“Take off your underwear,” she instructed. Right now? In this moment? Here? Can I get a gown or glass of wine first?
She’s the third doctor I’ve been to on my hunt for birth control. Despite this being a Catholic land, I’m told you can indeed procure those revolutionary pills. Eventually. Reluctantly.
Although I’m going to take you through this medical montage in a moment, I must note that I hesitate to write about the Italian health care system too deeply because:
- My experience, after only two months as a resident, is just one lil’ blip among 60 million.
- Every region of Italy manages its own system — you could have a drastically different experience in Lombardy compared to Calabria.
- I don’t fully understand the system (heck, I don’t fully understand the U.S. one), and if you aren’t sure about the facts, you probably shouldn’t make sweeping declarations — but embarrassing tales are fine.
- If I complain about anything, the trolls will pounce: “See?! Commies don’t know how to do medicine! Obamacare ruined my marriage!”
So, consider the following a mere collection of observations, not a final verdict.
Servizio Sanitario Nazionale – Italian National Health Service
To give you a lil’ context: Health care is a right in Italy and is provided to all citizens and residents through a mixed public-private system. In the public system, most things are free or have a modest co-pay (plus exemptions for low-income, young, old, pregnant, chronically ill, etc.), but you may have to wait longer or go to a less modern, underfunded facility to get treated. You can choose to go to a private provider instead and pay for the added convenience and/or quality. The following visits were in the public system.
Dr. Rita (aka Mamma’s Got a Medical License)
The first doctor we went to has examined Alberto’s bare baby ass; that’s how close she is to retirement. Dr. Rita’s* studio reminds me of a professor’s office — shelves full of books, miscellaneous artwork, a messy desk overflowing with papers and drugs. The only familiar item is an exam table, but it’s also covered with boxes of pharmaceuticals. She’s in jeans, a Kappa polo shirt, ballet flats — no white jacket in sight.
For someone who has only ever visited physicians in clinics/hospitals, this environment was quite an adjustment. It felt as if I were visiting a friend at their nondescript multipurpose apartment building, but instead of Holly being behind the door, it was a 63-year-old woman with a stethoscope. This, I learn, is because general practitioners are independent and self-employed, and if you actually need some sort of procedure or special treatment, they are the gatekeepers who refer you to a clinic/hospital outside of their quirky office.
Dr. Rita was nice enough, but she didn’t feel “comfortable” prescribing me contraception because she wasn’t familiar with an Italian equivalent of the U.S. brand I use. Even though she leafed through an Encyclopedia Britannica off the shelf, she couldn’t procure the answers she was looking for.
An Italian friend told me to watch my back (uterus) here — although contraception and abortion are legal in Italy, there are many medical professionals who will withhold care/counsel based on Vatican grounds, with or without informing you. I hope this wasn’t the case for Dr. Rita and that she was merely being prudent. Meanwhile, you can get condoms out of vending machines; go figure!
Although I was unsuccessful on one front, she did write me a note deeming me healthy enough for exercise, a document the gym requires in order to use their facilities. But first, she had to ask, very bluntly as she was listening to my heartbeat, “Do you eat?”
Who are you, my mother-in-law? I respond.
Cost: 0 euros, mild frustration
Dr. Joey Tribbiani (aka Mr. Fuggedaboutit)
Dr. Tribbiani is officially our new primary care provider, per public health system requirements that we select a doctor who isn’t maxed out with too many patients, like Dr. Rita reportedly is. How were we able to see her earlier for free, you ask? Who knows, OK? I have mostly questions and very few answers about my new nation. Anyway, apparently you can switch who your GP is whenever you want.
A week or so after Dr. Rita, we go to Joey’s studio to get set up in his system and once again try to get a prescription for birth control. There’s no receptionist on duty at this hour, but the elderly ladies in the waiting area inform us we’re in the right spot. None of them have appointments; they’re hoping they can just pop their heads in real quick because their knees and/or hips hurt. Sofia did have a terrifying toenail that I tried not to gape at; I should’ve given her my appointment slot.
The door opens and Dr. Tribbiani emerges, straight outta Jersey Shore with his chest hair wafting out of an unbuttoned shirt. I’m imagining now that he had a gold chain around his neck and a glistening watch, but I might be making that up. He for sure had flowing black hair and a fuggedaboutit vibe. He smooth talks the old ladies, explaining that he needs to see this couple (gestures to Alberto and me) first, otherwise he’ll look bad to the new patients, fare brutta figura.
We sit across from his desk; the office features flickering neon lights and shelves full of books, some are in English although he doesn’t speak English. To make up for this, he speaks to me slowly and loudly, as if I were a child and/or one of the elderly patients outside. “COOO-MEEEE-VAAAA-CHRI-STI-NA? TUUUT-TOOO-BE-NEEEE?”
He gives a spiel about his medical approach — he’ll answer his cell phone at all hours, he will see us without appointments, he wants us to tell him if we don’t like something he says or does. Since we are husband and wife, we can share appointment slots if we want.
Cool, Joe. Can I get la pillola? He does some research on his computer. Strike two. “You should go to the pharmacist or gynecologist; they might know better about formulations.” Sigh, ok. “Anything else?” Well, I have this neck/back pain… “Why don’t you take a painkiller?” Um, I’d like to maybe be evaluated and determine the cause instead, and I don’t know if you heard about the opioid epidemic in the U.S. or not but… “Ok, here’s an order for an X-ray you can take to the hospital.”
Cost: 0 euros, increasing distrust levels, 1 lost sale for Joey’s pharma rep
Dr. Fredda (aka Ms. In-N-Out)
The pharmacist we went to after Dr. Tribbiani wasn’t sure which pill was the Italian cousin of the American drug, so she suggested consulting with a gynecologist. OK fine, I’m due for my annual exam anyway. Nothing about the experience was pleasant aside from the receptionist believing it possible that I might be under 21 (youth don’t pay for care).
The clinic (it’s an actual clinic!) is nestled inside an old villa which is in the center of a park accessible only by foot, because #Italy. It looks a little rough around the edges, but maybe it’s a historical landmark, and I should be honored to have my ovaries prodded in the exact spot Garibaldi won the Battle of Carbonara.
Dr. Fredda, who speaks English and four other languages, has me sign some papers, asks me what contraception I’m on, and quickly writes down a new prescription. I don’t have time to ask any questions because she’s ordered me to take off my underwear.
She points to a chair in the corner that has a piece of that medical paper draped over it. “Do I use that to cover myself?” I ask.
“No,” you fool, “put your clothes on the chair,” she says, scribbling away at her desk.
But, umm, you’re not going to quietly exit the room as you gesture to a floral cotton gown and then politely tap on the door again in four minutes and ask if I’m ready? No? Ok…
So, now I’m Winnie-the-Pooh-ing in a war museum as I tiptoe to the exam table a few feet away. The bare steel stirrups, used as horse bits in 1836, stare at me menacingly. “Put them under your knees,” she orders. I do as instructed but keep my legs slightly closed as I wait for her to finish arranging her Saw II table.
She then turns, looks down and scoffs at me: “Are you ashamed?”
Well if I wasn’t before, now I am.
“No, no,” I say, scooting forward to unveil my Porta Venezia.
I stare at the vaulted ceiling, hearing only the clinking of metal and my inner shame dialogue, until she breaks the silence to say, “And this is the Pap test.” Fun fact: you get a free swab every three years.
“OK,” she snaps her gloves, “everything normal. You can put your pants on.”
Pooh Bear waddles back across the terracotta, and Dr. Fredda hands over a piece of paper. “Come back to the clinic in six weeks for the results of your Pap test.”
You can’t send me a letter? Or call me with the a-okay? No, ok, cool, save me a suite at the villa in six weeks.
I’m expecting some more small talk or general women’s health counseling (Maybe she was self-conscious about her English?), but the visit feels like it’s come to a satisfying (for her) conclusion, so I say, “Ok, bye? Thank you? Ciao?” and walk out the door.
Alberto’s there in the waiting room, a comforting sight after a most uncomfortable eight minutes. There’s at least one thing in Italy I’m sure about.
Cost: 28 euros, all dignity
*Doctors’ names have been changed