Learn Hardcore Portuguese (Portugal): Se os sintomas piorarem, ela renova a receita médica. - If the symptoms get worse, she will renew the prescription.

Because Portuguese uses the future subjunctive after words like se (if) when you’re talking about a possible future condition. So you say Se os sintomas piorarem (if the symptoms get worse) rather than Se os sintomas pioram. The version with the present indicative (se pioram) is either unusual or would mean something like “if indeed they (regularly) get worse,” not the standard future-looking condition.

What tense/mood is piorarem exactly, and how is it formed?

Piorarem is the 3rd person plural of the future subjunctive of piorar. To form it:

Start from the 3rd person plural of the simple past (pretérito perfeito): pioraram
Drop -am to get the stem piorar-
Add endings: eu piorar, tu piorares, ele/ela piorar, nós piorarmos, vós piorardes, eles/elas piorarem

Why is the main verb in the present (renova) instead of the future (renovará)?

Portuguese often uses the present in the main clause for a habitual or immediate result: Se os sintomas piorarem, ela renova… = whenever/if that happens, that’s what she does. You can use the future for a specific future outcome: Se os sintomas piorarem, ela renovará a receita or … ela vai renovar a receita. All are correct; the nuance is habitual/immediate (present) vs specific future (future/“vai + infinitive”).

Can I say Se os sintomas vão piorar…?

You can, but it means “if it is the case that the symptoms are going to get worse,” i.e., you’re checking/assuming a plan or forecast rather than stating a general future condition. For a neutral future condition, use the future subjunctive: Se os sintomas piorarem…

How would I make it more hypothetical or unlikely?

Use the “remote” conditional pattern:

Se os sintomas piorassem, ela renovaria a receita.
In European Portuguese, the imperfect indicative is also common in the main clause: Se os sintomas piorassem, ela renovava a receita.

How do I talk about past conditions with se?

Past factual condition: Se os sintomas pioraram, ela renovou a receita. (If they did get worse, she renewed it.)
Looking to a prior event relative to a future time: Se os sintomas tiverem piorado, ela renovará a receita. (If they have worsened by then, she will renew it.)

Why do we have os and a here? Do I need the articles?

Portuguese uses definite articles more than English, even with general nouns:

os sintomas (the symptoms, in general or contextually known)
a receita (médica) (the prescription) Dropping them often sounds bare or unidiomatic. If you want indefiniteness, you can say alguns sintomas (some symptoms) or make it specific: os seus sintomas (your/her symptoms).

Does receita mean recipe? Why add médica?

Receita can mean both “recipe” and “prescription.” In Portugal, receita by itself usually means a medical prescription in healthcare contexts. Adding médica (medical) makes it explicit and avoids any ambiguity outside that context. You might also hear prescrição in more formal or technical language.

Who is actually renewing the prescription here—patient or doctor?

Literally, the doctor renews a prescription. However, in everyday Portuguese people often say things like Eu vou renovar a receita to mean “I’ll get it renewed / I’ll ask for a renewal.” So ela renova can mean either that she (as a doctor) renews it, or that she (as a patient) goes and gets it renewed. Context decides.

How would I replace a receita médica with a pronoun?

Use the feminine direct object clitic a:

Se os sintomas piorarem, ela renova-a. In European Portuguese, when nothing in the clause attracts the pronoun to the left, the default is to attach it to the verb with a hyphen (enclisis). If you add a negative, you use proclisis:
Se os sintomas piorarem, ela não a renova.

Is the comma after the se-clause required?

When the se clause comes first, a comma is standard: Se …, ela …. When the se clause comes after the main clause, you normally omit the comma: Ela renova a receita médica se os sintomas piorarem.

Could piorarem here be a personal infinitive rather than future subjunctive?

No. After the conjunction se (if), you use the future subjunctive, not the personal infinitive. Forms like piorarem can look identical to the personal infinitive, but the function here is future subjunctive because of se.

Can I change the word order?

Yes. Both are fine:

Se os sintomas piorarem, ela renova a receita médica.
Ela renova a receita médica se os sintomas piorarem. The meaning stays the same; the placement can slightly affect emphasis/rhythm.

Any pronunciation tips (European Portuguese)?

Se: like “sih” with a very short vowel.
os: often sounds like “ush” before a consonant.
sintomas: sin-TO-mas (nasal “sin”).
piorarem: pyo-RA-rem (stress on RA; final -em is nasal).
ela: EH-lah.
renova: he-NO-vah (initial r is a throaty h/ɣ/ʁ sound).
receita: he-SAY-tah (the c before e is “s”).
médica: MEH-dee-kah.

Does médica here mean “female doctor”?

No. In receita médica, médica is an adjective meaning “medical.” A médica (with the article and no noun after it) would mean “the female doctor.” For example: a receita da médica = the female doctor’s prescription.

Are there natural alternatives to piorarem?

Yes:

Se os sintomas se agravarem, … (become more serious; very common in medical contexts)
Se os sintomas ficarem piores, … (get worse; more colloquial) All follow the same future-subjunctive pattern after se.