Aspergillosis can be difficult to diagnose and manage. Symptoms can overlap with other lung conditions, test results are not always straightforward, and some forms of aspergillosis are uncommon enough that many healthcare professionals will see relatively few cases.
If you are uncertain about your diagnosis or treatment, it is reasonable to ask whether another opinion or specialist advice might help.
This does not necessarily mean that your current doctor is wrong. Medicine often involves uncertainty, and another clinician with particular expertise may be able to confirm the existing plan, suggest further investigation or offer a different approach.
When might another opinion be useful?
You might consider discussing another opinion or specialist advice if:
- your diagnosis remains uncertain;
- your symptoms or test results do not seem to fit the diagnosis clearly;
- you have several conditions that make diagnosis or treatment complicated;
- treatment is not working as expected;
- you are experiencing significant treatment side effects;
- there are several possible treatment options and you are unsure which to choose;
- your condition is unusual or particularly difficult to manage;
- you would feel more confident if another clinician reviewed the diagnosis or treatment plan.
Sometimes a second opinion simply confirms that the current diagnosis and treatment are appropriate. That can itself be valuable.
Second opinion or specialist advice?
These are related but slightly different things.
A second opinion usually means asking another suitably qualified clinician to review your diagnosis, treatment or another aspect of your care.
Specialist advice may instead involve a clinician with particular expertise reviewing your case and advising your existing healthcare team. You may not always need to travel to another hospital or transfer your care.
For an uncommon condition such as aspergillosis, specialist advice can sometimes be particularly useful. Your local team may be able to discuss your case with clinicians who regularly manage aspergillosis while continuing to provide most of your care locally.
How to raise the subject with your healthcare team
You can start by explaining what is making you uncertain and what you hope another opinion might achieve.
For example, you might say:
“I understand this is a complicated condition. Would another opinion from someone with particular experience of aspergillosis help confirm the diagnosis or treatment plan?”
Or:
“I’m still worried because my symptoms haven’t improved as we expected. Could we discuss whether specialist advice or another opinion would be useful?”
Try to make the question about the clinical problem rather than about whether one doctor is right or wrong.
It can also help to identify the specific question you want answered. Is the uncertainty about the diagnosis? A scan? Antifungal treatment? Side effects? Whether another condition could be contributing?
A focused question makes it easier for your healthcare team to decide what kind of additional expertise might be useful.
Do I have a right to a second opinion?
You can ask for a second opinion, and professional guidance recognises a patient’s right to seek one.
However, this does not mean that every request automatically results in an NHS referral to any particular doctor or hospital. Referral arrangements depend on your clinical circumstances, the service involved and the way NHS services are commissioned and accessed.
If your clinician does not think another referral is appropriate, ask them to explain why and discuss what other options are available.
In England, patients also have legal rights to choice in some circumstances, particularly when being referred for a first outpatient appointment. These rights are not the same thing as an unrestricted right to a second opinion.
What if my doctor does not think another referral is needed?
Try first to understand the reason.
You could ask:
- Why do you think another opinion would not change my care?
- How confident are we about the diagnosis?
- What would make us reconsider the diagnosis or treatment?
- Could you obtain specialist advice without referring me for another appointment?
- What should happen if my symptoms continue or get worse?
There may be good clinical reasons for continuing with the existing plan. Equally, explaining your concerns may help your clinician understand why additional reassurance or expertise would be useful.
If you remain concerned, you can discuss the situation with your GP or another clinician involved in your care.
If the issue cannot be resolved through discussion and you are unhappy with how your concerns have been handled, NHS organisations have patient advice and complaints services that can explain the appropriate local process.
Specialist aspergillosis advice in the UK
The National Aspergillosis Centre (NAC) at Wythenshawe Hospital in Manchester is an NHS specialist centre with particular expertise in aspergillosis.
The referral route depends on the type of aspergillosis and the clinical circumstances. For chronic pulmonary aspergillosis (CPA), referrals to the NAC are made by the patient’s local specialist consultant. For non-CPA cases, the current NAC referral information states that a consultant or GP can refer through the NHS e-Referral Service.
The NAC also provides advice and guidance for NHS clinicians managing people with aspergillosis. Complex or challenging cases can also be discussed by clinicians with the NAC multidisciplinary team.
This means that specialist expertise does not always require transferring all of your care to Manchester. In some circumstances, your existing healthcare team may be able to obtain specialist input while continuing to look after you locally.
Read the current National Aspergillosis Centre referral information.
Information for clinicians about NAC Advice & Guidance and remote MDT discussion.
Preparing for another opinion
A second opinion is most useful when the clinician has access to the relevant information.
This may include:
- a summary of your medical history;
- your current medication and previous treatments;
- important blood and microbiology results;
- lung function results;
- CT scans and other imaging;
- details of treatment responses or side effects;
- the particular questions you would like answered.
You do not need to assemble an enormous file yourself. The healthcare teams involved can usually arrange transfer of the clinical information they require. However, keeping your own concise health summary can help you explain your history and priorities.
See Do You Carry Your Aspergillosis Information With You? for advice on keeping a simple health summary.
For family members and carers
If the person you support wants you involved, you can help them prepare for the conversation without taking it over.
You might help them identify the main question they want answered, make a short list of important changes or symptoms, take notes during an appointment, or remind them about something they wanted to discuss.
It can be particularly useful to agree beforehand what role they would like you to have. Some people want a family member simply to listen; others may want help remembering information or speaking up if an important question has been missed.
See How to Ask Fewer, Better Questions in Appointments.
Another opinion does not have to mean changing doctors
Seeking another opinion should not automatically be seen as a breakdown in the relationship with your existing healthcare team.
With a complex condition, clinicians themselves frequently seek advice from colleagues with different or more specialised expertise.
The outcome may be a different diagnosis or treatment plan. But it may equally be confirmation that the investigations, diagnosis and treatment you already have are appropriate.
Either outcome can reduce uncertainty and help you and your healthcare team decide what to do next.
A final thought
If something about your diagnosis or treatment remains unclear, ask questions.
The aim is not to collect opinions until somebody gives the answer you want. It is to make sure that important uncertainty is recognised, that appropriate expertise is involved when needed, and that you understand the reasoning behind your care.
For a rare and sometimes complicated disease such as aspergillosis, asking whether specialist advice would help can be a perfectly reasonable part of good healthcare.
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