion is usually all you’ll need.

But your health's important and sometimes you might want a second - or third or fourth - opinion to be sure. So how do you go about it, and is it always in your best interests?

In my experience, there are all sorts of reasons why you might want a second opinion:

Specific worries about your symptoms or a feeling your doctor hasn’t taken your concerns seriously
Frustration with the lack of a clear diagnosis
Dissatisfaction with your GP's explanation of your symptoms
A feeling your GP has reached the limit of his or her expertise and it’s time for specialist input
Wanting a range of opinions before you take the plunge into important treatment - for cancer, for example
Embarrassment factor
Given the personal nature of the doctor-patient relationship, I can see why some people could be embarrassed about asking their doctor for a second opinion – it could feel as if you're questioning your GP's professional competence.

But I think most doctors nowadays accept the need for second opinions, and although you have no legal right to one on the NHS, most doctors are happy to oblige. I don’t take requests for second opinions personally, and honesty and transparency are usually the key to success.

You have no legal right to a second opinion on the NHS, but most doctors are happy to oblige
My tip would be to ask your doctor directly why he/she is taking a particular line. This allows you to hear his or her thinking and the evidence behind their suggested plan of action. Take a curious rather than confrontational line.

This might reassure you there are good reasons for your GP's advice - perhaps local guidelines, strong evidence from trials or years of experience dealing with similar problems. If you’re still not entirely satisfied, consider your next step.

Two minds are better than one
As generalists, most GPs acknowledge they can’t know about every condition in great depth. Even if we did, medicine has many grey areas and experts don’t have all the answers.

Asking for second opinions is second nature for the average GP. We often discuss difficult cases at meetings or exchange experiences over a cup of coffee.

In our practice I often call in a colleague who’s an expert on skin problems to have a look at a patient’s challenging rash.

So if you have several doctors in the practice, find out if any have special areas of interest - they may be listed in the practice information leaflet - or ask the receptionists. You may also simply prefer another doctor’s style or approach.

Then book yourself an appointment with them but don’t try to hide the fact you’ve already seen someone else (it’s all there on the computer screen).

Another option is to ask the opinion of a GP outside your practice. This usually means either registering at a new practice (they don’t have to take you) or paying to see a GP privately.

When to refer
A key skill in general practice is knowing when - and when not - to refer to hospital specialists. A good GP knows his limits and acts in the best interests of his patient in seeking the best possible specialist advice and treatment.

There are also clear national guidelines on when to refer people, for example with suspected cancer.

But we all have different thresholds for pressing the referral button. Some GPs are happier to wait and see and save patients possibly unnecessary procedures; others prefer to refer early and not take too many risks.

I'm a relatively early referrer, I think. But sometimes patients still prompt me to refer them for hospital care. Sometimes it’s a helpful discussion, and I don't usually argue if they feel strongly about it, but if I’m worried it’s not in their best interests I'll say so.

Unhelpful and unnecessary?
If I have concerns they're usually about wasting NHS resources and putting patients through unnecessary tests and investigations, which are unlikely to reveal anything helpful.

The other worry is that a patient’s care can become terribly confused with several doctors offering several different opinions.

GPs traditionally have a 'gatekeeper' role, trying to make the best use of finite NHS resources. It seems unfair to me to use up a precious hospital appointment for someone with a relatively minor condition we can deal with in general practice when it means another patient will have to wait even longer to be seen for their crippling hip pain.

Having worked in hospitals, and being in constant touch with them, I also have a good idea of the sort of tests and treatment patients are likely to be offered. Sometimes, from experience, I feel strongly that batteries of further tests are unlikely to shed any further light on a patient's problem.

The onus is then on me to explain clearly why I feel that, and to accept responsibility if one day I'm proved wrong.

Finally, I've had a few patients over the years who have sought multiple opinions and have become trapped in the NHS (or private) hospital maze. They get passed from department to department without a firm diagnosis, become less and less clear who is in charge of their care, and grow more and more frustrated.

Your GP has overall responsibility for your care. Someone has to keep a coordinating eye on what’s going on. That’s why it’s so important that whoever you see, whether a consultant, private GP or out-of-hours team, keeps us informed about what’s happening to you.

It might seem like we're being obstructive in not recommending a third, fourth or fifth opinion, but often it’s because we’ve seen the grief it can cause.

Dr Graham Easton works in a London GP practice with around 10,000 patients. It has three GP partners, three salaried doctors and fully computerised medical records. His medical training was at The Royal London Hospital. He's also an experienced medical journalist who has worked for BBC Radio Science and the British Medical Journal.

http://www.bbc.co.uk/health/surgerynotes/