Italian Healthcare

The doctor had been a very handsome young man once, it was clear. His large eyes, easy smile, and grey hair betrayed a fidelity to style unchanged since his time in liceo in the sixties. I had been referred to Dr. Mastrolorenzo by my gynecologist for a short list of dermatological complaints related to a lifetime of living inside a thin suit of fair, sensitive skin.

I had a small lump here. A nubbin there. Another thing on my temple. An annoying rash on my torso that had been coming and going for a while now, even through both pregnancies, but which I had never managed to eradicate. He held my hand a few minutes into my explanation, looking at me with calm eyes. I am sure I was oozing historic anxiety about my questions.

My doctors in Oklahoma had been either too lazy or too uninterested to care much about any of these complaints, beyond shrugging, telling me "just don't worry about it," looking it up on WebMD in the office as I sat on the exam table, or measuring one lump with a tiny pair of calipers in attempt to at least apply some methodology and diagnosis (thank you, female doctor - truly). A well-meaning nurse midwife told me to try essential oil on the rash once when I was hugely pregnant with Eleanor in the summer of 2014. Of course the oil did not resolve the skin fungus I had picked up on the mats in the student gym where I used to routinely work out.

In the context of the US medical culture, out of pocket costs skyrocket, insurance expenses increase disproportionately to income as employers offload higher premiums to employees, and a good primary care physician can be hard to find. Even more so in a red state, as we were for years. It's bad enough in the US in a sane city. No good doctor really wants to stick around the third-largest town in Oklahoma with its transient university student population, making it very difficult to create a reliable patient base. The ER and assisted living centers seem to be busy enough in those parts, but the middle class squeeze, and our cultural reluctance to seek timely medical care, or to access reasonable preventative care, makes the doctoring prospect an overly challenging one.

I had an excellent physician for less than a year. After the usual uninspired care I received in Oklahoma, Dr. Wani was a breath of fresh air. Pakistani, intelligent, calm, confident, she ran her own office on the west side of Norman. She immediately put me at ease. She definitely had not drunk or slept her way through medical school. She did not open up her laptop to consult medical MD. She listened to my questions, silently nodded, and examined me as carefully as an valuable object connaisseur might prior to making an appraisal. Her nurse staff were all equally competent women, mostly African American, doing good work in a small office in a medium-sized Oklahoma town.

Dr. Wani moved to New York the year after I became her patient. I cried when I got the letter in the mail. I had finally found a sane, smart doctor, and she left. The letter offered to refer me to another doctor in the area. But who? I thought. Who. I trudged back to the university student health clinic, where appointments were booked for three weeks, and I was stuck in a ten minute phone tree just trying to make one. The healthcare culture of Oklahoma was exhausting. So many assumed premises, so little actual care, so much cost.

And, so much ingrained sexism, as with my regular well-woman appointments in Oklahoma. It's not like I am crazy about an annual exam, but when you've had two kids in four years, you tend to be very, ah, aware of your health. I've had irregular results before, so am very careful about checkups. I understand that it is recommended only once every three years now. One doctor recoiled when I simply asked him if he would be able to manage my well woman care. "No!" he said, recoiling, a look of distaste on his face. "We refer those out." In another, different doctor's office in Norman, I waited in a small exam room for an hour while the nurses outside argued over who might examine me, if anyone - no one ever did. They sent me home and said they'd reschedule me for a different day, or maybe next year. In a year sounds good. I received a reminder card for twelve months' hence, and left wondering why no doctor in Norman would acquit their professional responsibilities.

So, after childcare, healthcare was a major push factor for me to leave Oklahoma and the US for Italy (followed by, roughly in order, food, wine, nice people, gun control, non-fatal weather, good aesthetics, quality of life, scenery, language, literature, film). Our first year here was one of settling in, and so my short list of medical questions was placed on hold. This year, however, I found a handful of doctors in a practice on Piazza della Indipendenza that it turns out I really like, and it is a breath of fresh air.

Piazza della Indipendenza

The obgyn thoughtfully listened to my list of concerns. She was smart, patient, competent, and personable. I felt like crying to even receive such careful attention in a medical office. When I said I also had a short list of dermatological concerns, she immediately referred me to her partner in the practice, which was how I came to meet with Dr. Mastrolorenzo. The doctors here did not dispense the refrain of medical advice so beloved in Oklahoma: "Just try not to worry about it. Ignore it." I am not kidding.

Dr. Mastrolorenzo, like the obgyn, was pleased that I had brought a neat list of concerns. We covered each one of them at his desk.

"Step back here," he motioned me, back to the exam area, which was demarcated with an old-fashioned white fabric screen.

I showed his this lump, that nubbin, the other big lump, and the rash. I was self-conscious but relieved to be accessing a competent diagnostician. He was very clear on each of my concerns. They each had an actual medical term, and the term was not "you worry too much." He wrote out two prescriptions for my rash, which disappeared within a week (thus retiring my Human Cheetah moniker). He labelled and discussed the thing and the nubbin, which turned out to be a small cherry angioma (annoyingly sited on my left temple, just behind the bow of my glasses) and a sebaceous cyst on my thigh (sounds gross, doesn't hurt, easily removed with the cherry angioma, he assured me). The back lump was a small lipoma, which is common enough, I suppose, in people my age, along with the other two complaints. He referred me out to a clinic close by for an ultrasound to determine the nature of the lipoma, and a course of action.

I obtained an appointment at the clinic easily enough for the following day. Cost: 111 euros. My exam was completed by the clinic's namesake, a lugubrious radiologist who was efficient and kind. (Result: inert and fine. Do not mess with it without a good reason.) I picked up the results that week and shared them with Dr. Mastrolorenzo in his offer afterward.

"This is fine," he said, after reading the paper copies. "We will not touch the lipoma. What do you want to do about the other two things? And are you reading The New Yorker?" he peered at the magazine I had been reading idly in the waiting area.

"I am reading The New Yorker," I said -

Followed by a ten minute aside about his famous friend in New York.

New York, where the Italian doctor's doctor friend lives, and apparently reads The New Yorker.

"- And I would like to remove these two other things. They bother me. If it is easy to do - "

"Oh, very easy!" he boomed. "Very easy. That little angioma, 30 seconds. The cyst, twenty minutes, but I must stitch first on the inside, then on the outside."

This sounded fine to me.

"Are you going to the beach anytime soon?" he asked me.

I actually am. "Yes, the first week in July."

"Well. Put surgical tape over the sutures, or use a very good sunscreen."

We set the surgery date for June 7, and he made to conclude the appointment. I hesitated before I stood up.

"There is one thing I must, ah, ask you," I said. "I do not have great health insurance. The deductible is very high." I felt my American panic response to medical offices start spinning at high speed. "It is four thousand dollars."

"What?" he said. "You are not on Italian healthcare?"

"No," I said. "We do not qualify now, my husband and I are both on American payrolls, but I am paying Italian income tax now, so that could change." His eyebrows wiggled up. I continued. "But for now, I am on private American insurance."

I really wanted an estimate, to prepare, or brace myself. How much was this going to cost me, since my insurance will cover, in all likelihood, none of it? Four hundred euros? Two thousand euros? a hundred euros? I quickly calculated mentally my cash savings against some additional important health and dental needs I will be covering this year and next.

"Ah! Do not worry. I will write an excellent letter for your insurance company." He tilted his monitor toward me. It looked like an excellent letter, for sure. Long, and full of long words.

"Right. But they ... this won't matter. The letter will not force them to cover this procedure."

He looked at me blankly. This lovely Italian doctor had no idea what I was on about.

I wanted to shout, how much is it going to be, but that felt like a vulgar impulse. I was embarrassed by my anxiety about it, and still very relieved that this doctor was so competent and proactive. I did not want to suddenly seem to him like a neurotic American who was more trouble than she was worth. I took a deep breath, and left.

I still have no idea how much it is going to be. But the costs of Italian healthcare are all held down by the universal participation in their healthcare system. So far, my nervous medical estimates in Italy have been radically high, and I have been surprised by how low the cost has been, having been seen in an ER, for a regular obgyn appointment, various dental procedures, at a radiology clinic, and having taken Victor to the pediatric cardiology appointment last fall. All bills were shockingly low. One or two hundred euros, about, every time.

In the US, it was the opposite. My very nervous estimates were exceeded on an order of magnitude, and cleaned out our savings a few times for major but fairly common family health crises.

I think it will be less than a ... thousand euros. I will report back after I am stitched up.