Wednesday, April 20, 2011

in the clinic

today i met with the admin who’s in charge of all the medicine clinics at hospital são joão. it was a very good experience, as she and i talked a lot about how medicine as a system is managed here versus how it is run in america (the united states of). talking to the admin, i was able to learn that the portuguese have a “gateway” system that is supposed to work similarly to how some of our medical communities are supposed to work in america. i say supposed to because, as in america, portugal is suffering from a shortage of physicians who take on the responsibility of primary care. however, we didn’t talk much about specialists, and specialists are also in short supply in some parts of america, and i would wager it’s a pretty safe bet to say that the same applies to portugal.

how it’s supposed to work: if one person goes to a GP (general practitioner), the entire family goes to the same GP. unless one or more of the individuals from a family relocate, they all have the same doctor. if such a move occurs, those individuals are assigned to a new GP. family medicine. if a person needs to be evaluated by a specialist, then that person is referred by his GP. this is what we, in the healthcare field, call the gateway system. people see their GP for routine and urgent care but go to the ER for emergencies (hence, the ‘E’ in ER). this particular aspect of the system breaks down when there aren’t enough primary care physicians, as physicians are overloaded with patients, it may take up to four months to make an appointment. by then, one’s problem probably has spontaneously resolved, or one has resolved this issue in another manner. “what other manner is there?” you ask. welllll… here’s where the ER comes into play. if you have a problem, you KNOW that you have to be seen if you go to the ER, so…

we also talked about who pays for what. portugal has a more socialized system of medicine which pays for the vast majority of health care costs for its constituents. it’s in the portuguese constitution that individuals have the right to healthcare (hint for all you [future] legislators out there). actual healthcare, i.e. visits with physicians and treatments, are free. however, there is a co-pay scale for prescriptions that is income based, but for all major chronic illnesses, such as cancer or HIV/AIDS, the government pays 100% of the medical costs.

in action
yesterday, i was actually in the clinic with my attending dr. pestana and one of the residents, joana (number 1, joana number 2 is gone, as last friday was the last day of this rotation for the med studs). it’s definitely a different atmosphere here in portugal, as i’ve not only seen how dr. pestana works but also dr. carmela who works in the infectious disease department. here’s a basic run down of how an office visit works.
--the attending sits in his office
--the patient enters office, and everyone exchanges salutations
--the patient sits
--the doctor asks all the questions he needs to ask
--the doctor examines the patient
--the patient goes on his way
--the doctor calls for the next patient.
this method is in contrast to the method in america where patients are called back to a room, are seen by a nurse, then wait in whichever room they’ve been called to until the doctor comes in. in my opinion, it’s a much more comfortable system here because the doctor is in his singular office and doesn’t have to run around to all the different rooms he may be working out of. it’s also more comfortable for the patient because the patient knows once he is called back, he is seeing the doctor, not sitting in another room for another half an hour.

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