OF FAMILY DOCTORS AND HEALTH CENTRES

The first time, many years ago, that I was told to see my médico de cabecera, I responded by saying that I thought I had a chest infection and didn’t need to see a head specialist. My subsequent blushes ensured that I had learned that médico de cabecera is the Spanish equivalent of GP or family doctor. In most towns this doctor now works in the local health centre (Centro de Salud) but in a few smaller villages he is still to be found in his own surgery (consulta or more correctly consultorio). The hours and detailed working vary from place to place and the only way to be sure how your local health centre works is to go along and find out. If you are a resident or a long stay holidaymaker, I seriously recommend that you do this before you need its services – when you’re ill you won’t want the extra stress of trying to find out how to get to see the doctor.

Whether you are a visitor or a resident the local doctor should be your starting point when seeking treatment for any illness which is serious enough to require medical supervision without being so urgent as to necessitate emergency hospital attention. Usually it is possible to make an appointment in advance, either by phone or in person. If you choose to phone for an appointment you will be asked for your medical history number and/or your Social Security affiliation number; if you do so outside of normal Health Centre hours your call will be dealt with by the central appointments service  (in Sevilla, I suppose) which is a long-winded process, but probably no more time consuming than dialling and re-dialling a busy health centre. Do make absolutely certain about the date and time of appointment offered over the phone, especially from the central service, as this could be a few days away. It is becoming increasingly rare these days, but you may still find in the smaller villages that your GP operates the simple “sit and wait your turn” approach – in which case the all important question on entering is “¿Quién es el último?’’ (Who’s last in the queue?) and then to remember who it was that admitted to being the last person before you! It is also still the case in some health centres that you will find a ticket dispenser in the waiting room (after the style of a supermarket butchery department) which gives at least a theoretical sequence to those waiting to be seen. I say theoretical quite deliberately; you might well collect ticket number 83 and be pleasantly surprised to find only three people waiting, but as the morning unfurls a succession of people, with the easy skill of much practice, return from their shopping or other expeditions to wait but a few minutes before their number is called! Eventually number 83 will be called, but don’t forget that breakfast in Spain is taken mid-morning and so the doctor will probably disappear at some stage for his coffee and toast.

An increasing number of Spanish doctors have a working knowledge of English, but it is best not to take this for granted, for just as French is the principal foreign language taught in English schools, so was it in Spain until quite recently. Whilst most doctors can read English quite well, they often have almost no experience of either speaking it or listening to it, and their embarrassment at this often ensures that they won’t risk a single word of English with you. A friend of mine was recently told off by medical staff for not having learned Spanish, but that is somewhat unusual.

If you are a visitor from an EEC country there is a reciprocal agreement between your home government and the Spanish government entitling you to public health service treatment in Spain. You will be required to present your EHIC (European Health Insurance Card, which replaces the old form E111) which moves the responsibility for payment from you to your government. More about this in a later article when we look at the minefield of documentation and paperwork.

As a visitor from a country outside of the EEC you are in a different position with regard to the financial responsibility for the treatment, but you are still most definitely entitled to access to the public health system. Check with your embassy in Spain – there might be an interstate agreement in place, otherwise you will be relying on your health insurance to cover all your medical costs. So read the small print to see whether you are covered only by certain clinics in the private sector or if the insurer will accept invoices from the public health service. This is seriously important; I know of one man who was presented with a bill for many thousands of euros because his insurance cover did not extend to the public system and he needed comprehensive emergency treatment after a road traffic accident.

La cita or appointment will most probably be conducted in Spanish, so if your Spanish is weak, it is as well to take with you an interpreter, or at least a good phrase book. At this stage you will no doubt discover if your condition is easily diagnosable/ treatable or not. If it is, you’ll be given the all-clear or follow-up treatment after an appropriate interval. Again, check the workings of your own particular health centre; the doctor might say come back in eight days (that means, in a week!) But it is possible you will have to make an appointment with the receptionist before leaving.

The receta or prescription will either be a private one or a health service one according to which of the various regimes you belong to. The specific type of health service prescription you receive – and the amount you pay for the medication – will depend on whether you are a pensioner or not. And this brings us back to the chemist or farmacia. A word of caution: the pharmacist will give you the prescribed medicines and take your money, and that’s it. Unlike the situation in Britain, he will not affix a label with your name and the dosage details – so do make sure that you have understood clearly from the doctor how you are to take the medication.

If your condition requires specialist investigation or treatment your médico de cabecera will refer you to either a hospital or a “national health clinic” (ambulatorio). The specific division of responsibilities between these two establishments varies from place to place, but the Ambulatorio is essentially an outpatients department. So in next month’s issue we will look together at the unfamiliar ground of a hospital referral – till then, stay healthy!