Medico

Thanks to our overseas move, I’ve spent more time in medical offices in 2012 than I did in the ten years prior.  Dental, optical, general medical: you name it I had it checked. None of it because I was ill, mind you. I had hoped the appointments would end when we arrived, but a minor problem had me heading to a specialist in August. Luckily the Embassy refers us to English-speaking physicians so language is not a barrier. But there are surprising differences in our systems.

In Italy, staff is limited. The doctor met with me alone. Completely alone. There was no one else present, primarily I assumed because it was the end of the Ferragosto holiday period, but the experiences of friends – and one appointment Ric had – point to a trend: There is not a lot of support staff. One American doctor who is familiar with the situation here told me “they can’t afford a lot of extra people in the practice.” Still, there are not many American physicians who would treat a woman alone in his office, no one else even in shouting distance. There would be fear of allegations of inappropriate behavior. Maybe that happens here, too, but it doesn’t seem to paralyze. It certainly did not bother me.

It’s all about conversation. There were no forms to fill out or extraneous medical history. Just info pertinent to the problem at hand. Maybe that was because I was referred in and a foreigner.  (As an aside, I can’t even buy coffee at the Nespresso Store without having given my codice fiscale — sort of like a social security number or Tax ID — and it is not uncommon to be asked your date of birth as a form of ID, almost as nonchalantly as asking for a cell phone number.) The doctor simply engaged me in conversation: What is your problem and why are you here? What’s the family history? OK, let’s take a look.

Doctors do their own billing. Again confirmed by an Italian friend: yup, it’s routine if they want to get paid. I suppose this pertains only to private patients that are not on national healthcare, but imagine my surprise when I received an email from the doctor, at 8:00PM that same night, with a full report and bill.  (In a future post I’ll tell you about bill payment and banking. Another cultural shift.)  As if to prove it is not an anomaly, when Ric had a medical visit the doctor hand wrote an invoice and gave it to him. We were surrounded by fascinating and state-of-the-art healthcare and diagnostic technology, but the bill is written out long hand. It probably took less time to do it by hand than to submit the details to a billing department that would spew out an invoice. And neither Ric’s appointment nor mine cost nearly what one might expect from a specialist. Low-overhead = Sensible bills? Could be.

Doctors spend time with you.  Kaiser Permanente docs seem to have 15-minute increments for patient care. My doctor must have spent 75 minutes with me, not only on the medical issue at hand, but just talking: His vacation, my vacation, summer in Rome, working in an embassy, his time in Texas. It was nice. And he personally answered several emails.  The guy is a world-class vascular surgeon and he’s answering emails about my minor issue. No advice nurse, no middleperson, no gatekeeper receptionist. He even made my surgical appointment personally. (Although I did have a challenging moment in language use when I spoke to the hospital billing office. I always love it when they say my Italian is better than their English. That means their English is really limited. )

Doctors answer their own phones. Ric was given a phone number – turned out to be a cell phone – by the Embassy doc and called for an appointment. The specialist answered his own phone, made his own appointment, and when we arrived we found this excellent specialist in a one-man office. Very simple, very hands on, and (we think) very effective. There is no diluting the doctor-patient conversation. Need an ECG or an Echocardiogram? The doctor will do it.  No technician, no nurse, no waiting.

Patients have a greater degree of personal responsibility. Need lab tests? There’s a lab up the street. Send the doctor the results when you get them.  This means in all likelihood you will go for the lab test then have to go back in two days to get the results, scan them and email them to the doctor.

So no charming pictures of quaint villages this post. Just an observation of unique – not bad – cultural differences. Interestingly Italy is known for having the 2nd best health care system in the world (France is first). The U.S. is #37, but we spend more.  I’m sure some of the reason for the high-ranking is due to access to national healthcare, but they spend less than we do in the U.S., and rank higher. There’s no lack of knowledge or technology; these are good doctors with all the resources and expertise one would expect. But the story is not over. On Thursday I will have un piccolo intervento chirurgico (minor surgery). I’m sure I will have more stories.

OK you made it through an all text post. Here’s a beauty shot bonus. I can walk by this every weekend. SIGH.

Nobody does it better: Bernini’s Fountain of the Four Rivers, Piazza Navona.

Tags: doctor, healthcare, Italy, medical