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Second medical opinions in paediatric practice; proposals for a framework for best practice
  1. Vic Larcher,
  2. Joe Brierley
  1. Paediatric Bioethics Centre, National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, UK
  1. Correspondence to Dr Joe Brierley, Paediatric Bioethics Centre, National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre. London, UK ; joe.brierley{at}gosh.nhs.uk

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Introduction

The practice of physicians seeking second opinions (SO) from colleagues is consistent with professional guidance on good medical practice.1 Despite an emphasis on shared decision-making,2 and better communication techniques,1 3 there is an increasing trend for patients, especially those facing serious illness or tough decisions, to seek SO directly. Significant drivers have been: healthcare globalisation; enhanced connectivity (ie, the internet and social media); increasing patient activism and consumerism; a desire for greater autonomy and a more critical view of medicine.

Although there is no UK legal right to SO,4 clearly they support patients’ rights to make freely informed healthcare choices by allowing clarification of  clinical facts and defining treatment options.

Problems may arise if SO are sought from practitioners whose practice and values differ from the treating team, as occurred with three recent critically ill children whose cases attracted widespread comment and controversy.5 Despite this, there is little detailed guidance on best practice in seeking or providing SO, and that which exists relates to adult patients.6

The purpose of this paper is to review data on the practice of gaining SO, its ethical basis and to consider whether—in the current psychosocial milieu—regulation is necessary. We propose an outline framework for best practice in paediatric SO, and hope consequent harmonisation of process might be possible (box 1).

Box 1

Best practice in paediatric second opinions

The following recommendations concerning best practice are made with the overarching principle that the child’s welfare is the paramount concern.

  1. The primary duty of the provider of a second opinion is to the welfare of the child rather than to others. The fact that parents and others may desire a certain course of action should be considered but is not determinative.

  2. The provider of the second opinion must be independent …

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