Hundreds of doctors in white smocks took to the streets of the Portuguese capital Wednesday, the first day of a two-day nationwide strike over sweeping austerity cuts to the health budget.
The doctors, some also wearing black armbands to express mourning, gathered outside the health ministry, many holding placards with messages such as "Access for all and not just the rich".
The strike was set to trigger broad disruption to patients, with 400,000 appointments and nearly 4,500 operations cancelled, according to estimates from the Portuguese health ministry.
The government is slicing 800 million euros ($985 million) from the health budget to meet the terms of a multi-billion-euro bailout deal.
The strike went ahead after unions rebuffed an offer of talks from Health Minister Paulo Maceo, who said he was "ready for dialogue and negotiations".
Maceo said the government was "aiming to minimise the impact of the budgetary cuts with which we have to live on the general population".
He warned that authorities were "not excluding taking necessary measures to guarantee the viability of the precious public service sector to the Portuguese".
Doctors said earlier a minimum service across health clinics and hospitals would be guaranteed.
"The national health service is under threat. They want to destroy it by creating disparities in who has access to care," said Miguel Cunha, a 49-year-old paediatrician.
Twenty-five-year-old internist Eloisa Sobreira said she feared for her future as a doctor. "I'm here to protest the destruction of the health service and the end of medical careers," she said.
Hospitals in Lisbon were much quieter than usual on Wednesday, although a few patients still waited hopefully for consultations.
"I am due to have an operation today but I don't know if it is going to happen. I have been told to wait," said Lidia Goncalves, a Brazilian patient.
Another patient, Manuel Silva, told AFP: "I was supposed to have an appointment with a specialist this morning. I called yesterday but they couldn't tell me if I would be seen. This morning they told me to go home and that they would contact me soon."
Portugal is locked into a three-year programme of debt-cutting measures and economic reforms in return for a 78-billion-euro ($103 billion) rescue package from the EU and International Monetary Fund agreed in May 2011.
To meet the requisite cuts from its health budget, the government has reduced overtime, increased prices for prescription medication and even closed certain services.
Unions say the cuts have restricted access to health care for people who can no longer afford to buy medication.
Carlos Braga, head of a patients' rights group in the capital, has said the numbers of people who can no longer afford health care is rising fast.
"Thousands of people are now deprived of care because they cannot afford the prices that were put in place in January," he said.
Overworked doctors have denounced a "worrying and dramatic" fall in the quality of care in Portugal's health system -- which was ranked 12th best in the world by the World Health Organization in 2000.
The sector has also criticised the purchase of second-rate or obsolete equipment to cut costs and want the government to drop plans to use cheaper outside service providers instead of hiring additional staff.
On Tuesday, Portugal's central bank warned that further austerity measures may be needed to achieve the target of reducing the public deficit to 4.5 percent of output, as the country struggles to fix its public finances.