When I left Seattle for Italy I also left behind my doctor and my health insurer. My doctor is head of the department of internal medicine at the local medical school, a friend from church, and a sweet and kind man of about my age. He doesn’t take new patients, but 15 years ago he made an exception for me. When I see him he always has a med student or a resident in tow, and with that arrangement through the med school I get super health care and free parking in the underground garage.
My health insurer is a different story. For them I’m a card, a number, and another billing opportunity. My premiums went up about 40% this year, while my coverage stayed the same. I found them on the “Exchange,” and I think we both know that I will dump them at the first opportunity.
So no surprise I’ve been looking ahead with delight (ok, and some anxiety) to enrolling in the Italian health care system. Theresa had shipped me the last of my USA medicines, and the day after I went to the post office to claim my pills, my immigration mentor, Tony, contacted me to say that everything was ready for us to go to the post office to pay the Italian health insurance annual insurance premium. I already knew I’d need a Super Green Pass to do business with the Poste Italiane and Tony volunteered his. A few days after our post office rendezvous Tony made the trip to the health system offices outside the walls at Campo di Marte to show our receipt and pick up our temporary Tessere Sanitaria health cards. We met at Piazza Santa Maria on Monday so he could give me the original documents, and he pointed out something very important:
“Look here on the document,” he said. “This is the name of your doctor.”
I knew I’d need a new doctor. I also knew the English-speaking doctor many expats here use was retiring soon and not taking new patients.
“I don’t know if he speaks English. Maybe he does,” Tony said. “Anyway I asked my doctor and he’s too busy, so I picked one for you. His office isn’t far away. Here’s his address, his office hours, and his phone number.”
Ok, then. My shipment of meds from Seattle isn’t dangerously low, yet, but as I thought about it, it makes sense to establish a relationship with my new doctor, get Italian prescriptions to replace my American ones, and cut the umbilical cord to the American health system.
I double-checked the office hours of my new doctor and that afternoon I climbed onto my bike, rode out Via Borgo Giannotti, scanned the list of doctors on the office directory panel, and climbed the stairs up to my new doctor’s office. At the stroke of 15:00, as advertised in his office hours, in walks a handsome, slender man of about 32 years.
“Salve. Sono un nuovo paziente,” I say cheerfully. (Hi! I’m a new patient.)
“Salve. Hai un appuntamento?” (Do you have an appointment?)
No. Of course I didn’t. I knew better, but in the US if you have ‘office hours’ that means visitors can drop in. Not in Italy, which is fine. Since that hadn’t worked I waited until 15:30 for the clerk to arrive so I could book my visit. Mind you, my doctor in Seattle is booked four months in advance, so I hoped for something in March, maybe April. I was prepared for whatever date, hopefully this winter or early spring, might be available.
“Domani, alle 9:45?” (Tomorrow at 9:45?), she said.
Stunned, I asked her to repeat herself. “Domani. Nove …. quaranta … cinque.” I had heard it right.
Next day, hardly believing I had a confirmed appointment with my new doctor, I got back onto my bike, rode out Via Borgo Giannotti to yesterday’s address, climbed the stairs, reported my presence to the clerk, “siediti lì e aspetta” (Sit there and wait), she said, and I parked myself on the hard chair outside the doctor’s door and studied my phone until the door opened. In I walked.
My new doctor sat behind a small desk in a sparsely-furnished and sunny exam room, about the size of 2 windowless American exam rooms. He had a laptop in front of him. His hair looked good, in the manner of most Italian men. He wore street clothes, no lab coat. We shook hands.
“Do you speak English?” I blurted out, starting the conversation with my biggest worry.
“Un po.” A little. That seemed hopeful. As we continued to talk I realized that my “little Italian” was more than his “little English.” But not to be slowed down by languages I had come prepared with a Google Translate document that summed up my various, minor, medical conditions in pure, computerized Italian.
He smiled. The universal, “nice one, buddy.” While he typed details about me from my Google Translate document into his laptop, I scanned my new doctor more closely. Same style shoes as me, but his are Italian. Nice. I have those pants. Maybe four or five sizes larger. Narrow fingers and carefully groomed nails. Some product in his wavy hair. A few strands of premature grey? He asked questions, and no more English words volunteered themselves in among his clear and soft Italian. He took my blood pressure and pulse. I shared my blood test results and EKG from my online U.S. chart. He began writing prescriptions, told me he wanted another test, and went out the door to get papers from the printer at the clerk’s desk. When he returned he had new prescriptions, a referral for tests, and a promise to send me the link where I could easily get my Super Green Pass. “Hai WhatsApp?” he said. “Si,” I replied. Everyone here has WhatsApp.
Then I was back out on the street, in the bright sunlight, walking to the Farmacia next door to get my meds. I made it through our meeting. He seemed to understand my various issues.
Inside the Farmacia, the pharmacist took my prescriptions, ducked into the back, came out with a few boxes, not bottles – boxes of pills – scanned each one three or four times, pulled out a knife so she could transfer labels from the boxes onto the prescription form, smiled at me, and handed me my meds. She didn’t ask for money. In fact, all morning no money changed hands. No HIPAA forms. No signing of releases. No filling out of questionnaires. No deductibles. No copays.
How do I get refills? Where do I go for this referral test? Do I make an appointment for an annual physical? Is that all?
I have no idea.
As I thought through it all over lunch I decided there was one fun thing yet to do, now that I have my very own Italian doctor. With relish I sat at my computer to cancel my expensive US health insurance.
I guess my insurer must’ve known I was about to drop the bomb about our inpending break-up, because when I logged on to my account, this is all my American insurer had to say:
Touché, Molina Health Care. You’re not going to let me cancel easily, but I’ll find a way, now that I have my new, Italian doctor.