Before we left the states, we made sure to get paper copies of our prescriptions. We double checked that each medication was available in the EU, and that our prescription documents had all the information required for a Portuguese Farmacia to fulfill them; doubly important, because we are foreigners who do not yet have an utente – a user number for the national health system. That will come after our residence cards, and will simplify many operations by allowing use of the central online system to track and validate prescriptions. In general, this was an easy process.
A Portuguese Farmacia is not like your local Walgreen’s or CVS. Almost everything is behind the counter, and customers speak to a pharmacist to identify the correct item. When I had a head cold, Bernie explained my symptoms and the pharmacist handed him a nasal spray to clear my head, and a box of lozenges to soothe my throat. (Bonus here: pharmacists know what stuff is making the rounds, so they have a better guess about what’s causing your malaise.) Likewise, when he took his prescriptions in, they were able to fill them – and refills must come from the same store, which has the paper document on file.
But one of Bernie’s prescriptions is uncommon here. The pharmacist rejected the paper prescription and told us “this medication is not available in Portugal.” We were able to get it in the end, but it was certainly…a process. And will continue to be for the rest of this year.
Step One: The Doctor
Our concierge service identified an appropriate doctor – and right out of the gate, we realized it was a good thing we had them. In Portugal, this specific area is covered by an entirely different specialty than in the US! Since it’s less common here, he took a full history back to the original diagnosis, and verified each element of the need. He asked all the right questions, and then provided a prescription – for blood tests, to verify the diagnosis.
Step Two: Blood Tests
This was an easy one – we simply walked in to the lab for a blood draw. At our request, they emailed the results (so we could be sure to get them back in time for the next doctor’s appointment, a week later).
Step Three: Back To The Doctor
Another in-person visit to the doctor, to review the blood tests. With the diagnosis confirmed, he wrote a prescription – for a periodic injection. As it turns out, the medication is available here – just not in the way that the US doctor had prescribed it. There is no topical option – so the farmacy could not fulfill the prescription as written.
The doctor expressed that he would rather the injection be given in a clinical environment than at the farmacia (wait – they can do that?), so on our way out the door we inquired at the front desk, and were told that our clinic did not provide this service. (For those unfamiliar with US medicine – our old doctor would finished the appointment, told us to wait where we were, and sent a nurse in to administer the shot. But I have yet to see a nurse or assistant at our doctor’s offices.)
Step Four: Back to the Concierge
Once again, our concierge crew proves their worth. First, they determined that there were no clinics in our town that provide this service. We could have the injection done at the farmacia, or we could go to the farmacia to purchase the drug, then make an appointment at the hospital to have it administered. That seemed a bit convoluted, so we decided the doctor would have to deal – we’d have the farmacia do it.
So the concierge called around and learned that only one farmacia in our city carries this drug. Fortunately, they also administer injections, so we planned a walk downtown to get it taken care of.
Step Five: The Farmacia (Twice)
They were terrific. We could purchase the meds, and leave it there at the farmacia, the just come in when needed to have it administered. Even with a paper prescription, the information would be stored in their system so they would know what to do, and that we had already purchased the actual drug (there is also a small fee for the injection/staff time). Easy! Except it was morning and the person who does the injections isn’t in until afternoon. OK – it’s not a long walk. Home for lunch, and then back downtown!
Except…the tech who actually does the work says the recent ruels changes prevent them from giving the injection to someone who does not have an Utente (health system ID number), which we can’t acquire until our resident cards arrive. Sigh. OK – we collect up our three-month supply and head home.
Step Six: Back to the Concierge
Our contact at the concierge huffed a bit – not at us, but at the farmacia. They do not interpret the recent rules updates in this way, and feel the farmacia could have just done it. But this the the thing people mean when they talk about the Portuguese bureaucracy. It’s not really slower or more messed up than anywhere else – but it’s definitely less systematic. Different people, different offices/sites will interpret every rule differently, and it’s very much a case of “if you don’t like the answer you get, take a new number, and when called, go ask a different person.”
But the concierge called around and found that our best option was not the local central/public hospital, a 20 minute walk to the center of town, but our local private hospital – a 20 minute walk in the other directin, at the edge of the Arrabida open space. They scheduled an appointment for us, connecting us with a nurse to confirm details. She reminded us to bring the paper prescription – which we no longer had, since the farmacia kept it. Fortunately, I had scanned a copy and she confirmed this would work.
Step Seven: Field Trip to the hospital!
The day before our appointment, I scoured the hospital’s web site, and was unable to find anything that matched the location/department information on our confirmation. I printed a copy and we set out a little early so we’d have time to wander around lost and ask people where we belonged.
Most things in Portugal seem to involve taking a number and waiting your turn – but the Hospital da luz has a receptionist stand in the lobby that you can walk right up to, if you just have a silly question. She looked at our confirmation – and promptly called for reinforcements. After some consultation, and a quick phone call to we-have-no-idea-whom, we were directed to the second floor. Was there a department name, I asked? Just go to the second floor.
When the elevator doors opened, the first thing to come in sight was the second floor reception stand. She was clearly expecting us. We showed her our confirmation and she walked us over to the ticket machine. I watched her carefully, and saw her choose the option “hospital of the day” which seems to be something less than “urgent care” and “more than a walk-in clinic” (based on the fact that we had to make apopintments days in advance). She handed us a ticket, and showed us through some double doors to a new waiting area.
Victory!
From there it was the usual stuff: wait until our number was called, provide the documentation, phial of alchemist’s tincture, and insurance card to the lady at the desk, and wait some more until your name is called. A quick poke, and then off to stroll home in the sunshine!
In the future, this will get simpler. Once our resident cards arrive, we’ll apply for healthcare IDs – and from there, our local farmacia will just take care of this sort of thing for us. But even that was a new concept for us. Other than a few flu shots, we had always received injections at our doctor’s office, so even the “simple and easy” version was new for us. The convoluted elements – I think I can honestly say we wouldn’t have managed it without help. We learned a lot about various elements of the system – but mostly we learned that the decision to engage the concierge service was one of our smarter choices.
We’ve managed most of the moving and immigration process ourselves – but navigating a complex system based on totally different assumptions than we’ve encountered in the past is an extra challenge rating. Sometimes, the best way to handle a task is to hand it off to someone who can teach you how to do it well.
