I write this article to portray a situation that occurred in the National Health Service in Portugal. I make this reference because what I am about to tell you is based on real facts.
In the north of the country, at the end of the afternoon, the patient started to have an abdominal pain, which diminished at that time. The situation did not ease and, about an hour later, the abdominal pain was so intense that it did not even allow him to drive to the hospital. The pain had no position of relief, it was the most intense pain he had ever felt.
Contacted 112, which was answered in about 1 minute. They passed the call to an INEM operator, as it was a health situation. The situation was triaged, the location was recorded and the INEM operator informed: “I will send an ambulance to the location”. This call lasted about 2 minutes.
The patient waited at the scene, sitting in the car, trying to find the best position to withstand the pain, which was clearly impossible. The ambulance arrived at the scene in about 10 minutes. The situation was explained to the firefighters, who measured the oxygen saturation in the blood, the blood pressure and the heart rate.
They then left for the Centro Hospitalar Universitário de São João. The trip was short, about 10 minutes.
He entered the emergency room, accompanied by the firefighters who took care of his registration. Then he went to wait for triage.
He was sorted, within minutes, and an orange bracelet was placed on him.
They immediately asked an operational assistant to take him to the Observation Service (SO), where he was installed in a chair.
I was not familiar with the hospital's emergencies, but it was possible to observe the existence of excellent quality facilities, very clean, security guards at the entrance, without any stretchers in the corridors and without patients piled up in the waiting room.
In the OR, sitting in chair number 13, he waited for about 10 to 15 minutes until a young doctor came to him. She performed the clinical history of the situation, obtained all the personal history and did the objective examination. He asked about drug allergies twice and took notes. He informed the patient of the diagnostic hypotheses he was considering, the medication he was going to prescribe for pain and also that he was going to ask for blood and urine tests and a renal ultrasound.
Soon after, a nurse arrives who places a catheter in the vein and starts the pain medication. He confirms the identification properly and asks again about drug allergies.
The medication relieved the complaints, the analyzes were taken and, shortly afterwards, they took him to radiology.
He waited, a little while, and the renal ultrasound was performed. The ultrasound confirmed the diagnosis of a kidney stone, which was currently in the ureter (the channel that connects the kidney to the bladder), hence the intense pain.
He was accompanied by the operational assistant to the same chair where he had been previously. Some time later, the doctor came again to report that the stone had been detected in the ureter, confirming that it was renal colic and that, in the analyzes, there was a worsening of renal function.
The doctor had computerized access to the patient's file at the hospital where she resided. She also confirmed that there was a dilation in the kidney calyx and that it was advisable to be evaluated by urology.
Some time later, two urologists come to discuss the clinical situation with the patient. They explained the situation and mentioned that, weighing the risks and benefits, it would not be necessary to carry out an immediate surgical intervention.
They informed that he would be medicated with an anti-inflammatory, with another medication to facilitate the expulsion of the kidney stone and medication for pain. They also mentioned that it would be necessary to carry out analyzes and a new ultrasound the following week and that there could be some complaints until the stone was expelled. If this did not happen, in about two to three weeks, surgery would then be considered.
Shortly afterwards, they handed over a copy of the analyzes and exams, as well as the prescriptions and explained how to take the medication.
The nurse subsequently removed the catheter. Naively, the patient thought he could leave.
The OR doctor immediately said: “Wait a bit, you have to get the discharge note”. She waited a little longer and they handed her the discharge note.
They gave us the directions to leave and, as I was about to leave, a security guard said: “Before leaving, you have to stop by the secretariat”. He went to the secretariat, they verified that he had the discharge note with him and that he had been discharged by the doctor in the computer system. Only then was he allowed to leave.
He left the hospital, crossed the street and saw a pharmacy open 24 hours a day. You can buy the prescribed medication there.
Here is an account of a situation of an SNS user in Portugal, in which everything went fantastically.
It was possible to highlight the high quality of care, the safety for users at various levels, the fantastic appearance of the facilities, the organization of the service, the absence of stretchers in the corridors, in short, a hospital with a top level of care in any part of the world.
This is on SNS in Portugal! Yes, this is a luxury service, but not a luxury private clinic! Just a hospital that bets on quality!
In some areas of the country, it seems unbelievable that this is the description of the SNS. However, if it is possible here, in the rest of the country it will also be possible! Have the will and, above all, the ability to do so! Betting on quality is a winning bet!
Put yourself in the shoes of a patient like this one. Let the administrations and health professionals focus on providing the best conditions for SNS users, focusing on the quality of the service.
I repeat: This is the SNS in Portugal, so it is possible and this quality should be the goal!
Let us not be hypocrites, nor try to deceive, with mediocrity, those who will not be easily deceived.
The Algarve also deserves this quality!! It's possible on SNS!
Author Nuno Marques is a cardiologist and Associate Professor at the Faculty of Medicine and Biomedical Sciences at the University of Algarve
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