Le Malade Imaginaire
You Take the Lead in the Italian Health Care System
| Figuring out just when to make your doctor's appointment.
“Beware!” scolds everybody, from my Italian mamma-in-law to the greengrocer, uniformly dismayed at my lackadaisical foreign ways. “If you leave home with wet hair, you’ll get a cervicale!”
Contrary to linguistic cues, a cervicale has nothing to do with the cervix. Rather, it’s a fearsome Italian headache caused by inflammation of the neck vertebrae, which you get from going out with wet hair. In times gone by, I was only dimly aware of my neck having vertebrae. Here in Italy, they are under threat.
The Quest Begins
Are you new to Italy and angling for some health care? Suffering from a bout of the vapors? Tranquillo! You’ve found your home, corporally speaking. Because no nationality tracks the nuances of the body quite like the Italians do. Whether the subject pertains to the manifold perils of catching a chill (il colpo d’aria), or the importance of covering one’s tummy to enable digestion, unsolicited public comment flows thick and fast. Daily updates amongst kith and kin touch on the state of one’s bowels or blood pressure and the vagaries of temperature change as detected in the head and neck (see above). It’s mindboggling for the foreigner—akin to finding oneself in a modern rendition of Molière’s Le Malade Imaginaire. Grab the chance and grant your inner hypochondriac the lead role.
Obtaining the Documents
As a newcomer to Rome, I want to sign up for free national health service, il Servizio Sanitario Nazionale. “Free” turns out to mean for little or no financial cost, but at a substantial deficit to what was once your “free” time. With my change of residence first confirmed at the municipality, I become eligible for a carta d’identità. This I obtain in a single visit, during which I pay for the right-size photos and the card is issued immediately, ink still fresh.
Only with that secured, can one request a tessera sanitaria (health card). Even though your address will appear nowhere on it, the health card cannot be issued unless your residence status is first finalized in il Computer. In the interim and in lieu of the genuine artifact, the Agenzia delle Entrate (Tax Office) might print out a certificato provvisorio (temporary document). This joins my folder of Italian paperwork until the real card arrives two weeks later, in the mail. The tessera sanitaria is not just a formality. It facilitates access to medical treatment throughout the member states of the European Union.
Going to a Doctor in Italy
About fifty cappuccini later, perked up, I embark on the next challenge: How to go to the doctor in Italy? You can’t just show up unannounced, they tell me. You need to be on the books of a medico di famiglia (family doctor). But that’s a breeze, they say––“they” being those helpful locals down at the bar in the piazza. “Just take your ID document and health card to the ASL (Azienda Sanitaria Locale, local health centre), and there you’ll be allocated a family doctor.”
So off I go to the ASL (pronounced “Ah-zleh”). While I believe in picking a doctor based on skill and bedside manner, this is not to be. “Why can’t I meet the doctor before approving of her?” I enquire rhetorically.
Choosing Your Doctor
In response, the official waves me towards a daunting list stuck on the wall bearing the names of hundreds of doctors in tiny, barely legible font. These doctors have space for new patients. “Come back with the one you want,” he says.
Pin the tail on the donkey would be one selection strategy. Choosing the most alluring name another. I like the ring of a certain physician called Manlio. (Sound it aloud, “Manly-oh!”) More practically, the salesperson at my local health shop has recommended a young doctor setting up afresh, just up the road. So I dig out my scribbled notes and match her name with the list, thereby selecting my family doctor. The health official issues me with a doubly-perforated slip of paper and advises me to take one half to the doctor’s rooms, to register there. Owing to some karmic discord unbeknown to me, I get to do this entire process twice, a couple of weeks apart: once for me, once for my partner.
|Picking your doctor from a list of hundreds.
Not having a job, I take it in my stride. More specifically, I fear that if I lose my momentum, it will slip into an irreversible catatonia. When the relevant half of the perforated slip is accepted by the doctor’s receptionist, I am finally eligible for an appointment at no charge whatsoever, whether I’m sick or not. For a mere chat! And chatting is exactly what I do, because I want to see if I like her. Thus far, I note that with time and tenacity, the public health system can be made to work.
The Doctor/Patient Relationship in Italy
Subsequent visits reveal that Italian family doctors have a particular, somewhat different range of powers to those expected. My doctor prescribes medicines merrily. If I represent my partner, in loco girlfriendis and request medicine for him, she doesn’t bat an eyelid. She reacts favorably to Internet-aided self-diagnosis pronounced in sketchy Italian. Really, she is most accommodating.
When the orange prescriptions are state-subsidized, one pays the pharmacy il ticket (the base levy). Extra luxuries, such as medicine that isn’t covered go al pagamento (by payment), coming out of your pocket. However, when it comes to a more serious matter, the doctor listens, nods and prints out a different kind of orange slip: a referral to a specialist or other health care professional.
The “Hands-Off” Approach to Medical Practice
Diagnosis, prescriptions, et cetera, are all based on talking. Whatever else, don’t expect your Italian family doctor to actually touch you, to feel your glands, take your pulse, lay a hand gently on your back while making you say “Aaah”. “Isn’t a perk of visiting the doctor the tender care administered?” I wonder. Apparently such is not the case. Doctors elsewhere are extremely free with their hands, but not here. If you’re coughing up a storm, such that words fail you, the doctor may resort to his stethoscope and prompt you to say trenta-tre (33).
Consider, for example, the following post-car accident exchange: “Doctor, I was in a car accident two days ago and suffered whiplash. Would you be able to check my neck, please? ... Well, yes it hurts and feels stiff, as expected. But could you take a look? ... No thank you, I don’t think it warrants an x-ray. I doubt it’s that bad. Just take a look, won’t you?!” To which the doctor responds: “Do what you like then. Go for an x-ray or don’t. You’re the one who said you wanted your neck checked.” Instead of the laying on of hands comes the offer of an orange slip and a referral to somebody, somewhere else. (The referral went into the trash.)
Opting for the Private/Public Balance in Health Care
At this point, you may fear that the hours of absence from your life are leading to divorce or retrenchment. You may want to jet back to your country to sort it all out, properly, paying exorbitant fees that once disgusted you. An alternative is to do in Rome as the Roman does: opt for a balance of private/public medicine, occasionally paying the handsome fees that Italy’s private doctors charge.
Should you choose to pursue the prospects of the orange referral slip, one is eligible to book at a local hospital or health centre to see a specialist, when there is a space, which may be many months away. This doh-si-doh can feel infuriating. “They are conspiring to drive me to a conniption fit!” you cry. Indeed, your blood pressure is escalating. But rest assured that if you’re seriously ill, you will be attended to at little or no cost, under the beady eye of the ubiquitous Virgin Mary, statues of whom festoon the hospital corridors. Just show up at pronto soccorso (the emergency room)—preferably, with a huge, engrossing novel and a picnic.
Rest Assured: Grave Problems Are Attended To Rapidly
By some molieresque ratio of need to speed, the graver the problem, the more rapidly it is addressed, usually. This includes procedures that elsewhere would be prohibitive, such as open-heart surgery, weeks in intensive care, serial blood transfusions and cancer treatment. That said, for those niggling pains in your third meta-tarsal brought on by the damp, you had better gear yourself up for a wait. Or pay for private.
Health Care by Region
As a rule of thumb: The further north in Italy, the better the quality of service; the further south, the worse. Should you be convinced, as a case in point, that your appendix is soon to rupture, a well-timed shop-and-drop trip up to Milan might be advisable.
When Virgil wrote “The greatest wealth is health”, he wasn’t thinking of the greedy pharmaceuticals or that convertible Z4 that your dentist drives. For that, he would’ve said “My falt’ring tongue and shiv’ring limbs declare / My horror, and in bristles rose my hair” (Book III, Aeneid).
Health Care in Italy Viewed as a Right
Fellow Romans—albeit centuries later—feel similarly. Italians regard health care as a fundamental right and deem those countries where it isn’t as barbaric. In Italy, nobody gets turned away from emergency rooms. Not the illegal immigrant. Not the 93-year-old with palpitations. Not even the drunk who cracked his skull while dancing La Macarena on a chair. All are welcome. Just take a number and wait your turn.