Preventive care in Portugal

I see no-one has replied so let me be the first one:

There is a very large difference between REACTIVE and PREVENTATIVE care in Portugal.

My experience with reactive care is absolutely amazing - where you have a problem and suddenly need treatment. I don't understand why anyone would buy private health insurance in Portugal based on reactive care needs. The only thing is, you need to understand how the system works. Speaking Portuguese is one enormous step towards that. If you can figure out the system, you will wonder why you ever spent a penny on reactive care insurance.

Preventative care is another story altogether, and follows two prospective paths:

1. If you a Family Doctor / General Practitioner assigned.

This is the best scenario, but also the least likely if you are a new immigrant, as waiting lists are so long it can be years or "never" before you are lucky enough to have a GP assigned to you.

In this scenario you can make appointments and get various tests done without pressure, and in fact, you will be contacted by them for tests.

1. If you do not have a Family Doctor / General Practitioner assigned.

This is the worst scenario and also the most likely if you are a new immigrant.

In three years I have only received a single communication from the health department around preventative care. No invitations to make a visit for any kind of testing.

At the same time I still would not buy another insurance policy as my experience was that I paid a lot each month in the first year, and was not able to access it ONCE. So many excuses - no doctors in my town on their plan, excess so high that it wasn't worth it, gigantic total excesses before even one penny of coverage kicked in, no way to cancel a policy in Portugal! and on and on. My advice to anyone is: read the fine-print very carefully; you might be surprised at the difference what you think you are buying and what you actually will get.

@Perpetual_traveler

I would agree with respect to the reactive side. If you have an accident and need urgent help then the SNS will likely be there for you. If you have a painful, but not life threatening problem (e.g. need a new hip) then you might be waiting for many months before the SNS will provide surgery. If you have a good insurance you can get the surgery within days or weeks. I assume (!) that this is true for quite a few ailments/treatments.

Regarding preventive care we have taken this into our own hands. Living away from "home" for over 30 years we are making sure that all the examinations and consultations we - and a trusted doctor - deem necessary, are done and we are having a record of everything. Our health insurance covers the majority of the costs, but there is always a co-payment required.

When it comes to basic vaccinations and women's health, the SNS is pretty good, inviting my wife annually for mammography and the like. If you would like to be vaccinated to higher (but basic Western European) standards (e.g. Herpes Zoster) then you have to pay this out of pocket (with or without insurance).

I think that the need for insurance simply depends upon your financial means. I have friends without insurance and they pay with a credit card (even for quite major surgery). Others make different decisions and pay for insurance.Insurance is a risk management tool.

I was a family doctor in Canada before retiring and moving to Portugal, so I was surprised by how little family doctors actually do in Portugal compared to my scope of practice in Canada (and my scope of practice in Canada was already quite limited compared to other GPs).

It terms of preventive care, it is not clear to me how exactly GPs practice in Portugal and based on what do they make certain recommendations. There doesn't seem to be a system to it all.

Vaccinations seem to be up to date and they keep track of everything, but on the other hand there seems to be a total disconnect between doctors of any kind (including GPs) and the various exams or investigations they may request.

In Canada, for example, every single lab or imaging result, any specialist consult report, any ER visit report were being sent to patient's GP as soon as available. In Portugal, however, it seems to be patient's duty to keep track of results and take them to the doctor when needed. I tried once to send in my daughters' lab work, each with a minor problem, just so that the family doctor had them at the upcoming visit, only to be told by the USF receptionist that I have to bring them personally at the consultation. My understanding was that they don't even keep such exams in patient's file.

From here, a lot of unnecessary or overlapping examinations requested by various doctors with various purposes, just because everything is not being collected in one place.

To me this all is an absolute mess and I personally don't see how I could ever practise in a system like the Portuguese one. Difficult for patients and even more difficult for doctors.

So that's my two cents worth of opinion...

In Portugal, however, it seems to be patient's duty to keep track of results and take them to the doctor when needed. - @ctomac

1) What if the patient doesn't have a family doctor? Unfortunately, a large part of the population doesn't have one. Many of the family doctors currently in the NHS are temporary and not permanent.

2. What if the tests are ordered by speciality doctors? Where do the tests go?

3. What if the patient wants to see one or more speciality doctors instead of their family doctor?

I honestly don't see this as a problem. There are bigger problems in the NHS, I should say. I've always taken tests, I've picked them up, on different media, DVDs, paper, X-rays, etc.... and I've taken them to the doctors I wanted, in the public system, in the private system (clinics / hospitals), etc. And then I kept the exams with me.

This method can clearly make it easier for my family doctor who ordered tests and for me to go there to pick them up after the appointment. But it doesn't work in other situations....

just because everything is not being collected in one place.

That's an interesting question, but who controls access to the data? Can public and private sector doctors access centralised patient information? Who controls this? Note that sharing between the public and private sectors is not allowed without the patient's consent. And even within the NHS, this information would be made available to several doctors...?

As far as I'm concerned, the patient should be in control of his own tests/exams and access to the data should be provided only by the doctors he goes. There is a data protection law that must be respected.

1) What if the patient doesn't have a family doctor? Unfortunately, a large part of the population doesn't have one. Many of the family doctors currently in the NHS are temporary and not permanent.

The patients without a family doctor usually to the USF closest to their home, don't they?  That's where all the medical information should be kept, including consultation in the USF, consultations by specialists or hospital, labs, imaging, everything pertaining to that patient.

2. What if the tests are ordered by speciality doctors? Where do the tests go?

To the specialist as well as to the family doctor or USF (they both get a copy).

3. What if the patient wants to see one or more speciality doctors instead of their family doctor?

They should all send copies of their reports to the family doctor or USF.

I honestly don't see this as a problem.

You wouldn't, because you got used with an ineffective and wasteful system. But I worked and was a patient in a different, more effective one, so I can tell the difference. I'm not saying healthcare is better in Canada, because in many ways it isn't, but in terms of how things are organized there, it is a lot better than in Portugal.

There are bigger problems in the NHS, I should say. I've always taken tests, I've picked them up, on different media, DVDs, paper, X-rays, etc.... and I've taken them to the doctors I wanted, in the public system, in the private system (clinics / hospitals), etc. And then I kept the exams with me.

Quod erat demonstrandum. You've never known anything better, so you're satisfied with what you have. :-)

But the fact that you've never known anything better is not really a reason for not accepting that there are better ways, is it?

Why, for example, waste your time picking up your tests results? And once you picked them up, what? Of course you have to go to see the doctor to review them, whether they are normal or not. Again wasted time (both yours and the doctor's) if the results are normal.

Whereas in Canada I used to review all the reports I was receiving every day for my patients, flag those that needed my intervention and call the respective patients in to discuss what needed to be done. For the rest of the normal results or reports the patients always knew that if I didn't call nothing needed to be done, so they didn't need to waste their and my time coming to see me for nothing.

just because everything is not being collected in one place.

That's an interesting question, but who controls access to the data?

The patient controls it and the family doctor or USF holds it. By law, in Canada, any family doctor or clinic has to guard and preserve patient information for a certain number of years. The patient is the owner of the medical information and the doctor or clinic are not allowed to provide it to anybody without patient's consent (except for other health professionals that the patient is seeing and who may request certain bits of that information). The patient also has access to it and can request copies at any time.

Can public and private sector doctors access centralised patient information? Who controls this? Note that sharing between the public and private sectors is not allowed without the patient's consent. And even within the NHS, this information would be made available to several doctors...? As far as I'm concerned, the patient should be in control of his own tests/exams and access to the data should be provided only by the doctors he goes. There is a data protection law that must be respected.

You make it sound as if only Portugal or the EU have such laws. But they do actually exist in other countries too. :-)

- @JohnnyPT

As I mentioned, under current legislation, this sharing of medical information (public/private sectors) is not possible in Portugal. And if it were to change, I wouldn't be interested in keeping my medical information somewhere, all my clinic background, available everywhere, available to anyone, without my knowledge and consent. I and most of the people. And I don't care if it's more efficient for the USF doctor or not. It's private information that concerns the patient and only he knows what to do with it.

You've never known anything better, so you're satisfied with what you have. :-)

But the fact that you've never known anything better is not really a reason for not accepting that there are better ways, is it?

It's been a while since you've made aggressive and arrogant comments from someone who thinks himself on a higher pedestal... Do you know if I've known better, worse or whatever? Stick to your reality, (which is often distorted (as we've seen in your previous comments) and don't extrapolate. That way, you'll be happier and others will be happy not to read what you write here...

Nosce te ipsum.

Carpe diem.

As I mentioned, under current legislation, this sharing of medical information (public/private sectors) is not possible in Portugal. And if it were to change, I wouldn't be interested in keeping my medical information somewhere, available everywhere, available to anyone, without my knowledge and consent. I and most of the people. And I don't care if it's more efficient for the USF doctor or not. It's private information that concerns the patient and only he knows what to do with it.You've never known anything better, so you're satisfied with what you have. :-)But the fact that you've never known anything better is not really a reason for not accepting that there are better ways, is it?It's been a while since you've made aggressive comments from someone who thinks himself on a higher pedestal... Do you know if I've known better, worse or whatever? Stick to your reality, (which is often distorted (as we've seen in your previous comments) and don't extrapolate. That way, you'll be happier and others will be happy not to read what you write here...Nosce te ipsum.Carpe diem. - @JohnnyPT

Oops! Somebody got up on the wrong side of the bed today?

Relax, your information already is somewhere (surprise, surprise!), and that's not in your home. As for "available everywhere and to anyone", I'm sure that's not the case, at least not without your consent.

You make me laugh, aggressive, me? Not unless you have very thin skin. I just expressed my opinion as to how I see things in Portugal compared to other places.

As for extrapolating, you said it yourself that's the way you've always done things, which implicitly means you've never done or known anything else. No extrapolation needed here.

I don't see myself on a higher pedestal, but I'm probably more travelled than others (and I'm not talking here in taking 2-3 week trips but actually living for years in other countries, several of them on various continents), therefore I have experienced in depth more diverse things and views. That doesn't make me better than others, just possibly more experienced.

And what exactly makes you such an expert on what other people like or don't like, that you feel the need to speak for them?

Finally, if you don't like to hear opinions opposing your own, don't ask for them. I simply answered the question that was posed here (Preventive care in Portugal)

Nothing beats a good polemic, does it? :-)

In the US, there's a rather restrictive policy for sharing medical records, HIPAA.

I don't know all that much about how it works in the US, because I just didn't go there much.  But in principle ... there's a well known problem with medications, where multiple practitioner may prescribe what turns out to be an unwholesome array of medications, unaware of what they're collectively doing.  It seems like an opportunity that a centralized health system could capitalize on, to make a patient's treatments visible to all the practitioners involved.

The facilities that our insurance covers here, are somewhat limited in our medium size city, but they're good if we're willing to go to one of the regional centers, Coimbra or Leiria.  There's a local provider that offers a significant variety of services, but the quality is kind of hit or miss - they must have a niche that they fill well, but it isn't ours.

Polemic? Wrong side of the bed today ?

Of course not. Although you are the right person to polemicise, and creating these frictions with many people. It's not my extrapolation, but easily deducted from your words in other posts....

Yes, the medical information is somewhere, but you know who has it and who accesses it. If it goes outside the boundaries that the user knows, it's easy to see where the breach of data privacy has occurred, and they can take legal action against those who have shared clinic information improperly.

As I've already mentioned, information is not yet shared between the private and public sectors.  Legislation and procedures must be defined. And this is not just a portuguese issue, as you would lead us in your previous post regarding those NHS system's inefficiencies, but a European one, which Portugal is a part of.

Eg.

https://www.publico.pt/2024/08/27/socie … os-2101675

You make me laugh, aggressive, me? Not unless you have very thin skin. I just expressed my opinion as to how I see things in Portugal compared to other places. - @ctomac

Hi ctomac. By now you should know that JohnnyPT has a very thin skin and is very protective of everything Portuguese. I got used to it. And he is extremely helpful to the whole Expat Community.

As we travelled all around the world for over 30 years, we are used to keeping our own electronic health records (including X-rays, MRIs, CTs and so on) on my server. As we have health insurance and are usually using CUF or Hospital da Luz, we always get our data without a problem. However, as you said, there is a lot of room for improvement in the Portuguese systems.

I would also consider the mentioned aspects of the Canadian system superior to what is available in Portugal, but from Canadian friends I know the situation in Canada is far from perfect. Overall we personally (and so far) prefer what we get in Portugal.

Yes, the medical information is somewhere, but you know who has it and who accesses it. If it goes outside the boundaries that the user knows, it's easy to see where the breach of data privacy has occurred, and they can take legal action against those who have shared clinic information improperly.

It's exactly the same in all civilized countries, bro, but that doesn't prevent communication between doctors, doesn't prevent all specialists and labs and hospitals from sending all reports to one single place and doesn't force patients to act like mules carrying their reports from one place to another and from one doctor to another. That's exactly the idea behind storing all info in one centralized place - easy access by the doctor, easy accountability of unauthorized breeches, and also decreasing risk of such breeches (easier to defend one spot than one hundred).

And I'm not even mentioning the fact that patients do not have the medical knowledge needed to assess what information any given doctor would need, so they either end up either bringing everything (and I've seen people carrying really big and thick folders with them) or not bringing all relevant information because they didn't know it was relevant. Adding to that, then, the time wasted by the doctor looking through the big thick folder and trying to dig out any relevant information from there. To me it all sounds like a doctor's nightmare. And guess who will suffer in the end if the doctor is not able to find what is needed and make sense of it? You, dude, you're the one who will suffer, not the doctor! You will be the one receiving worse healthcare than the one you could have had.

Wouldn't it be more effective to be all digitalized and stored on one secure server with the GP as it happens in other civilized countries? The GP would have instant access to any and every bit of information, would be kept in the loop with all the medical issues of any patient, would avoid asking for redundant investigations in case such investigations had been ordered by another doctor recently, would have access to history of various labs or investigations and see their evolution in time in one second with graphs and stuff.

You said something like you don't care about making your doctors life easier, but don't you realize that this would make YOUR life better, because your doctor could take better care of you if he/she had easy access to all this information???

You also said that you've always done things this way in healthcare and don't care for a change. But isn't human progress based on and caused by change. Is the fact that we've always done things a certain way a reason to continue that and reject change and improvement?... If you think so then don't be surprised that I don't agree with you and I see that as a backwater mentality.

True, I don't know anything about your life and what you've known in your life, but when you make such a statement it makes it quite obvious that you have not known something better in healthcare, because if you had, why in the hell would you want to go back to and continue doing (and even defending) something worse? It's like an Eskimo lived all his life finally goes on a trip to Mexico and then declares that he's perfectly happy to return to his igloo and live there and eat fish and seals for the rest of his life. Does that make any sense? Would most people consider the Eskimo weird?

As for offending others, I don't remember to have had any issues or contradictions with others here except for you. But I do remember other members mentioning in their posts that you were rude and offensive and were attacking them with no reason other than apparently your getting pissed off that you didn't share their opinion. I even added my voice to theirs occasionally.

So, who's extrapolating here?... Who's the pot calling the kettle black?

Sorry, I'd like to spend more time with you here but I do have a life now.

I would also consider the mentioned aspects of the Canadian system superior to what is available in Portugal, but from Canadian friends I know the situation in Canada is far from perfect. Overall we personally (and so far) prefer what we get in Portugal. - @TGCampo

Hello there,

Yes, me too, I consider what we get in Portugal better than in Canada, particularly because access to private healthcare, which in Canada is forbidden by law, and which was one of the main reasons for leaving Canada.

But that doesn't mean that things are all fine here, and the one that I mentioned was a really sore point with me, this disconnect between doctors and labs and hospitals and the lack of access to a centralized store of information for any given patient.

I realized that this affects the quality of the medical act, I actually heard Portuguese doctors complaining about this and wishing they could have easier access to all patients' history. And the fact that I worked in a system where I used to have all this and I now see it absent here makes me wish that doctors here also had what I used to have, as a doctor and as a patient, in Canada.

That being said, would I go back to Canada as a patient? Hell, no!!!

Would I go to practice there as a younger version of myself? Hell, yes!!!

@ctomac

If the world were perfect, everyone would be happy, but it isn't. You live in a country, so you follow its rules, laws, and systems.

If the world were perfect, everyone would be happy, but it isn't. You live in a country, so you follow its rules, laws, and systems.

@SimCityAT

Rules, laws and systems can be improved. Suggestions and ideas should be accepted.

As we travelled all around the world for over 30 years, we are used to keeping our own electronic health records (including X-rays, MRIs, CTs and so on) on my server. - @TGCampo

How does this work, exactly? Which server are you keeping everything on?... In what form?

Sounds very intriguing to me...

As we travelled all around the world for over 30 years, we are used to keeping our own electronic health records (including X-rays, MRIs, CTs and so on) on my server.  - @TGCampo
How does this work, exactly? Which server are you keeping everything on?... In what form?
Sounds very intriguing to me... - @ctomac

There are such things as "Clouds" I have a Dropbox account, which stores a lot of my files, I also have a personal hard drive, the size of my wallet which is 2Tb. There are so many ways to carry data with you these days.

@ctomac,

The difference is that I'm here to help, and you're here to complain and criticise.... Complaining about everything and everyone, thinking that it's the country that has to adapt to you, and not you who has to adapt to the country, which you chose for personal reasons.

Yes, I'm rude when I think I should be. And it's not about what you say, but HOW you say it. And especially when what you're complaining about has a background that you're naturally unaware of. I can also complain about waking up in the middle of the night in an Arab country because of the shouting for the call to prayer. Or the French who put their bread under their arm, or the arrogance of Italians, especially in Rome, towards foreigners, or the noise Brazilians make at their parties, in the middle of the night, ignoring the nuisance they cause their neighbours. I can complain about anything, but despite my view, which is justified in the light of my education and cultural background, I can also be unaware of the explanation for what irritates me.

I can be rude sometimes, but when dealing with thousands of people who write and read here, all different, from different countries, from different social backgrounds, with different educational and cultural backgrounds, it's natural that I don't please everyone. Patience.

As for you, you were rude to me, posting in threads that didn't even concern you, in an ironic, aggressive way, not helping, but criticising, targeting me. And if you revisit those threads, you'll realise that it was you who was wrong. 

The Eskimo wouldn't be happy in Mexico, I assure you. Nor would the Mexican be happy dealing with seals. But if the Mexican wants to go on the ice, he'll have to adapt to it. It's not the seals that have to adapt to the warm waters of the Gulf of Mexico.

Regarding the sharing of medical data, your vision is of a perfect world, where USF doctors are infallible, perfect, and interested with patients (!). Where there are no flaws in the computer systems or those who handle this data. I know you're going to say that we're subject to this in an increasingly digitalised society. True, we can't escape that.

For you, the patients are ignorant people who can't read a medical report. I know of several cases, many of them in my family, where the USF doctor is totally incompetent, careless, sloppy, forgetful,..... Should we be limited to that doctor when all the tests go to the USF? And when the patient moves house, where do the physical, non-digitised test files go? For example, if he becomes an expat like you. And if there's a problem at the USF, theft, fire, breach of data privacy, how do you deal with it? OK, I know there are backups (if there are any).  For me, this problem in Canada's health system is much more worrying than the lack of centralisation of medical data between the public and private systems in Portugal.

And then there are other aspects, but that's my personal perspective, which can be criticised:

- I no longer believe that the State takes proper care of its citizens and in particular their data. The less data they have about us, the better.

- I know that NHS health centres / private health centers make data about their users available to businesses, in particular their date of birth and phone number. This data is then used by these companies to use telemarketing to sell mattresses, hearing services and so on. Imagine what it would be if everything from the NHS and the private sector would be centralised. Who would control that?

Yes, there are always ways round all these problems, but the hardest thing, the real challenge,  is to be more flexible when you come up against new realities that you don't agree with...

I was going to suggest that we start up a National Health Records system, but while looking into it, ran into this -- https://health.ec.europa.eu/system/files/2016-11/laws_portugal_en_0.pdf

Overview of national legislation on EHR in Portugal

Executive Summary

1. Stage of development of EHRs in Portugal

One of the objectives in the area of public health included in the Programme of the XVIII Constitutional Government was to ensure that, by the end of 2012, all Portuguese would have an electronic health record (EHR). In May 2012, as the result of the work carried out by a series of specialised working bodies specifically created for this purpose, the National Platform for Health Data was finally launched in Portugal.

This platform consists of two different portals connected to the National Health Service – one for health professionals and other for the patients. The Health Professionals’ Portal provides access to three different types of information, including to the RCU2, the Portuguese Single Clinical Summary, which compiles the most relevant data from other electronic health records (EHRs) which is identified by the patient’s physician as essential information to be provided to health professionals for the provision of health services. The Patient’s Portal allows these to register their health data (including e.g. height, weight, blood glucose, blood pressure, cholesterol). The user needs to authorize the access to his data and has the possibility to consult the historic of accesses. Since July 2013, users of this portal have also access to some of the information included in their own RCU2.

As an old person with limited attention span, and not much involvement with medicine, I'm not going to think hard enough about all this to determine whether it's relevant, but I will say I vaguely remember signing off on some permissions that sounded like that.

For many years I may have worked for an university "health" faculty in a technical capacity, NDA prevent me from saying much.  One overriding and ongoing issue with heath/mental health research was/is security of patient information. Large organisations have serious issues safely keeping confidential patient info whilst letting only permitted people access the info. For some research projects we used patient/participant  paper forms/questionnaires which were kept locked in a room in locked filing cabinets (and some more measures) with only researchers, me and head of security having any access as approved by the body governing patient data. 

  For me I do not keep any data in any cloud if I can help it. I was happy with the medical heath provision in Cuba, Brasil and Mozambique.