I was thinking about my other country this morning. I started to write this post on the morning of the Fourth of July, which in Italy doesn’t mean anything. But I was seeing holiday memes pop up in my social media feeds, stuff like “salute those who paid the ultimate price for your freedom.”
Really, folks, does it always have to default to saluting the military for the way we live? How about the dudes who started the whole thing by brandishing words, not muskets?
Sorry, I can’t resist. The country of my birth, the United States of America, has not distinguished itself lately. The supreme court rulings, the attempted coup by Trump and his thugs, the endless shootings of kids by the insane and of unarmed civilians by cops paints a picture of a country that’s falling into violent chaos with no good end in sight. Our friends here are puzzled and even distressed, because they grew up with American culture and the romance of the open west.
Then again, daily life for most people is not affected that much by what happens in the news. Society changes on its own, often without much intervention by government or what the press tells people to do. And it’s in the little things, the day-to-day living, where the U.S. is falling behind, too. I honestly don’t think that’s entered the consciousness of my fellow citizens, who are fed pep talks since birth about how great a nation it is. And when people talk about what ordinary citizens of other advanced nation have, the pundits and Republicans immediately denounce “socialism,” whatever that is. And that people there drive funny little cars.
So I’m going to go micro. Let me recount a few details about what it’s like to get healthcare here in Central Italy, and leave it up to you to decide whether you still want to settle for what the U.S. grudgingly grants its people.
Romantic types rhapsodize about the sweet Italian way of life, la so-called dolce vita. It’s a little different living here than being on vacation. But bureaucratic stuff aside, it is less of a hassle here to do certain ordinary things than it is in the U.S., or at least in New York. Like, for instance, seeing a doctor. I once posted about the aftermath of a car accident here, which featured a doctor visit to ensure that my parts were still in the right place.
THIS TIME, HOWEVER, A LONG-STANDING condition came to a head. Every now and then, after inhaling mold or mildew, I develop a chronic cough. It’s been enough to scare fellow subway riders, who think that I have tuberculosis. The cough ranges from annoying to debilitating, and this time it became the latter. But my New York doctor dismisses it when I mention it or break into a coughing spell. He tells me to take Claritin if it’s bothering me. Like a lot of American doctors, he’d rather I go to the standard Medicare-paid tests for people my age, rather than address a really annoying problem right in front of him, as though I’m asking for a prescription for heroin.
I asked a friend here in town for the name of a good doctor. He gave me a name and phone numbers of a physician he said knows his stuff. I put off calling for a while—I’m great at avoiding new situations. I didn’t know how I’d have to negotiate the process of getting an appointment here after years of dealing with American medical office assistants, who act as though their primary responsibility is to keep people from seeing the doctor.
I didn’t have to worry. Our exchange went like this (translated from the original Italian):
Me: Hi, my friend M gave me the doctor’s name. I live in town and have a chronic cough and I’d like to see the doctor.
Nurse/assistant: Can you wait a minute?
Man’s voice: Hi, I’m Doctor C. What’s the problem?
Me: I explain while coughing throughout.
Doctor: It sounds like allergic asthma. Can you come visit this afternoon at 18:30?
Me: Sure, thanks.
Doctor: I’m right off the piazza. I’ll be waiting for you.
I hung up in a semi-daze, just amazed that A DOCTOR I DON’T KNOW GOT ON THE PHONE TO TALK TO ME AND TOLD ME TO COME VISIT THAT VERY DAY. I’m used to calling my doctor’s office in New York, being put on hold, then a distracted office person tries to find me an appointment six months out for that date. And after that hanging out in the waiting room a couple of hours. I’ve left doctors because of that. Once during one of the cough emergencies i was shunted off to a PA in a clinic near a hospital because my own doctor (who really is not a bad guy at all) couldn’t see me for months.
To make a long story short, I saw doctor C. He listened to my cough, checked my blood pressure, sat at his desk and typed up a page of notes and three prescriptions. He demonstrated how to use the inhaler and told me to come back in….two weeks. Not six months. Since I’m not yet enrolled in the state healthcare system, he charged me €60 for the visit, or about USD $61. I’ll be reinbursed by private insurance I have here, which costs less than the typical Medicare deduction and much, much less than individual health insurance in the U.S.
I took the prescription to our local pharmacy. It’s in a small modern shopping center just outside the center of our little town. There’s a supermarket, a bar (what we call a café in Italy), a garden shop, and a clothing boutique. The pharmacy is not a chain; offhand I don’t even know if chains like CVS exist here. I went in with my prescriptions, which were typed on the doctor’s letterhead along with detailed instructions on when and how to take the meds. The pharmacist took a look at one of the inhalers. “Do you have a tessera sanitaria (medical card)”? I don’t; I’m not a full time resident, so I’m not yet in the state-run medical system. “It’s expensive,” she told me. I told her that I needed it anyway. And the damage? Just under €22, or about $23. I traded meds info with my daughter in New York, who also has asthma. We looked up the equivalent inhaler in the U.S., and it costs, wait for it, $350 retail.
(Can I put in a plug for locally owned pharmacies here? The CVS near our NY house treats people with prescriptions like applicants at the welfare office, forcing them to stand in line and then wait for hours or even to return in a few days. They bought up all the good family owned ones in the area, except the one owned by our friend Nick.)
Doctor C, unfortunately, had a little problem. He tested positive for Covid, and posted on Facebook, knowing that he’s friends with his patients on Zuckerberg’s platform. I did call the office after two weeks, and his assistant told me that as soon as he tested negative, they’d get in touch. They did—actually, he did, a few days later, and told me to come in. I did, he did the usual checks and adjusted the meds. Plus he told me to see a lung specialist, who’s semi retired after heading the pulmonary department in Perugia’s hospital, but still sees patients. I thought, whoa, this is going to add another layer. But no. So, same drill, I called a mobile number, the good doc answers and tells me to come in in a few days. He tells me to send a text on WhatsApp, and he responds with his address and driving directions.
I won’t bore you with the details; it was a typical asthma/allergy bunch of tests. I found the place easily; it’s a huge medical center that houses the clinics for the area. You go in and a color coded sign guides you to the right office. Dr. D answered the door himself. He was reserved at first but then became conversational as we spent a whole hour together. And—The Spartan Woman tells me this unheard of in New York—he did the breathing test and allergy prick tests himself. (In addition to mold and household dust, I have mild allergies to olive trees, cypress trees, and the nasty thorny weeds that populate our lawn.) The cost for a specialist visit? €190, or USD $194,also reimbursable.
And so there we are. Dr. D told me to text him periodically over the summer to let him know how I’m doing, and to see him next month. I’ll try to be a good patient, because these people seem to be concerned and less arrogant than a lot of the masters of the universe doctors I’ve seen in New York.
A few caveats: We live in a small town with about 3,300 people, so Dr. C probably has it easier than a lot of his counterparts in bigger cities. And our region, Umbria, is in Central Italy, and is known for its relative efficiency and medical services. (People here like to complain about everything, but trust me, it’s easier to do these everyday chores than in New York, which also presents its own set of challenges.)
[Inhaler photo and asthma diagram courtesy Wikipedia Commons]
5 thoughts on “Can I make an appointment with Doctor C—? What? This afternoon?”
WOW! Anthony, I am glad that your experience with the health services was great and I’m super jealous. I know that meds in EU are cheaper, but I didn’t know medical care was too and was so much more personal (which is what I’m more used to in PR). I wish our system was like that here (and not so damn expensive!). Hope you start feeling better soon. Eat watercress if you can find it – it’s good for the lungs! Abrazos, LG
I’ll have to remember watercress. I didn’t know.
Great essay. My wife and I have a home in Umbria also and I’ve experienced great care that was not expensive. I deeply appreciate it!
So glad you got the care you needed! We will soon be part-timers for a while. Can you share the medical insurance company you use there? Mille Grazie!
Nice to read an objective review of the Italian health service. AFAIK, the quality of the service varies region by region. I live in Milan and am under the impression that the Lombard service is the best because it is adequately funded by Italy’s wealthiest region. The cost of a private appointment is at €100-€250 appears to be much higher than your location in Umbria. The quality of the public and emergency services, however, is excellent. By way of an example I called the emergency services in the middle of the night during the height of the pandemic to tell them that I was having chest pains. The ambulance arrived two minutes after I set down the phone! I was shocked. Although there is a lot of waiting for Public Health Service treatment, urgent care becomes immediately available if a referring doctor an urgency class, such as to be seen within 48 hours.