Health care (again)

Yep. It's a thing we need. (82)

As we’ve mentioned before, when we first arrived, everything was overwhelming. This was particularly the case with health care. We had immediate challenges with how to get prescriptions (and refills from doctors when you can’t contact them outside of a making another appointment), some long-term conditions that needed management, and a few short-term injuries. We stuck it out as long as we could, but finally sought out the services of a company that helps immigrants manage the health care system.

Some of you may use such a company. We would love to hear your experiences.

We’re at the 8 month mark now with that company. So how’s it been going?

Honestly, we’ve had some successes, but in large part we have not gotten out of the program what we’ve hoped for. Our goal is to not have to rely on such services in the future. Many of our questions are of the “How does this typically work” type and many of the answers are of the “We’ll make the appointment for you” variety. That’s only half helpful. To be honest, we have not expressed our goal to become independent to them. But, it would be nice if they would answer the question we ask. We’ll try to be more directive. We understand it’s not in their best interest to train us out of needing them, but in our case, that’s what we’re paying them for. It’s not fair if we don’t express that to them.

They were helpful in setting up our first public doctor appointment. We needed this appointment in order to establish care in the public system. Being in the public system brings the cost of our medications to almost squat. Amy has decided to go with a public pulmonologist to try out using a public system specialist. This company has set up all of the tests she needs to have done prior to her pulmonology appointment. We’re not sure how we would have done that ourselves as there was very little English spoken at the reception area of public clinic we went to. Apparently after she has the tests, she can then make the appointment for the pulmonologist herself by returning in person to the clinic. Where there's zero English. That'll be fun. If it goes awry, we know we can call on our service and they will fix it.

What they haven’t been very helpful at is explaining how certain aspects of the Portuguese medical system work - like prescriptions, or contacting your doctor. This is not the United States; certain things are very different, and can feel very harsh. For example, Scott had a routine colonoscopy in December. In the US, Amy got accustomed to being allowed back to the recovery area as soon as he awoke from the anesthesia. Here, she had to stay in the waiting room with no information on his condition until Scott staggered out, dressed and ready to be taken home. We would have appreciated a heads-up that the system worked so differently.

The other area we had hoped for help in was being connected to fluent, English speaking practitioners who do not act as though the doctor is God and the patient should not question their pronouncements, an attitude we have encountered more here than in the United States. Instead we have found doctors on our own, either through luck or trial and error, who are great. We have a fabulous podiatrist that we’ve recommended to two other people to absolute raves. The endocrinologist we’ve stumbled on is amazing.

And now … Amy here

I’d like to tell you of my experiences with one of my needs.

I’ve had jaw problems since I was 2. I won’t go into the entire history, but my first experience was when I was 4. I’ve had 4 surgeries. I don’t want a 5th.

In St. Louis, my bite worsened. And, I thought it might be affecting my chronic migraines. Yeah, I have those as well. I went to three orthodontists there who specialize in TMJ. All were hot to trot and certain they could fix it. I went with the one that had the best plan. Then we got this crazy idea to move to Portugal. Now, I have braces but no one to care for them. Since we arrived in June, I have been searching for an orthodontist to pick up where I left off in the US and I’ve visited several.

The first person was … different. Fancy office. Big sell. Wanted to remove my braces immediately, put on a new appliance that would definitely cause constant migraines, and then put the braces back on. We left.

#2 orthodontist said, oh, I don’t do braces. I can get you in to see my orthodontist who does. (Orthodontist who doesn’t do braces. That’s … new.) Meanwhile see this physiotherapist. I did. She was a disaster.

#3, recommended by #2, said, hm, um, I don’t know. I am unsure if I can do this.

#4 said I want you to have a consult with a surgeon (NOOOOO!!!!). I thought about it. Weighed what #3 and #4 said. And said ok.

Surgeon (Prof. Dr. David Angelo of IPFace) was amazing. He watched me talk and eat (gave me a dried apricot - yummy!) to see the function of my mouth. Sensible, smart things that no one has ever done and I’ve been through many surgeons. He came up with a plan that made sense. So I said yes.

Instead of a big procedure where they rip me open and move everything, he’s using a variety of cutting-edge techniques, many of which he’s invented. He showed us a replacement jaw joint. That’s the big thing if you go for jaw surgery now in the US. He went to a symposium in US (he’s the first doctor in Portugal invited to join the US Temporomandibular Joint Surgeon Society) where this replacement was described. (Jaw replacement is major difficulty for the patient.) At end he asked, why don’t you just do these smaller procedures that are proven to work? Afterwards, a doctor come up to him and said that a replacement nets the doc $50K. If you get $50K, maybe you stop thinking about the small procedures. He’s still shaking his head over it.

At my first procedure, he was being observed by two doctors from Italy. They said he is the best in Europe.

At my second procedure, he was being observed by a doctor from Mexico. Who said he is the best in the world.

What’s next? The universe, or just the solar system?

This is an example of Portuguese health care. It can be weird. It can be confusing. Or frustrating. Or it can be magic and make you feel like this is the reason you moved to Portugal.

That’s all for now.

Love from Lisbon,

Amy & Scott