Wednesday, February 20, 2008

Getting Personal

At the beginning of the year I took the bureaucratic leap into the Italian health care system. While it was not excruciatingly complicated, it was quite time-consuming. First, I had to go up the hill to the main health office to wait in line in order to declare my intent, show the proper residenza paperwork and obtain the enrollment form. Then I had to go to a specified bank in town in order to pay the required fee, as I am not a dependent worker who has an employer paying the subscription for me. Once I had the receipt, I took that back up the hill to once again wait in a long line, give my personal data and become enrolled. The clerk informed me that my tessera (enrollment card) would arrive in the mail in about two months.

When I returned from my trip to the US I found a letter from the health system and thought my card had arrived surprisingly quickly. Instead, it was a letter informing me that, as a new member, I was entitled to a free PAP test. It listed an office address, date and time. I called the number provided to confirm the appointment, figuring that as it had been more than 20 months since my last exam, I ought to have it done, though I admit I was little hesitant about introducing myself to nationalized healthcare in such an intimate way.

Male readers may want to stop here. The rest deals with what is delicately labeled as “female issues”.

As all you feminine readers well know, a pap test is not usually a major ordeal, but the whole set-up is a bit uncomfortable in general. Cold, sterile room; paper gowns; metal tables; and, of course, stirrups. Ah, it’s fun to be female, isn’t it? My gynecologist in New Mexico was very nice but always behind schedule. After checking in at the reception desk, I’d be freezing in the scanty, back-closure gown for nearly an hour awaiting her entrance to perform the deed. Outdated magazines can only go so far to keep you occupied in such a state, then sighing and clock-watching sets in. Just when I was about to get dressed and stalk out, she would enter, all smiles and apologies, and get down to business.

The exam was just a tad different here. I arrived at the appointed time slot at the address provided. The building contained many closed doors, presumably offices or exam rooms, but I had no way of knowing as they were all unmarked. No reception desk for checking in, no one around to ask. I stood about a minute trying to figure out where I needed to go, then latched on to a nurse as she came out of an office, before she could flee for lunch. I told her I was here for the pap screening but didn’t know which office I needed. She told me to simply take a seat and wait. “Uh, but how will they know I’m here? Don’t I need to check in somewhere?” I asked ignorantly. No, no. They’ll come for you, she responded. Va bene. Pretty soon, a few other women trickled in and just sat down, each clutching the same letter that I had received. We all smiled at each other weakly, but no one attempted to converse.

About five minutes later a woman yelled out of an office down the hall, “AVANTI!” Basically meaning, whoever is first, come on down. I entered the office and sat in front of her desk while she took my letter and started to input the information. No matter how hard she tried, the spelling of my last name, Schneider, completely defeated her. Not for the first time did I rue the day I changed my name upon marriage. Italians cannot grasp all those consonants in a row. Then she had a hard time finding my inscription in the computer system. Meanwhile, a nurse had entered who seemed very kind, and helped her find it. I thought she’d be the one conducting the actual exam, but she departed with a friendly “arrivederci”.

Once the clerk finished the paperwork and I had signed it all, she instructed me to strip down in the nether regions. “Uh…where?” I asked, looking around the office. “Over there,” she bobbed her head in the general direction of the filing cabinet. I was a little confused but got up and peeked around to find an exam table set up, within the office space, with only a shabby filing cabinet shielding it from view. I suddenly longed for the cold, sterile exam rooms I used to complain about, but obligingly did as I was instructed and hopped up on the table. No gown, no covering, just…uh, out there. Then, the not-so-friendly clerk abandoned her computer terminal, walked over and slapped on a pair of latex glove and set about performing the exam, the details of which I won’t go into but which you all know well enough (except to say that the usually-metal speculum was plastic). She mumbled something that I didn’t understand and asked her to repeat it, which she did but just as hastily and garbled as the first time, so I have no idea what she was communicating. I didn’t much care at that point, and quickly got dressed and left, the clerk/nurse instructing me to tell the next lady-in-waiting to come in.

All told, the process took only fifteen minutes, a far cry from the hour wait I had in my plant-festooned and brightly-lit gynecologist office at home. And I guess the procedure and outcome are the same, only free. My first welcome to the Italian health care system was a relatively painless, albeit very personal, one.


Annika said...

It's the same here in Sweden. I just hate to undress my lower body and then walk half-naked to the examination chair. Hate it. And then you have to lay there, still halfnaked and uncovered, and WAIT until the nurse is ready. Last time she even told me to put my legs "up there" while she still was putting on her gloves and so she sat for what felt like minutes with a full view of my private parts. To feel relaxed enough to chitchat under those circumstances isn't easy!

But hey, it's free, or at least almost free - we pay €10 for a pap smear here. I can take five minutes of humiliation for that price.

Anonymous said...

Soooo, now that you know the routine, why not bring your own little *drape* next time you have to go to the doctor? Personally, I'd rather look stupid, wrapped up in my own drape, than *hanging out* behind the file cabinet.....must be that American modesty thing. On the other hand, if that's the trade-off for living in Italy, it seems like a small indignity. Boh!

Anonymous said...

We run an office (in Canada - that is "plant-festooned" and folllow our office wait times very carefully. When we moved to a larger office we assumed that our wait times in the office would drop as our capacity increased. Quite the opposite -- people had to wait longer in the office because the complexity of the process increased. Sometimes simplier is better but I would suggest that careful management in a more modern facility is the ideal. I blog on this exact topic at!

Texas Espresso said...

i am not looking forward to that. it seems like such a "back alley" kind of thing. I mean i know its not, but just very cold and impersonal doing a very personal not that I want lots of conversation - i don't like dawdlers. hehe just from what Ive read from bloggers having babies there - well it doesnt sound like a great

Valerie said...

Annika, that was pretty much the routine I went through...not what I'd expected! I guess it's better you're "only" half-undressed but still. Yikes. But it was over very quickly. Phew.

Anonymous, at least I was sitting there with it all hanging out for long, just a minute so not really time for draping...but maybe I'll bring an oversized scarf next time...just in case! ;)

Ian, that's interesting...I'd have thought it would become more efficient, too. Hmm.

Texas, it sure was different! I guess you could pay for a private doctor, but I figured this was a free invitation and chance to try it out. Besides, it was a blogging opp, too. ;)

Anonymous said...

I'm speechless! I guess the next time I lay there looking at that pretty picture on the ceiling while waiting an hour in my little paper gown, I will be thankful I have that paper gown.

Anonymous said...

Sorry I don't think you should complain to much as the service is free...ok could be better, could be improved but as an Italian leaving abroad I prefer the doctors in Italy where at least they seem to understand their job. I believe that they are not always kind as we can aspect but I can tell you that signing up for the social health system and then receiving a letter for a pap test is not as bad as you described it... Where I leave I have been insulted by doctors, a traumatologist a doctor specialized in bones...pretending to pass for a endocrinologist told me that I need to remove my thyrod after I have told that mine was a completely different problem and I needed just doing a chech-up like I do every year. Italy often is misunderstood, foreigners often think that we are like in the American films...I mean those film where we appear as mafiosi, people that just shout and sing eating pasta all day in a old country that doesn't work. You should travel to other mediterranean countries to see that afterall Italy is not such bad place!

Kataroma said...

Welcome to my world! I'm pregnant in Italy and have to deal with this for pretty much every exam that I do publicly. Dirty offices, rude people, no privacy, having to pay for everything (it's not free in my region) and then having to run around town getting impegnative, picking up results (which are never ready on time) etc. Then people say "but what do you expect? (sigh!) this is a public office" Sorry but considering all the taxes I pay here I expect more - some toilet paper in the loos, signs on doors, a receptionist to tell you where to go and non-rude nurses would be the least I would expect in a 1st world country!

Luckily I'm not a terribly modest person.