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.