Medical kit

Before I go any further, I’d like to stress that the receptionists at my local health centre are usually very patient with my inadequate Portuguese and do their best to understand and help me.

This is a welcome change from my first experience of the Portuguese health care system in Coimbra a few years ago with a deliberately obstructive receptionist who was seriously lacking in empathy and unwilling to release any information to a sick foreigner that might help me understand how to actually go about seeing a doctor.

Despite improvements in both my Portuguese and the level of service I receive at the local doctor’s surgery, I still put off visiting a doctor if I can help it, even when I know I shouldn’t. I have, however, just been there which has prompted me to write this post.

If you just want some practical advice without the anecdote, scroll down. Otherwise, keep reading.

This week, I noticed that one of my moles had changed shape and colour and had become a little painful. Perhaps unsurprisingly, after investigating moles and melanoma on the internet and comparing photos with reality, I became concerned that I might have a melanoma. Since the unanimous advice is to get these things checked out by a doctor sooner rather than later, I rang to make an appointment.

It being August, it didn’t come as a huge surprise to learn that my family doctor was on leave for at least another week.

Could it wait until he got back? Not being an expert on manky moles, I didn’t know so I looked up the word for mole in Portuguese (it’s verruga, which also means wart) and set off for the health centre during open surgery hours.

After tracking down the only staffed reception area, I stood in line, hoping I was in the right place. My turn came and I explained that I wanted to see a doctor for a consulta alargada (where you get to see the doctor on duty for minor but urgent problems).

“What’s wrong with you?” asked the receptionist. I looked around at the people queuing behind me and the woman in a white coat standing behind the receptionist and resisted asking her why I should tell her since she wasn’t a doctor. Feeling very uncomfortable about having to explain my medical problems to a room full of strangers, I told her I had a verruga.

She raised her eyebrows and looked at me as if I was mad. Surely it could wait until the doctor returned from leave? I explained that as I’m not a doctor, I wasn’t sure how urgent the situation was, which was why I was there. Reluctantly, the receptionist caved in and took my 5 euros for an appointment, waving me off to a room on the right.

Off I went, embarrassed that everyone in earshot thought I was coming to see the emergency doctor just because I had a wart.

I toddled off down the corridor, past the consulta alargada waiting room trying to find the room number she’d mentioned. None of the doors in the gloomy corridors had numbers so I retraced my steps. One of the other patients spotted me and beckoned me over to where she and others were waiting.

The doctor took one very brief look from across the desk at my misshapen mole and prescribed a pomade to be applied 2 or 3 times a day. Now I’m no expert but I really can’t see how a pomade might cure a cancerous mole.

Apparently, it contains an antibiotic.

Still confused, I pushed for a better explanation and was told that if there was no improvement after a week, I should make an appointment with my family doctor who is the only one with the power to refer me to the hospital for a biopsy to determine whether or not have the offending mole surgically removed. If it does need to come off, I shouldn’t expect that to happen for at least three months. So much for prompt action!

I guess I’ll be going back to the health centre next week to find out what my own doctor thinks. Unless, of course, it’s all better by then.

My advice for dealing with your local doctor’s surgery 

Registering with your local health centre (Centro de Saude)

If you are resident in Portugal, you’ll need to get a social security number and residency certificate before you can register with your local health centre.

Once you’re registered and assigned a family doctor, you will be given a print out with all your details. I carry a copy of this with me at all times in case I have to go to hospital.

Getting an appointment at the Centro da Saude 

In theory, you can book non-urgent appointments using an online system but it doesn’t work for my local health centre.

Try to find the direct phone number for the secretary who deals with your family doctor to save waiting for your call to be transferred. If you visit the health centre in person to make the appointment, again, you need to be standing in the right queue for for your doctor. Each receptionist usually has a list of their doctors’ names on display.

Frustratingly, I have found it impossible to make appointments in advance for my family doctor. I have to ring up on the day, at specific times, in order to be assigned a slot. Many GPs in Portugal also work privately in clinics or hospitals so you need to find out which times and days they are available for patients at your health centre.

If you need an urgent consultation, turn up during surgery hours, pay for your appointment at reception and wait until you’re called. Don’t expect too much from this service and don’t use it for non-urgent situations as you will probably have to come back to see your family doctor to get referrals and tests.

Language barriers when you go to the doctor’s in Portugal

Although many Portuguese doctors and nurses speak some, if not very good English, you can’t take it for granted, especially in rural areas. Even if the medical staff can communicate in English, the receptionists probably can’t.

Learn and write down key phrases for making appointments while you’re healthy. Try Practice Portuguese as a helpful learning tool.

When you go to the doctor’s do everyone a favour and try to find out the translations for your symptoms. Write them down and take a dictionary with you just in case. You will feel less helpless and frustrated with a little back up.

Getting bloodwork and other medical tests done in Portugal

In my experience, anything other than basic urine analysis with a coloured strip of paper is done offsite at a separate, private clinic. The doctor will give you a sheaf of papers which authorise and describe the tests. They usually suggest one or two clinics to you but you can use any that can carry out the required test so ask around for recommendations if unsure.

It’s best to check with the clinic about times – some blood or urine tests can only be done on an empty stomach so you need to try and get there early. For x-rays and the like, you’ll need to make an appointment.

Even if you go to a private doctor, don’t be surprised to find you have to go elsewhere to get tests done.

Last time I had a routine gynaecological check up, I thought I’d take advantage of the fact that I have medical insurance and go private. I saw the doctor and she did an internal exam and ultrasound using fancy shiny equipment but then sent me back to my family doctor to get the prescriptions for having the smear test analysed at a reduced rate and for a mammogram that had be done at yet another clinic. Next time, I’ll skip the private doctor and go directly to my health centre.

Paying for medical treatment

The standard fee is 5 euros for a consultation with a doctor at your local health centre. If you end up going to Emergencies (Urgencias) at a hospital, the initial consultation will cost 10 euros. There are exemptions for children, pregnant women and family planning services as well as for patients with severe disabilities and the unemployed. The official Portal da Saude (Health Portal) has detailed information in Portuguese.

You also need to pay for tests and treatments. Keep copies of all consultation receipts, prescribed tests and medications so you can claim a refund if you have medical insurance or to claim exemptions and your tax return. Ask the pharmacy to take a photocopy of the prescription and keep the original with the stamped receipt.

Family planning in Portugal

Based on my own experience of trying to organise contraception when I first moved to Portugal, you need to assume that whatever method you choose will take a long time to arrange. If you’re planning to move here, try to sort your contraception out before you leave home and stock up if you’re on the pill just to tide you over.

Emergency and health-realted phone numbers you need to know

The emergency number in Portugal is 112 and the 24-hour medical advice line, Saúde 24, is 808 24 24 24. As I mentioned above, it’s a good idea to make a note of the direct line to your family doctor’s secretary and carry that around with you.

Health care for visitors to Portugal

If you are visiting Portugal from another EU country, be sure to bring your European Health Card and take out travel insurance to cover any unexpected medical bills incurred during your stay. You can get emergency treatment at local health centres and hospitals but be sure to get receipts for any payments you make so that you can claim a refund when you return to your home country.

If you have a problem during your stay, the above phone numbers apply to you, too.

28 Comments

  1. My previous comment is a reply to ALENA/DALLASTX calling us primitive, not the article. The article is genuine and informative.

  2. Funny how the person living in a country without an NHS, where people die because they don’t have health insurance and cannot afford to pay for health services, where, according to the WHO, ranks 37th on the healthcare rank, talks about a country where healthcare is universal and mostly free, ranked 12th on the healthcare rank, like this is some sort of near stone age banana republic.
    It’s true that bureaucracy can be overwhelming, but we’re working on that. And rest assured that you will never be denied health care in Portugal no matter who you are.

  3. It’s helpful to read about other’s experiences. The comment about receptionists is very enlightening…”fierce and unsympathetic and full of their own importance.” I had never encountered such behavior, and took notes, intending one day to write a complaint. Now I fear it may be of no use if the behavior is so universal. I did find out, though, that other centers were aware of this offensive individual, since so many people wanted to avoid her. It’s the only location having a vacancy for a doctor, apparently, so I’m stuck with her.

  4. Do they have private hospitals in Portugal? A lot of places where the healthcare is ‘difficult’ I am covered for a private hospital so can avoid this

    1. Yes, Emily, there are private hospitals in all major cities.

  5. Sounds as primative as Mexico and many countries outside the USA. You’d need a ton of patience and endurance to survive such a place.

  6. WAIT what????? Okay but in the USA we pay 2372728 bajillion dollars for every doctors visit. In Europe and even Latin America you can pay such low fees for certain doctors that it’s worth it to fly here for vacation and a doctors visit (if it’s something you can wait on)

  7. Being an American in the USA, and reading about many experiences of expats, I can tell you that the USA isn’t run so ineptly. Every American that lives outside the USA has to experience untold frustration because of the backwardness and inefficiency of many countries.There is much to be said about a slower pace of life and a lower cost of living, but inefficiency can be quite maddening. This is something I’ve tried to prepare myself for, as I research a place to retire. I’m actually seeking a place that is somewhat compatible with the USA. Some may consider the more advanced countries spoiled and ungrateful, when in fact we like efficiency and order in our lives. It’s thoughtful and caring and wiser. But I’ve also learned that those coming to more advanced countries extreme stress too, because our standards are a lot higher and a lot more is expected of them. I imagine that most people experience some type of cultural change when living in another country.

    Thanks for all of your efforts and information here. It’s very helpful and I appreciate it so much!

    1. Author

      I agree, you will find cultural differences wherever you go but if efficiency and a similar sense of logic are important to you, I would suggest looking into countries that are known for their organisational skills and systems. Germany springs to mind, along with other northern European countries like Norway and Sweden. Portugal, though lovely in many ways, can be extremely frustrating and baffling in some cases where their systems appear to make no sense and customer service is unheard of.

      If you do decide to retire in southern Europe, bring bags of patience, a tolerant attitude and enough money to be able to afford private healthcare and a translator when necessary. And perhaps a therapist for when the annoyances become overwhelming 😉

    2. As an American having lived in rural Portugal since ’08 I can say I’ve never had as much frustration with the medical system as this blog speaks of. I use a private Dr. In Viseu (€50 for an office visit) for important problems but have received prompt and competent service from my local health center. Last time I had about a 30 minute wait and was in/out in an hour. But, just like in the US, there are times and days you should stay away from places unless absolutely necessary. I also most often take a book just in case waits are going to be long.

      From your words I can believe that Portugal wouldn’t be the place for you and it isn’t for everybody. But Portugal has been Portugal with it’s present day borders since the mid 1200s and it isn’t going to change much.

      I’ve watched many expats move here and one of three things happen. They either don’t try to assimilate into the culture, become frustrated and leave in a few years. They withdraw and spend time only with a small circle of other expats trying to make a mini (country they are from) become frustrated and leave in a few years. Or they learn the language, study the culture, eat and shop locally, become part of the community and thrive with few regrets missing very little from where they came. Myself, I tell people I found in present day Portugal the US of the 50s I grew up.

      As my supervisor said upon my arrival to live in the West African bush in the 90s, “You’re not going to change Africa, Africa is going to change you”. Those words are true for most anywhere an expat goes if they are to be happy with a successful transition.

  8. Our local surgery is nightmare, difficult to know when they will see you, some patients take their lunch with them as it takes so long to get seen. At coffee time All the staff disappear including the doctors, leaving people at the desk waiting to register and the phones ringing unanswered. I was told that I needed to see my “family” doctor when I wanted a referral for a mammogram – I thought he was my family doctor, but apparently I needed to register at a neighbouring village doctor’s practice. They were only open on Thursday evening at 7.30, when I asked to register she said that they were full and my original doctor’s surgery would take me, she phoned them to say I’d be back to register with them. Now I go to to A & E and skip the middle man.

    1. Author

      Sorry to hear that, Gill. It sounds similar to a health centre near me (not mine, thankfully!). Friends of mine went to help a new arrival to register only to be kept waiting while the receptionist walked out halfway through dealing with an elderly lady. She didn’t explain where she was going but my friends guessed that she was going for a coffee and decided they may as well wait in the local café. Sure enough, there was the receptionist, chatting over a coffee and cigarette with her friends! When she eventually returned to her counter, and my friends rejoined the queue, she finished whatever she’d been doing with the old lady in about 2 minutes. It’s all about the power in some places, sadly.

  9. Hi Julie,

    I lived for some years in the UK and one of the contributing factors for me to return to Portugal was, in fact, the organization of the SNS (PT) / NHS (UK).

    I absolutely HATE the UK requirement for referrals, even if you want to go private (which, in fact, you can’t as you can over here). What I would say, if you have a mole that is troubling you, I would go directly to a dermatologista and skip the GP.

    It is NOT true that only your GP can refer you to an hospital appointment (or for an exam), any can. But unless your situation is plainly urgent (and he didn’t think so, based on the cream prescription), replacent doctors (“locums”, for all purposes) will not do it, as they might not know your full medical history.

    Regarding the mole (again), it is unlikely that you would get a biopsy out of a GP from the get-go. What I would expect would be an hospital referral (for a dermatologist) or a follow up appointment with after taking a photo (this is increasingly common with dermatology).

    Also, I wouldn’t worry too much about the 3 month period for surgery. If it is a cancerous growth, surgery will be much, much faster (but you have an oncological dermatologist following you). If, on the other hand, it is a pre-cancerous lesion, that they will recommend removal which can take the 3 months (because it is not urgent).

    Again, if you are worried, please book directly with a private dermatologis for peace of mind.

    1. Author

      Hi Carlos,

      Thank you for taking the time to comment and for your helpful suggestions and reassurance. I have since been back to my GP and didn’t seem too worried either so neither am I.

      However, it’s good to know that I can skip the family doctor and go straight to a dermatologist if I feel the need.

      All my dealings with the health care system in Portugal so far had led me to believe that even if I tried to go private or directly to a specialist clinic, I’d get sent back to my family doctor at some point. Having the option of bypassing the GP if necessary could be useful.

  10. Going to the doctors here is really quite an adventure. Sadly I don’t have a family doctor (not enough of them where I live…) so I queue up for a ticket as and when necessary. When I did actually book smear test, I then needed to cancel it… was that possible?!?! After a series of calls to the health centre even the receptionist seemed to get annoyed and uttered “I think they need to ask the Pope for permission to pick up the phone”…. As for the hospital here, have had generally good experiences although missed an appointment a couple of months back as they changed the date, sent me a letter, which of course as I’m sure you can I imagine, I just simply didn’t receive… next appointment DECEMBER!

    1. Author

      Oh dear! Seems I’m not the only one with hit and miss experiences of the Portuguese health system. I remember trying to book an appointment to get vaccinations for a trip to Vietnam – getting someone to answer the phone took determination and persistence that time, too.

  11. I guess even with some proficiency in the language, you are still doomed and face tough times while going for the medical treatment. I guess health care system has problems like most of the European countries. For expats it seems to be really bad.

    1. Author

      Hi Vinnie, I think for expats there are two main problems. One is the language barrier, if applicable. The other is not knowing how the system works, which is compounded by not being able to understand or even find the right information. Even though we know we should try to find out as much as possible before the need arises, it’s often the case that we find ourselves muddling through and trying to work out what’s going on when we’re at our most vulnerable.

  12. I recently had a potentially serious health scare here which resulted in two A&E visits and finally a referal to my family doctor for intensive tests. I also had a similar experience in the UK with a different but equally serious issue.

    In the UK it took a year of constant pain and final pleading in tears for something to be done to help me before I finally got a referal for a scan. I then had to wait a further 2 weeks for the scan to be done, a further 10 days for the results to be sent to my doctor and another 10 days for blood tests to investigate the likelihood of cancer, which was thankfully minimal. I was finally operated on two months later and a benign tumour was removed. The time scale involved with the final diagnosis left me frantic with worry and something I would not wish on anyone.

    In Portugal, following my weekend visits to A&E I visited the doctor on the Monday as was experiencing frightening symptoms. I explained my previous condition and he suggested scans to double check things – so I was sent for a myriad of tests including two scans which I had done on the Tuesday at an external clinic. I had the results back, was diagnosed, prescribed treatment and my mind was at rest by the Friday. Just over a week from start of symptoms to diagnosis and the start of treatment.

    I guess it really depends on your own personal experience but I found the Portuguese system to be efficient and effective. I liked the fact that I was given control of my own tests, meaning I could choose the time frame and not have to wait weeks for referals and results by which time you are so sick with worry let alone the original illness.

    This was a really interesting post to read, to hear another perspective of the health system here and helped me to understand other people’s concerns when they also find the system does not quite work for them. Invaluable information too! Thank you.

    1. Author

      Thank you for sharing your experience of both the British and Portuguese health care system. I can imagine how terrifying and frustrating it must have been for you back in the UK. I’m glad you got such prompt and efficient service and treatment here and hope that you’re back to full health now.

      You’re absolutely right though about it all depending on who you see here. You can be very lucky and get excellent treatment and care from the outset or experience the complete opposite.

      Knowing the right people can make a big difference in terms of how quickly you are dealt with, which can put many expats at a disadvantage as we haven’t usually got the same network as local people. An expat friend of mine had tried and failed three times to get an appointment with her local doctor even though she’s been registered with them for years. The receptionists there are fierce and unsympathetic and full of their own importance. In the end, one of her neighbours went with her, marched straight up to the receptionist and demanded to see the doctor. That worked but should not have been necessary.

      As I said at the start of my post, I’m lucky with the receptionists where I live but I still hate having to explain to a room full of people, and to the secretary why I want to see a doctor. Especially in crap Portuguese 😉

  13. Hello Julie, I have been reading all the info you send me on a regular basis and find it most usefull, informative and interesting, also you cover all the aspects of the particular subject in a most profesional way. Thankyou. I hope your medical problem is not too serious and is soon sorted out. Very Best wishes David Bell. ps I am hoping to drive back to Portugal soon in my Motorhome and will find your blog most helpful

    1. Author

      Hi David, Thanks for your comments. I’m happy to hear that you’re finding my blog useful and that you’ll be using it to help you plan your next trip to Portugal.
      I also appreciate your concern, and I’m sure it will be sorted out soon enough.

  14. I agree with Valentina, as after coming to Australia (where I work in the medical field as a clinic’s receptionist), I find the way of doing things like booking appointments, going for tests all over the place and getting results weeks later is so time consuming and a waste of time! Here there is no need to book appointments for x-rays or blood tests, you just show up with the referral when you want. If the x-ray is urgent, they will then fax the results to the Dr within the hour and you just go back to the Dr to discuss the result.
    I also remember in Portugal going to the Urgencias (emergency) with a back problem and I was told to go to my Doctor the next day, as the Dr on duty could not give me a referral for a scan! What round about way to do things!
    Hope your mole is nothing but a mole! Take care.

    1. Author

      Hi Sami,

      Once you’ve seen how much more efficiently heath car can be organised, for example in Australia or even the UK (which isn’t perfect but is a lot more joined up and straightforward in many respects than the Portuguese system), it’s really frustrating having to deal with a system that appears to be so illogical and time-consuming. I really can’t understand why duty doctors can’t make referrals. There doesn’t seem to be any provision for when family doctors go on leave. And if they can’t deal with emergencies in the Urgencias, what hope is there?!

      I have, at least, had good service when I’ve had to go to Urgencias. In both cases, I needed x-rays and got them done onsite within a relatively short space of time.

      The only thing I had to do offsite was fill my prescriptions at a pharmacy.

  15. Hi, Julie!
    I’ve had treatment on a number of skin lesions over the last twelve months and you have made me feel very grateful to the National Health Service! I can sympathise with how you must be feeling, but I am sure that your own doctor will take the necessary action when you see him next week. I am thinking of you x

    1. Author

      Thanks for your concern, Vivienne. It is actually starting to look a little better, even without the pomade, which I decided not to bother with. I’ve got to go and see my doctor with a list of things I’ve been putting off dealing with so I’ll get him to take a look just to be on the safe side.

      But this is why I avoid going to the doctor here. Nothing is straightforward and it always involves trips to clinics and a lot of wasted time.

  16. I am an expatriate myself from Italy to USA. Now when I go back to Europe and need a doctor or accompany someone for a doctor’s visit, I realized how backward they are still today, how awful is their way of doing things and the organization of every life is almost non-existing. I understand now why Europe it’s called Old World.

    1. Author

      Hi Valentina, It really is an eye-opener when you see how health care can (and probably should) be organised and streamlined. The inefficiencies in some of the European systems are glaring and involve a lot of unnecessary effort on the part of the patient, who is probably not feeling at their best and the last thing they need is to be passed from pillar to post chasing after basic tests, which could be performed at the health centre.

Over to you. Please share your thoughts in a comment.