This article was written specifically for Good Portugal by the public health specialist Mariia Melnikova.
First, surprise: it is almost impossible to do something without a referral.
This is unexpected; it puts you in a bind and further complicates the stupid quest for examination and treatment. The argument, “I’m paying for the exam myself, do me this and that!” – doesn’t work. In the local system, the patient is not considered competent enough to prescribe their examinations, much less evaluate their results. First, talk to Dr. X, have him write down precisely what you need, how to look for it, and sign and stamp it – then we’ll make an appointment. (*Some labs and centers put the name and surname of the doctor who ordered the test in the report).
Where do you get the referral?
In the state network: from your family physician or hospital specialist. These referrals are paid for by the state (in part or in total), so-called “free tests”, P1.
In the paid network: a doctor from your insurance company, any doctor in a paid hospital, and most doctors who work privately.
Surprise number two: you find a doctor at a fee hospital, and finally get to see him; you say, “I want an abdominal, thyroid, prostate, and breast MRI, plus a colonoscopy with sedation, let’s go!” And the doctor disagrees with you and will prescribe you, at best, a head X-ray (and alprazolam, so you don’t get nervous). Because – once again – the local system considers the patient to be not competent enough, and self-medication is not encouraged. “And what to do?” Look for a doctor who agrees with you and recommends the right referral. Deal with the local system. Get checked out at home, with recommendations from your home doctor or advice from the Internet. “Well, can you write me a referral?” I can, as long as it doesn’t go against my medical beliefs. It’s one thing if you and I have discussed the complaints and chosen the best diagnosis. It’s quite another when they unnecessarily ask for a CT / MRI / three liters of tests for a child. Sorry, I don’t want to sign up for that kind of thing.
Got the right referral for the right tests. Where to get them done?
1) In small clinics near you: google exames médicos, imagiologia, ecografia, Rx.
2) In fee-based hospitals and diagnostic centers: CUF, Luz , Trofa, Affidea, and others. Interesting detail: “free” examinations and tests are usually done in the same clinics, but you have to clarify that you have a government referral and look for “acordo com SNS” (not all clinics accept “free referrals”, but most network ones do). Public hospitals only do tests prescribed by doctors from the same hospital (i.e., you cannot go to public Santa Maria or Sao Jusa with my referral. But you can go to fee-based centers).
Okay, I have a referral; I found a clinic! How do I make an appointment? You can go there in person or make a phone call. Sometimes (quite often) the administrators speak English, and if not – you can show the referral, and you will be understood. You can try to make an appointment through the website, but most often you will get a call back to clarify the details.
Surprise number three: the appointment will be a few weeks or months later! And I don’t have any tip-tips on how to speed this up (other than signing up at several clinics at once, calling small offices, and looking for options in other areas).
How much do the tests cost?
By referral from the family doctor: free of charge, in those clinics that have such a protocol (acordo com SNS).
By insurance: it depends on your insurance conditions; you may pay a certain notional amount or percentage of the total price; ask your insurance agent and the clinic you have chosen.
At your own expense: from 30-50 euro for simple ECG, X-ray (Rx), audiogram, about 100 euro for ultrasound, from 150 and above for endoscopy, CT, MRI. In small clinics, it will be a little cheaper; in private hospitals – it will more expensive. The conclusion and description are given in hand or sent by e-mail. Sometimes it takes another week after the study.
Surprise number 4: there may be very little information if you want to send this report to your doctor at home. For example, “abdominal organs – no pathology.” That’s it. No long protocols, no excellent descriptions about “gallbladder bends.” If you wanted something more specific, your doctor should indicate it in the referral. “Dear colleague, I refer to you a patient with a clinical picture of cholecystitis. I humbly ask you to assess the size of the gallbladder and the presence of stones in it. Best wishes, Drª Mariia”.
Health and strength to all of us! Let the examinations be only routine, and the doctors admire your health results!