By Cellina Polifrone Occelli

I am immensely grateful for the opportunity to experience Spanish Primary Healthcare and to have been embraced by the Spanish medical community. 

The structure of my placement consisted of day placements (8:30am-3pm) sitting in with family medicine doctors at several urban primary healthcare centers including; Centro de Salud San Pablo, Universitas, Delicias Sur, Actur Sur. 

I also experienced the rural primary healthcare system, travelling with family medicine residents to the towns of Cariñena and Tauste. 

My supervisor Dr Pilar Astier, encouraged me to seek placements with other medical professionals, hence I also spent days with the physiotherapist, dentist, pediatricians, nurses, and the Matrona (who is a nurse specialist in woman’s health. 

I am immensely grateful for her support and that of others including Dra Nuria Val and Dra Marta Sanchez who invested their energy into my learning and personal development.  

There exist critical differences between the Australian and Spanish healthcare system. In Spanish primary care, only 6 minutes are allocated to each consult, requiring interactions to be rapid and efficient –only permitting several key questions to be asked of each patient. 

The consulting style used by the doctors is extremely direct and relatively interrogative. The patient is often interrupted within the first 10 seconds of speaking and I have noticed the use of a more patronizing style of consultation with less focus on shared decision making - than I have seen in Bega thus far. 

I do not believe the allocated consultation time facilitates the development of a trusting relationship between the healthcare provider and patient. However, unlike Australian healthcare, the patient can return with ease the next day to demand a consult if their condition has not improved. 

In Spain, primary healthcare is free and each patient within the population is allocated a doctor and nurse with whom they can seek an appointment. A doctor is typically allocated up to 1700 patients in their ‘Cupo,’ and they often see anywhere from 40-60 patients a day. 

The cost of medication directly depends on the patient's salary with retirees having free medication, however wealthy Spaniards do not tend to pay more than 10euro per medication. 

All specialists are accessible within the public system, and patients do not need to pay to visit a specialist, however the appointment must be sought through a family medicine doctor. 

I gave several presentations to the Spanish medical residents about how the Australian Healthcare system functions (Medicare, Pharmaceutical Benefits Scheme, Medicare Benefits Schedule) and they were astounded that patients can pay $30 per month for each medication required – they were also shocked that people often had to pay >$100 for out of pocket specialty expenses –  and made comparisons to the United States of America Healthcare System. 

Interestingly, Spanish Medical Education has an academic focus and during their time as a medical student they are simply expected to observe – attendance was expected but they do not have a portfolio to complete. They only have ONE OSCE style exam at the end of their 6yrs at medical school.

I experienced an unforgettable moment on placement owing to the fact that in Spain paramedics do not exist.  Ambulances usually have the technician (the driver) and sometimes there will be a nurse and primary medicine doctor (or registrar) also sitting in the back to assist. 

When you call an ambulance in Spain you need to specify if you require a doctor. On my first day in Cariñena, it had snowed for the first time in 3 years in Zaragoza and a crash involving 7 cars had happened on the local highway. We drove (2 family medicine doctors, 1 resident and 1 medical student) through the stopped traffic, beeping our horns, to reach the crash site to assess the patients prior to going to the hospital. 

We were greeted by the ambulance technicians, one of which asked me if I could sew a wound on the patients so they would not need to go to hospital. As the patient had hit their head in the crash, we sent her and all the other wounded patients to hospital.