Notes from A Doctor’s Waiting Room in Barcelona
On eleven years as a patient of Catalonia's primary care system
1
Something different today: my experience of primary health care in the nearly eleven years I’ve lived in Barcelona, including one occasion when I turned up convinced I was having a stroke. I’m writing about this because the UK NHS is a continual source of anxiety to British friends and relatives, and because it seems like a better option than one of my usual topics, given how awful everything is.
2.
There’s no Spanish national health service as such. What there is is a national law that establishes universal public health care as a right. It also gives Spain’s 17 Autonomous Communities a wide degree of scope in how to implement it. Your experience will vary depending on which one of them you live in.
3
How is it all financed? A mystery, wrapped in an enigma which forms part of the Schleswig Holstein question that is the financing of the Autonomous Communities in general. Suffice it to say that it’s free at the point of use for everyone registered with the national social security system. Which is basically everyone.
4
Primary care in Catalonia is run by the Catalan Health Institute, a Catalan public body. It has 280 primary care centres throughout the region. The range of services they offer varies, many are open 24/7, some aren’t, but one of them will be your first port of call when you get sick and it’s not an emergency that requires you to go straight to the hospital.
5.
Okay, you have a pain in your stomach that’s been bothering you and you don’t want to wait to see your doctor. What do you do? You show up and take a number from the ticket machine. When your number gets called you approach the counter, get your health care card scanned, and the staff member will say “Qué te pasa?” (What’s wrong with you?)
This initial enquiry may be barked as much as spoken and you’ll have to give a summary of your symptoms in earshot of other people. This is public health care after all. The staff member smashes your details into her computer and tells you where you should go and wait.
After a while your name is called (better listen carefully with a name like mine), you see a doctor and job done. I’ve not kept a record but in all this time I doubt this whole process has ever taken more than two hours, often a lot less.
Note that this is a doctor, not your doctor. Still, he or she can see your clinical record.
If the doctor has given you a prescription you can get it filled in any pharmacy in Catalonia by showing your card. They have the details as soon as the doctor enters them. The cost is heavily subsidised.
6.
What if you want to see your own doctor, the one assigned to you when you joined the system? She is the one who will have packed you off for blood and urine analysis then too. You can make an appointment to see your doctor in loads of ways but I use the Catalan health service app, you and your doctor can message on it too.
When I came here you could always get an appointment in two or three days but that has stretched out to a week or more now.
My doctor is firm, direct, very Catalan and I trust her completely.
It went like this the last time she sent me for blood and pee analysis a few months back
0800 at the health centre, security guard opens the main doors and says “No running!”. It’s open 24/7 if you need to see a doctor, but routine procedures are from 0800 to 2000.
I go up the stairs to where people with my postcode are assigned. Doors not open. Queue forms. 0810 doors open and nurse yells in Catalan “Everybody take a number, and wait to be called.” Someone asks if that applies to them too and gets told everybody means everybody. I get A13.
My number comes up, I approach the counter and put my health care card under the scanner, the woman asks me to say my name, I do, but as often happens, she struggles to associate how I say it with the letters in front of her so I repeat it phonetically, as if it were Spanish.
She prints out details of the tests required and gives them to me with a plastic number card and tells me where to wait. I sit and wait. I’m number 7. After a while a nurse appears and shouts in Catalan if anyone is pregnant or has mobility issues. No one among the 30 or so of us does.
She calls my number and again checks my name and if I’ve fasted. Again in Catalan, I confirm both. She shouts in Spanish to someone that they are walking down the wrong corridor and would they please come back. She takes the urine sample and tells me in Spanish where to wait; she calls me “cariño.”
A nurse gestures me into the room. Her colleague is on the phone speaking Catalan, while she and her other colleague talk to me in Spanish and chat about their schedules as they take my blood. When they’re done, their phone call colleague tells me when the results will be ready.
Total amount of time from entering to leaving the building about 45 minutes. Results online the day after.
7.
I once had what I was sure was the beginnings of a stroke as the left side of my face was sagging. I went to the primary care centre and in the circumstance thought it would be okay to jump the queue. As the evidence of what was wrong was visible to the naked eye the staff didn’t object and sent me straight to a doctor. She got me to do a range of movements, look at a pen as she moved it, asked me a bunch of questions and so on before deciding I had Bell’s Palsy not a stroke and packing me off to see another doctor.
Her manner was very brisk. Again, it’s frontline public health, your feelings are a secondary concern, sick people are waiting.
The second doctor I had to wait a bit to see. She did some more assessment before sending me on my way with a prescription. My face was back to normal in a few weeks.
8.
Apart from that the only medical drama I have had are a couple of MRIs and a CT scan, all done in the public system within a few weeks of them being ordered.
I have a monthly prescription for a couple of issues, the cost is roughly equivalent to a fancy coffee.
9.
People here complain endlessly about the primary care system. It has completely collapsed they say, “What are they doing with our money?” they ask.
I’ve found it entirely satisfactory and amuse myself by telling them that in Ireland only about half the population has free access to GPs and the rest pay 40 to 60 euros per visit. I’m sometimes told I must be joking as Ireland is a rich and successful country, not like poor and backward Spain