The Challenges of Getting a GP Appointment in Rural Portugal

Written By Araci Almeida

The day had yet to begin for anyone, neither for the sun still sleeping nor the entire neighborhood. Were it not for the sound of the television interrupting all this early morning silence, this would be a typical quiet fall morning.

From the TV, the news alarmed us about the rainy and windy weather forest for that day. Notwithstanding our possible displeasure about a gray sky, rain is welcome, especially in such a tremendous year of drought in Portugal and all Iberian Peninsula.

It was not yet six in the morning, but an alarm had already sounded, reminding me that I had to get up earlier than usual. There, I struggled with the cold and a certain laziness in the morning.

Usually, the Portuguese don’t get up so early, contrasting with Nordic or Central European countries where the culture of going to bed and waking up early prevails.

Therefore, it would be strange to see the cause for such an early wake-up. However, there is a good reason to do so, even if it costs us to get out of bed early.

You wake up early to go to the local health center to get an appointment with your GP, also known as a family doctor. In Portugal, health centers open at eight in the morning, but still, it’s better to get on the road earlier and arrive there one or two hours before.

And when you arrive at about six thirty AM, one or two people are already queuing up. You ask who arrived first, ask about your turn and the doctor’s name for whom you are waiting. When you hear someone say a doctor’s name other than your own, you sigh in relief because you can catch a vacancy to meet your GP.

And if the reader by now might be pretty confused by all this, I will explain further how everything proceeds typically. This method of waking up early, going to the health center, and staying there to be able to make an appointment with your doctor isn’t new.

In fact, it is obsolete, but it is still in effect, especially in smaller towns where it is difficult for people to get an appointment with their family doctor.

The appointment booking systems have changed over the years but don’t seem to progress, making the bureaucratic machine more complex instead of simplified. Recently, when I wanted an appointment for any day, I was told that I would have to come back the next day to be able to make an appointment for about a month and a half later.

If I wanted to meet with my doctor on the day, I would have to come as soon as possible and make an appointment quickly, right in the morning, since the doctor will always have one or another vacancy available. So, that’s what I did on that particular fall morning.

My reason for going to the doctor was, among other minor things, to present the results of some medical tests that he had prescribed me.

I arrived at the health center, and just as I predicted, an old man was sitting on some old, makeshift wooden benches. He was already there because everyone knows that people arrive early, and we all want a spot with the doctor.

And then everyone stays there, with the cold, the rain that falls, and only three small benches that don’t fit everyone. Still, nobody in charge wants to make it official because that would be admitting the system’s flaws.

We chatted while the sun was slightly rising. People were arriving slowly, sleepy, some sicker than others. People then complained about the same things, mainly the lack of proper facilities.

The gentleman who was already there wondered why they didn’t build a kind of marquee where they could protect themselves from the cold. Meanwhile, the two benches were not enough for everyone, and I gave my seat to older people. And, of course, there is always someone who tries to cut in line, thinking they are more clever than the others.

All this is how a decades-old tradition is maintained. So are the difficulties of getting close contact with the doctor. And I also complain, but I do it, nonetheless, as they say here, “with a full belly,” privileged because I should be grateful simply for the fact that I have a family doctor.

A friend of mine is not so lucky. He had the same family doctor for years until the doctor retired. Meanwhile, in his even smaller health center, young doctors appear as fast as they disappear.

They go, they stay, and when they realize the lack of a career progression and the enormous stagnation of the Portuguese interior, at the slightest opportunity, they flee to a more cosmopolitan environment that can provide them with a more pleasant life. I don’t condemn them. I understand them perfectly, and even I constantly have this urge.

But while one is young and can go from one place to another, the same cannot be said about the elderly population from these areas. And it’s our senior citizens who need medical care more than anyone else.

And in the midst of them, some resilient young people can also be found who may even be thinking about starting a family. And when anyone thinks about something like this, or when one makes this decision, they sure need prenatal medical care.

But how can you ask a young couple to embark on this adventure when it’s so hard to get a simple routine consultation? And if a woman decides to become a mother, the news is not very encouraging.

Many maternity hospitals have closed in Portugal, creating more insecurity for those who choose to be mothers. Along with this, stories of pregnant women from distant areas of big cities who could not get the proper assistance also keep popping up in the news, making us all consider this option.

It is easy to ask the population for an increase in birth rates in a country like Portugal with such an aging population. Still, as long as the conditions for access to primary health care are not created, the country will undoubtedly continue to see its population decline.

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