A Day at the Pronto Soccorso
There’s nothing like a trip to the ER to get the real feel for another country and its culture. With the help of a friend, I had the opportunity to do just that on Monday.
My friend’s Italian health care odyssey began in Milan where exacerbation of a health condition required a “house call” from the hotel’s recommended doctor. For just E200 (“Cash only, grazie”) she got a diagnosis and a prescription. While she packed up for our trip to Panzano, I walked to the nearest pharmacy where the pharmacist retrieved the med in two minutes and I paid the E16.
For two days here in Panzano my friend seemed slowly on the mend, but still not as quickly as she expected. We deliberated on the next step. “I think you need to go to the ER,” I told her. “You need lab work and tests a doctor can’t do on another house call.” She reluctantly agreed and so off we went with directions and advice from Monia, my landlady, to Santa Maria Annunziata Ospedale in Florence.
Then the adventure began!
At the reception window she was handed a clipboard with a paper form to collect her basic information. When she handed it back she was directed to sit on a red couch. Ah, so now we noticed the waiting room was filled with red couches and blue couches! A simple and ingenious system! There were albout a dozen people scattered among the 6 or 7 red couches. We soon deduced that the red couches were for Triage!
About twenty minutes later an efficient male nurse called her into his office. His English was limited so he interrupted the interview a few times to run out to the receptionist for her translation assistance. Interview completed, my friend was given a wrist band with a number and directed to return to the red couches. How do we get to a blue couch?
As we observed the process we saw that a transport aide came into the waiting room and called out numbers. When the number on your band is called you got to see the doctor! Two hours passed on the red couch before my friend’s number was called. The doctor examined her, did tests and then she was sent to a blue couch!
An ER is a facinating venue for people watching and this ER did not disappoint! We saw countless foot and leg injuries which my friend concluded were the result of ancient, uneven streets, sidewalks and curbs. As good an explanation as any. A pregnant woman in active labor walked in with her husband and stood patiently waiting her turn, grimacing every few minutes with a contraction, like an island in the middle of all the activity. After at least 15 minutes while nurses and aides came in and out attending to other patients, it was finally her turn in Triage.
In the end, after 10 hours, most of it on lumpy blue couches, my friend was discharged. Giacomo, a warm, engaging, young nurse with plans to visit California next year, handed her the discharge summary and a printed bill for E167 almost as an afterthought. When she asked where and how to pay, he seemed uncertain and unconcerned.
My personal note after a career in healthcare: In Italy, health care is every citizen’s right. And even we, as foreign ‘Visitors” (immmigrants?) were given the same care, treated with dignity and without prejudice. The inconsistent, confusing, expensive, insurance driven system we have here seems insane by comparison. In Italy, the patient and her needs are the primary concerns, not the payment method. Isn’t this is a more compassionate approach than the entry into our health care where the first person you meet is a registrar who must confirm how you are paying for care before any care is rendered? It seems a country as rich as ours where billions (Billions!) of dollars are being spent to saturate the air waves with campaign attack ads could figure out a way to redirect spending for things that would have a lasting, positive effect on people- like universal health care!