Rute Ferreira

Did you know that there are around 800,000 people with COPD in Portugal and that 7 out of 10 don’t even know they have the disease ? It’s just that the signs often seem like everyday tiredness: a persistent cough, shortness of breath when climbing stairs, a chest that tightens in the cold. The body resists until breathing is no longer so simple. And that’s when COPD is discovered – an invisible but real disease that needs to be recognized before it progresses in silence. Key points of the article COPD is a chronic and progressive respiratory disease that affects around 800,000 people in Portugal Persistent coughing, shortness of breath and tiredness are common but often overlooked symptoms The main cause is smoking, although exposure to dust, fumes and genetic factors can also contribute Diagnosis is made with spirometry, but 70% of cases remain unidentified There is no cure, but it can be stopped with proper treatment, respiratory rehabilitation and lifestyle changes Prevention, early diagnosis and follow-up are essential for improving quality of life. COPD: what is it? It’s not a single disease, but rather an umbrella that combines two chronic respiratory conditions: chronic bronchitis and pulmonary emphysema. Both cause obstruction of the airways, making it difficult for air to pass through and making breathing a real effort. The obstruction doesn’t go away on its own and gets worse over time, especially if it isn’t diagnosed and monitored. But it’s not all bad news: with the right treatment and a few lifestyle changes, it’s possible to live better with COPD. Causes and risk factors The big villain has a familiar name: tobacco. Smoking for years is the main cause of COPD. But there are other factors to take into account: Exposure to dust, fumes and chemicals, especially in the workplace Air pollution, especially in urban areas Smoke from fireplaces, common in poorly ventilated houses in rural areas Common respiratory infections in childhood Family history or genetic deficiency (such as the rare but relevant absence of the alpha-1-antitrypsin protein). It’s important to emphasize: not all smokers get COPD, but the longer and more you smoke, the greater the risk. And, of course, those who already have asthma or other respiratory diseases are even more vulnerable. COPD: symptoms COPD comes on slowly, often silently. For this reason, the first symptoms are easily overlooked. But there are signs to look out for: Chronic, dry or expectorating cough (often associated with smoking and therefore ignored) Wheezing (a high-pitched sound when breathing) A feeling of tightness in the chest Shortness of breath (dyspnea), first on exertion, then even at rest Constant tiredness and limited daily activities In more advanced stages: anxiety, weight loss, frequent respiratory infections and even bluish fingers (a sign of lack of oxygen). How is the diagnosis made? The progression is slow but continuous, which is why identifying the problem early makes all the difference. The most commonly used test to confirm the diagnosis is spirometry – a simple but essential test that measures how much air the lungs can breathe in and out. It can also be complemented with: X-ray or chest CT scan (to detect emphysema and exclude other diseases) Blood tests and arterial blood gases (to measure oxygen and carbon dioxide levels) Evaluation of genetic deficiency of alpha-1-antitrypsin in suspected cases. If there is a persistent cough, expectoration, tiredness and a history of smoking or exposure to irritants, it is always worth making an appointment with a pulmonologist. COPD in Portugal: the weight of the numbers and the experts’ warning Despite affecting around 800,000 people in Portugal, COPD remains largely unknown to the population. It is estimated that 70% of cases go undiagnosed, which means that many patients do not receive adequate follow-up or treatment. And this has serious consequences: in 2022 alone, respiratory diseases caused more than 12,000 deaths in the country, and experts warn that they could become the leading cause of death by the end of the decade. This scenario has led to the creation of various awareness and research initiatives, such as the Respiratory Health Forum 2025 which advocates an integrated response to the respiratory disease crisis, and the new national study promoted by the Portuguese Society of Pneumology and AstraZeneca Portugal, which will help outline the clinical and therapeutic profile of COPD patients in Portugal. The aim is clear: to improve early diagnosis, personalize care and guarantee a fairer and more accessible response to the population. COPD GOLD: what is it and how is it measured? The GOLD classification (Global Initiative for Chronic Obstructive Lung Disease) is used internationally to assess the degree of obstruction and guide treatment, and helps doctors choose the most appropriate treatment plan for each patient. It is based on the results of spirometry and divides COPD into four stages: GOLD 1 (Mild): mild symptoms, little impact on daily life GOLD 2 (Moderate): more shortness of breath, limitations to physical exertion GOLD 3 (Severe): greater functional limitation and risk of exacerbations GOLD 4 (Very severe): constant symptoms and risk of respiratory failure. COPD treatment COPD has no cure, but it does have treatment. And the sooner it starts, the greater the benefits. Key measures Stop smoking. It’s the most important step and the only one that can halt the progression of the disease; Avoid polluted environments or those with toxic fumes Annual flu and pneumococcal vaccination to prevent infections Respiratory physiotherapy and pulmonary rehabilitation, which help restore physical and respiratory capacity. Medicines available Bronchodilators (short or long-acting inhalers): help open up the airways and make breathing easier Inhaled corticosteroids, which reduce inflammation and prevent seizures Antibiotics, when there are respiratory infections Oxygen therapy, in cases where oxygen levels are low Non-invasive ventilation (with a mask), in more serious situations. In more advanced cases, lung volume reduction surgery or, ultimately, lung transplantation may be considered. How long does a COPD patient live? Rather than counting the years, the important thing is to make the days better. How long you live

Did you know that more than 200,000 people suffer from dementia in Portugal? To talk about dementia is to talk about a difficult journey, both for those who live with the disease and for those who care for them. Little by little, memory begins to fail, behavior changes and everyday life is no longer the same. It’s hard, confusing and sometimes even unfair. But knowing what to expect can make all the difference. Because even when everything seems to be falling apart, there are ways of caring with more calm, more presence and less fear. Key points of the article Dementia is a set of symptoms that affects memory, reasoning and behavior and worsens over time There are several types of dementia, the most common of which are: Alzheimer’s, vascular dementia, dementia with Lewy bodies and frontotemporal dementia Each type of dementia has different manifestations, but they generally evolve through three stages: early, moderate and advanced Identifying the first signs and knowing the stages helps to better prepare support for people with dementia Early diagnosis, cognitive stimuli and a supportive environment can slow down the progression of the disease Supporting someone with dementia requires constant adaptation, empathy and often specialized support. What is dementia? Dementia is not a specific disease, but a term used to describe a set of symptoms that affect the brain. We’re talking about progressive memory loss, difficulty thinking, communicating, making decisions or even recognizing familiar faces and places. These symptoms interfere with the person’s autonomy and gradually make everyday life more challenging. In Portugal, it is estimated that dementia cases could double by 2080, exceeding 450,000 cases (almost 5% of the population) according to a study by CIDIFAD. This increase is directly linked to the ageing of the population, making it even more urgent to focus on prevention, early diagnosis and support for families. Against this backdrop, it’s important to learn more about the disease and understand how it manifests itself. There are various types of dementia, but they all have one thing in common: they are progressive diseases. This means that the symptoms begin mildly and worsen over time. What are the first signs of dementia? The first signs of dementia can be subtle – so subtle that they are often mistaken for “things of age” or simple tiredness. But there are behaviors and forgetfulness that, when they become frequent, deserve attention. Some of the most common signs include: Recent forgetfulness, such as repeating questions or forgetting where you put objects Difficulty finding words or following a conversation Disorientation in time and space, even in familiar places Changes in mood or behavior, such as irritability, apathy or unjustified distrust Less ability to plan or make simple decisions, such as preparing a meal or paying bills. These signs do not in themselves mean that dementia is involved, but they are an important warning to seek medical evaluation. The sooner the diagnosis is made, the sooner action can be taken to slow down the progression and ensure a better quality of life. For more information and support, you can consult Alzheimer Portugal, one of the main national references in the field. The four most common types of dementia Not all dementias are the same. While some begin with seemingly harmless forgetfulness, others are manifested by personality changes or episodes of hallucination. Knowing the different types of dementia is an important step towards a better understanding of what is happening to the person living with the disease… and even to avoid hasty judgments. Alzheimer’s disease It is the most common form of dementia. It mainly affects memory and often begins with seemingly harmless forgetfulness. Over time, it compromises language, reasoning and the ability to recognize people or places. Vascular dementia Caused by circulation problems in the brain, such as strokes. The symptoms depend on the area affected and the progression can be “jumpy”, meaning that the person can suddenly get worse after a new vascular episode. How long you live with vascular dementia depends on the severity of previous strokes, comorbidities and how quickly cognitive decline sets in. On average, after diagnosis, life expectancy can vary between 5 and 10 years, but with large variations between people. Dementia with Lewy bodies It is characterized by fluctuations in attention, visual hallucinations, tremors and muscle rigidity. It can be confused with Parkinson’s, but cognitive decline appears earlier. Memory may even be preserved in the early stages. Frontotemporal dementia It affects the frontal and temporal regions of the brain, which means that the first signs are not always linked to memory. Instead, the earliest signs are changes in behavior, impulsiveness, difficulty communicating or even loss of empathy. This was the type of dementia that actor Bruce Willis was diagnosed with, a case that brought greater visibility to the disease and showed the world the real impact it can have, even on people who are still relatively young. Initial phase (mild) At this stage, the signs can go unnoticed or be mistaken for natural aging. The person remains relatively autonomous, but subtle changes begin to be noticed. Which is common at this stage: Frequent forgetfulness, especially of recent events Difficulty finding the right words or following a conversation Disorientation in unfamiliar places Mood swings or apathy Loss of initiative or interest in hobbies Small mistakes when handling money or simple household tasks. Intermediate phase (moderate) Here, the symptoms become more evident and begin to interfere with daily life. The person begins to need help with basic tasks and the loss of autonomy is more noticeable. At this stage, they may appear: Constant forgetfulness, even of important events Disorientation in time and space Difficulty getting dressed or preparing meals Confusion with faces of family or friends Behavioral changes (aggression, distrust, repetition of words) Language and comprehension problems Onset of urinary incontinence. Advanced stage (severe) This is the most difficult and painful phase. The person loses most of their cognitive and physical abilities. They become totally dependent for all basic activities and may

Becoming quieter, losing interest in the little things or withdrawing from the people you care about? At first glance, it may seem like an “age thing”. But it’s often more than that. Depression in the elderly does exist – and you don’t always see it at first. The signs can be discreet, confusing, even silent. But the impact is real and profound. So often mistaken for “normal” aging, it ends up being hidden. But it shouldn’t. Because suffering is real and treating depression can restore meaning, pleasure and even hope to those who thought their best days were behind them. Key points of the article Depression is not a natural consequence of ageing and can go unnoticed in the elderly Symptoms don’t always include sadness – they can appear as physical pain, apathy or isolation Factors such as loneliness, chronic illness and loss of autonomy increase the risk Early diagnosis and appropriate treatment (medication, psychotherapy and social support) significantly improve quality of life Prevention involves promoting an active, healthy lifestyle with a connection to the community There are helplines available for those who need help or guidance. What is depression in old age anyway? Depression is not just a phase of sadness, nor a sign of weakness. It is a profound emotional disorder that affects the way a person thinks, feels and lives. And when it appears in old age, it can be even more difficult to recognize, both for those who feel it and for those around them. Often, it doesn’t manifest itself with tears or sad words, but rather with prolonged silences, causeless pain, constant tiredness or an apathy that takes over every day. Instead of saying they’re sad, many elderly people just say they’re tired, in pain or that they don’t have the patience for anything anymore. This is why so many symptoms end up being mistaken for “normal” aging – and go unnoticed. Which countries suffer most from depression? A DREES study, based on the 2019 European Health Interview Survey (EHIS), revealed that France had, before the pandemic, the highest rate of depression in Europe, with around 11% of the population affected. Portugal had one of the highest rates of chronic depression, according to Eurostat, with 12.2% of the population reporting symptoms, surpassed only by Slovenia. More recently, an OECD report from 2023 reinforces that Portugal is among the countries with the highest levels of anxiety and depression in the European Union. Why does depression affect so many elderly people? The truth is that ageing brings profound changes: the loss of friends or life partners, retirement, social isolation, the onset of chronic illnesses or the feeling that you no longer “belong” in the active world. All of this can profoundly affect mental health. In Portugal, according to data analyzed up to 2023, studies indicate that around 15% of the elderly may have depressive symptoms. And this figure rises to 30% in institutionalized environments, such as nursing homes or hospitals. It is also more common among older women and among elderly people with multiple health problems. But it’s not inevitable. And it must not be ignored. Symptoms of depression in the elderly: what to look out for The signs are not always the classic ones and there are also cases in which depression is confused with dementia, especially when there is forgetfulness, slow thinking and disorientation. Here are some of the most common symptoms in old age: Social isolation and lack of interest in being with other people Constant fatigue or lack of energy Physical pain with no medical explanation Insomnia or oversleeping Significant weight loss or weight gain Difficulty concentrating or making decisions Feelings of guilt or worthlessness Recurring thoughts about death. What are the main risk factors? Depression in old age rarely has a single cause. It is often born out of the accumulation of losses, changes and silences. The body weakens, loneliness grows, life slows down. These are biological, psychological and social factors that together make the days more difficult to cope with. In the elderly, the most common are: Loss of spouse or friends Retire and lose purpose or routine Living alone or with little family support Economic problems or difficulties in maintaining autonomy Chronic diseases such as diabetes, stroke or heart disease Prolonged use of certain medications Previous history of depression. How to diagnose and treat depression in the elderly? The good news? Yes, depression can be treated, even in the elderly. The first step is to recognize the symptoms and seek medical help. Diagnosis is clinical, made by assessing the symptoms and sometimes with the help of validated scales for the elderly population. Then, the treatment may include: Antidepressant medication, always adjusted to age and other health conditions Psychotherapy, namely cognitive-behavioral therapy, which has shown good results Regular physical activity, which helps release hormones linked to well-being Socialization and participation in activities, to break isolation Family and community intervention, essential to create a supportive and safe environment. In more severe or resistant cases, therapies such as electroconvulsive therapy (ECT) or transcranial magnetic stimulation may be considered. Prevention: small changes that make a difference It is possible to prevent (or at least reduce) the risk of depression in old age. How? Through healthy habits and routines: Encourage regular physical exercise, even light exercise Maintaining a balanced diet Create routines that include moments of pleasure, conviviality and purpose Encouraging participation in cultural, recreational or volunteer activities Regularly monitor physical and mental health. The most important thing? Being present. Listening. Validating feelings. And acting on warning signs. How to help an elderly person with depression? Helping an elderly person with depression starts with something simple but essential: being there. Often, the greatest gesture is to listen without judging, to show that you are there, even when words are lacking. But there’s more you can (and should) do. Take the signs seriously. Mood swings, isolation, constant physical complaints or loss of interest in activities are warnings that should not be ignored Encourage people to

As the years go by, something happens almost invisibly in the human body: the muscles start to lose mass and strength. This condition has a name – sarcopenia – and affects millions of people around the world, especially from the age of 60. But there’s a lot you can do to stop it and even reverse it. And it all starts with getting to know it better. Key points of the article Sarcopenia is the progressive loss of muscle mass and strength, more common after the age of 60 It can affect mobility, balance and the ability to perform everyday tasks Sedentary lifestyles, poor diet and chronic diseases are factors that contribute to its development It is possible to halt or even reverse sarcopenia with regular exercise and a high-protein diet Supplements such as whey protein, vitamin D or creatine can be useful in some cases Maintaining an active lifestyle is the best way to prevent this condition and preserve autonomy over the years. What is sarcopenia? It is a progressive disease characterized by the loss of muscle mass, strength and physical performance. Although it is more common in people over the age of 60, the process begins much earlier: around the age of 30 or 40, the body is already slowly starting to lose muscle. From the age of 65, this loss tends to accelerate. In practice, what happens is that your muscles get smaller and weaker. And this doesn’t just mean that you lose the strength to open a bottle or carry shopping bags. Sarcopenia affects mobility, balance and the ability to perform basic everyday tasks such as getting up from a chair, climbing stairs or walking safely. What are the symptoms? The signs of sarcopenia directly affect a person’s autonomy and can lead to loss of independence and, in more serious cases, the risk of falls, fractures and hospitalization. They can appear discreetly, but become increasingly evident over time. The most common include: Constant muscle weakness Faster tiredness during normal activities Difficulty climbing stairs or getting up from a chair Slower gait and less physical endurance Loss of balance and frequent falls Visible reduction in muscle volume, especially in the arms and legs. What causes sarcopenia? Aging is the main culprit, but not the only one. Several factors contribute to the development of sarcopenia: Sedentary lifestyle: lack of physical activity is one of the biggest allies of muscle loss Poor diet: a diet low in protein and essential nutrients weakens muscles Chronic diseases: such as diabetes, kidney failure, arthritis, cancer or COPD (chronic obstructive pulmonary disease) Chronic inflammation: the body in “constant alert mode” can degrade muscle tissue Hormonal changes: such as a drop in testosterone or growth hormone Obesity: especially when associated with sarcopenia (sarcopenic obesity), can aggravate the condition Immobilization: being bedridden for prolonged periods, even due to illness or recovery. How is it diagnosed? There is no single test to diagnose sarcopenia. Usually, symptoms are assessed using a simple questionnaire called the SARC-F, which measures how difficult it is to make basic everyday movements (getting up, walking, climbing stairs, etc.). Tests can then be carried out such as: Grip strength (measured with a hand-held dynamometer) Chair test (to see how many times the person can stand up without using their arms) Gait test (assessing walking speed) Body composition analyses, such as DEXA or BIA, which measure the amount of muscle in the body. What is the treatment for sarcopenia? The good news is that sarcopenia can be treated and even reversed, especially if it is detected in the early stages. The main strategies are simple lifestyle changes: 1. movement is essential Physical exercise is the most powerful weapon against sarcopenia. Ideally, you should do strength training (such as lifting weights, using elastic bands, doing squats) as well as aerobic exercise such as walking. Two to four sessions a week can make a difference. 2. Eating well is just as important as moving A balanced diet rich in quality proteins (meat, fish, eggs, legumes, dairy products) is essential for rebuilding and maintaining muscles. Over the years, the body needs more protein for the same effect, so it’s worth increasing your intake. 3. Supplements can help In some cases, it can be beneficial to include supplements such as: Whey protein Leucine (an amino acid that stimulates muscle synthesis) Vitamin D (especially if there is a deficit) Creatine (to increase strength and energy) Omega-3 (helps reduce inflammation) Collagen and magnesium, to support muscle tissue and joints. But beware: supplements should always be used under the guidance of a health professional. Sarcopenia or muscle atrophy: what’s the difference? Muscle atrophy is a more general term and means the loss of muscle mass for various reasons, which can happen at any age. Sarcopenia is a specific form of muscle atrophy associated with ageing and a decline in muscle function. How can sarcopenia be prevented? It is possible to grow old with strength, mobility and independence, and it all starts with small gestures in everyday life. Keeping your muscles active and well-nourished makes all the difference. A longitudinal study published in the journal Ageing International in 2025 analyzed data from the UK Biobank and concluded that regular moderate to vigorous physical activity significantly reduces the risk of developing sarcopenia in middle-aged adults. The study highlights that only light-intensity activities do not have the same protective effect. So here are some practical tips: Get moving every day, even if it’s just walking Do strength training adapted to age and physical condition Eat a diet rich in protein and nutrients Avoiding tobacco and alcohol in excess Sleep well and keep well hydrated See your doctor regularly. If sarcopenia or another health condition makes it difficult for you to get to appointments, exams or treatments, you ‘re not alone. Ambula offers a transportation service for non-emergency patients, with comfort, safety and support tailored to your needs. A simple and safe way to continue taking care of your health, even when your mobility

When Stephen Hawking was diagnosed with amyotrophic lateral sclerosis (ALS), he was told he would only have a few years to live. He lived more than 50. ALS, as it is also known, is a rare degenerative disease that affects the muscles and gradually takes away the ability to walk, talk, swallow or breathe. Join us to learn a little more about this condition. Key points of the article ALS (or ALS) is a rare and progressive degenerative neurological disease that affects the muscles and impairs functions such as walking, speaking or breathing Symptoms appear gradually and vary, but include muscle weakness, speech and swallowing difficulties, among others There is still no cure, but there are treatments that help slow down progression and improve quality of life Diagnosis is clinical and requires the exclusion of other diseases. Family support and monitoring by multidisciplinary teams are fundamental throughout the process Scientific research has seen promising advances, such as new genetic and immunological therapies and communication support technologies. What is ALS? It is a degenerative neurological disease that affects motor neurons, which are the nerve cells responsible for sending messages from the brain and spinal cord to the muscles. When these neurons stop working, the muscles lose their ability to contract properly and begin to weaken. Over time, functions as simple as walking, talking, swallowing or breathing become increasingly difficult. This is why ALS is considered a progressive degenerative disease; it worsens over time and increasingly affects a person’s autonomy. Difference between ALS and ALS ALS and ALS are, in practice, the same thing. The acronym ALS (Amyotrophic Lateral Sclerosis) is more commonly used internationally. In Portugal, the most common term is ALS – Amyotrophic Lateral Sclerosis. Both refer to the same neurological condition. Causes of ALS The truth is that we still don’t know for sure what causes ALS. In most cases, the disease appears without warning and without a family history. Only around 5 to 10% of cases have a genetic origin. Possible links with environmental factors such as exposure to toxins, smoking or even military service are being studied, but so far there is no clear explanation or identifiable cause in most cases. We know that it is more common in men, generally from the age of 60, and that its progression varies greatly from person to person. It is also estimated that there is a prevalence of three to five cases per 100,000 people. What are the first symptoms of ALS? The symptoms of ALS can begin subtly, but gain strength over time. The first signs usually appear in the hands, legs or speech. Although most people keep their mental abilities intact, some patients also develop associated forms of dementia. Some of the most common symptoms: Muscle weakness in the legs or arms Difficulty walking, holding objects or writing Muscle atrophy (muscles decreasing in volume) Frequent spasms and cramps Slurred speech or difficulty articulating words Difficulty swallowing Increased saliva Extreme tiredness Emotional or cognitive changes (in some cases). How can ALS be diagnosed? The diagnosis of ALS is clinical, which means that it depends on the assessment of symptoms and the exclusion of other diseases. There is no single test that confirms ALS immediately. Usually, the neurologist performs: Detailed neurological examination Electromyography (to analyze the electrical activity of the muscles) Magnetic resonance imaging Blood and urine tests Muscle or nerve biopsies, in some cases. Unfortunately, the whole process can take time, which delays the start of support treatments. Is ALS curable? What is the treatment? So far, ALS has no cure, but there is medication that can help slow down the progression of the disease and preserve some functions for longer. The results vary from person to person, but the goal is always to provide comfort, relieve symptoms and maintain autonomy as much as possible. Treatment requires an integrated and multidisciplinary approach, which may involve: Physiotherapy and occupational therapy Speech therapy Nutritional support (and in many cases tube feeding) Non-invasive ventilation, when breathing is compromised Equipment to support mobility and communication. Throughout the process, it is essential to have a specialized team: doctors, physiotherapists, speech therapists, nutritionists, psychologists, caregivers and other professionals who help adjust the care plan to each person’s needs. Although there is still no cure, scientific research has made great strides. In 2023, the first treatment targeting a genetic mutation associated with ALS – the SOD1 gene – a hereditary form of the disease, was approved in the USA, representing a milestone in personalized medicine(Mass General Brigham). Innovative approaches are also being studied, such as immunotherapy with monoclonal antibodies, which could help slow down the progression of the disease(OHSU). Another notable advance was in the field of assistive technology: an experimental brain implant allowed an ALS patient to regain the ability to communicate via a brain-computer interface, reaching a speed of up to 32 words per minute(Reuters). What is the life expectancy of people with ALS? The average life expectancy after diagnosis varies between two and five years, although there are exceptions. Physicist Stephen Hawking, for example, lived with the disease for decades. It all depends on the speed of progression and the areas of the body initially affected. The bulbar form, which immediately affects speech and swallowing, tends to progress more quickly. Respiratory failure is the main cause of death in the most advanced cases. That’s why investing in supportive treatment early on can make a big difference to the quality and length of life of people with ALS. Living with ALS: the role of family and caregivers Receiving a diagnosis of ALS is a difficult time, both for the patient and for those around them. It is a disease with a profound impact, which requires constant adaptation and ongoing support. Family caregivers become key players in the patient’s life. They are often the ones who ensure daily care, help with basic tasks and provide emotional support. It is essential that caregivers also have support. Help groups, psychological support and scheduled rest are

Being ill, whether for a simple or more serious reason, is never easy. In a situation of fragility, the least anyone deserves is to be treated with respect, empathy and dignity. In Portugal, fortunately, patients’ rights are well defined and protected by law, but they are not always known by those who need them most. What are patients’ rights in Portugal? These rights are provided for in Law no. 15/2014, the Basic Health Law, the Charter of the Rights of the Hospitalized Patient, among other pieces of legislation. Here are the main ones, in simple format: Right to dignity, respect and non-discrimination The right to adequate, timely and quality health care Right to clear, objective and accessible information on health status Right to accept or refuse examinations, treatments or interventions The right to a second medical opinion Right to spiritual and religious assistance Right to be accompanied by a family member or nominated person Right to privacy in all clinical acts Right to confidentiality of clinical and personal data Right of access to medical records The right to submit suggestions, complaints or denunciations Right to continuity of care after hospital discharge Right to individual freedom, with legal exceptions. The Patients’ Bill of Rights: what is it? The famous Charter of Patients’ Rights, approved by the Ministry of Health, brings together a set of principles that guarantee that every person is respected as a user of the health system. Many of these rights are enshrined in the Constitution of the Portuguese Republic, in the Basic Law on Health, and in international documents such as the Charter of Fundamental Rights of the European Union. You can consult the version published by the Portuguese Medical Association or on the SNS24 website. Right of access to clinical information and data protection Being hospitalized can be distressing and, for this reason, the rights of hospitalized patients include special care: Facilities adapted to patient comfort and well-being Right to privacy and tranquillity, including during hygiene care or rest Clear information about hospital services (meals, visits, spiritual support, etc.) Prohibition of discrimination based on age, gender, ethnicity or religion The right to visits, whenever the clinical situation allows. In the case of children, the Charter for Hospitalized Children which guarantees, among other things, the continuous presence of parents. Cancer patients’ rights People diagnosed with cancer face very specific challenges. The rights of cancer patients include: Access to specialized and humanized healthcare Respect for the patient’s emotions, fears and decisions Proper monitoring at all stages of the disease Psychological and social support Possibility of receiving palliative care with comfort and dignity And, in many cases, the right to free transportation to treatments such as consultations, chemotherapy or radiotherapy, especially when the patient is frail or has no means of travel of their own. Rights of the terminally ill patient When a patient is terminally ill, the focus becomes comfort, well-being and respect for their wishes. The rights of the terminally ill patient include: Receive adequate palliative care Be accompanied by whoever you want Control over treatment decisions The right to tranquillity, privacy and a welcoming environment. Informed consent: what it is and when it is mandatory Informed consent is the patient’s right to make a free and informed decision about what is going to be done to them. To do this, they must receive clear, accessible information that is appropriate to their level of understanding. It is mandatory in situations such as: Surgeries and invasive acts Administration of blood or blood derivatives Voluntary termination of pregnancy Prenatal diagnosis with invasive techniques Sterilization or medically assisted procreation Participation in clinical trials or medical research. Note that even after giving consent, the patient can back out at any time. How to file a complaint with the health system Everything doesn’t always go smoothly. There may be mistakes, misunderstandings or situations in which the patient feels disrespected, ignored or mistreated. If this happens to you or someone close to you, don’t be afraid to take action. Complaining is not being annoying. It’s exercising a right. It’s contributing to a fairer, more humane and more efficient health system. Here are the steps you can take calmly and confidently: Talk to the person who attended you first. Sometimes all it takes is a conversation with the healthcare professional or the person in charge of the service to clarify the problem If it doesn’t work, fill in the Complaints Booklet, available in physical format, on site, or online You can also go to the User’s (or Citizen’s) Office at the hospital or health center. They are there to listen to you If the situation is more serious or is not resolved, you can complain directly to the Health Regulatory Authority (ERS) And if you really are facing an unfair situation with serious consequences, you can go to court, with legal support. If you need help or don’t know where to start, you can also call DECO PROTeste which provides consumer support in the health area: 808 780 250 (landline) or 218 418 783. Remember: complaining is also taking care of yourself and others. And everyone deserves to be treated with respect and dignity. Need help getting the care you need? Ambula will help! If you are entitled to non-urgent patient transportation – due to a doctor’s prescription, disability or clinical situation – know that you are not alone: Ambula is to accompany you safely, comfortably and with all the empathy you deserve. Whether for physiotherapy sessions, cancer treatments or hospital appointments, you can count on a reliable, punctual and humane service. Talk to the Ambula team team for more information on how to schedule your transportation. Partilhar:

The doctor explained everything to her calmly, but even so, a feeling of uncertainty remained in the air… Is this really it? Is there another option? If you’ve ever felt this knot in your stomach, you have every right to seek a second opinion. It’s not a lack of trust. It’s not disrespect. It’s care. It’s wanting to make a clear decision about what matters most: your health. After all, what is a second medical opinion? It’s exactly what it sounds like: listening to another doctor. In essence, it’s asking a second specialist to analyze your case, review the diagnosis or treatment proposed and give you their perspective. It could be through a new analysis of the medical history, requests for additional tests or simply a frank and enlightening conversation. The right to a second medical opinion is one of the patient’s fundamental rights and is provided for in the Charter of the Rights and Duties of the Patient, which means that anyone can and should use it whenever they feel the need. When to ask for a second medical opinion? The truth is that there is no “right” time for everyone. But there are situations where this step can make all the difference: The diagnosis was unclear or seemed uncertain You have a serious, rare or terminal illness You have several treatment options and you don’t know which one to follow Not responding to current treatment Feels they weren’t listened to at the first appointment The treatment proposal seems too invasive, experimental or risky The doctor is not a specialist in your specific condition Or simply… you still have doubts. There are also cases in which the doctor himself may suggest seeking another opinion and this should be seen as a sign of professionalism, not a cause for concern. How do I ask for a second medical opinion? First of all, take a deep breath: you’re not offending anyone by wanting to confirm a diagnosis. It’s your body, your health, your decision. Here are some steps that can help: Speak openly with your doctor. Tell them you’re thinking of getting another opinion so that you feel more secure. Many doctors understand and will even help you Collect all medical documentation. Exams, analyses, clinical reports, prescriptions – everything can be useful. If you don’t have these documents, ask the clinic or hospital for them. This is another patient right, guaranteed by law – you have the right to access your clinical information whenever you need it Choose the second specialist well. You can ask your family doctor for recommendations, your health insurance (many include this cover), go to specialized clinics or even turn to patient associations In the new consultation, be clear. Explain that you’re looking for a second opinion. At first, you can even choose not to share the first assessment straight away, to ensure an unbiased view. Then, with everything on the table, compare the opinions. What to ask at the consultation? Be prepared. Having a list of questions will help you not to forget anything important. And remember: there are no “dumb” questions when it comes to your health. Some questions you can ask: What exactly is my diagnosis? Are there other treatment options? What are the risks and benefits of each? What happens if I don’t do anything now? Would I recommend the same treatment to someone in my family? What if opinions differ? How do you decide? And when doctors don’t say the same? It happens more often than you think and can be disconcerting. The important thing is to stay calm and look at both opinions critically. Here are some tips to help you make your decision: Compare the arguments: which opinion do you think is better founded? Did the doctor explain the reasons clearly? Evaluate the degree of trust: with whom did you feel most comfortable and well-informed? A relationship of trust counts for a lot! Consult additional sources: you can read about the topic on credible health websites, talk to patient associations or even seek a third opinion Talk to both professionals: share your differing opinions and see if one of them re-evaluates their opinion. Sometimes this dialog can lead to a consensus. In the end, the most important thing is to feel safe and well-informed in order to make the best decision for you What if you have to go abroad? If you have a rare or serious illness, or if you need treatments that don’t exist in Portugal, you can ask for a second international medical opinion. Many health insurances already offer this possibility, including support for travel and subsistence costs. So check what your plan covers – it could open important doors. Need support to get to your appointment? Count on Ambula! If you are planning to ask for a second medical opinion and need help getting around comfortably and safely, Ambula is ready to accompany you throughout the process. Because taking care of your health also means making sure you get where you need to go, with peace of mind. Partilhar: