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Trip Report: My Encounter With the Italian Hospital System

Trip Report: My Encounter With the Italian Hospital System

Old Feb 28th, 2015, 12:26 PM
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Trip Report: My Encounter With the Italian Hospital System

If, as it is said, one of the benefits of traveling to another country is learning about and experiencing another culture, then I experienced that benefit in a rather unusual way last fall when my wife and I were on vacation in Verona.

Our first night in Verona I awoke about 1 a.m. to a racing heartbeat in my chest. I knew that I had a mitral valve problem that would have to be fixed at some time in the future, and I also knew that having atrial fibrillation (a fast and irregular heartbeat) would be a possibility for me. So my wife and I got dressed and went down to the desk, where the night clerk called a cab and told the driver to take us to the emergency room.

We arrived around 2 a.m. at the general emergency room (Pronto Socorso Generale), a large, rectangular room mostly filled with people sitting on hard, plastic chairs. On the wall at one end was a television screen playing the news. At the other end, near a set of double-doors, was an open widow, behind which sat a man who looked like the only hospital employee in the room.

I went to the window and attempted to explain to him, in a combination of English and my minimal Italian, what my trouble was. I also gave him a copy of our emergency medical form consisting of a list of my current medications as well as information about my current medical situation, recent tests, and previous surgeries. We always carry a copy of this when we travel, and for this trip, I had also printed the information into Italian, courtesy of Google Translate.

The staffer took some basic information from me, looked over the medical form, and then motioned me to go through a nearby door which opened onto a small room. When I got into the room, the same staffer took my temperature, blood pressure, and pulse rate, and then gave me a small piece of paper on which was written the word “verde” (green) as well as a number. He then motioned for me to go out into the large room and wait.

We sat down and then noticed a large, computerized message board hanging on one of the side walls. Down the left column of the board were rectangles of either red, yellow, green, or white. To the right of each rectangle was a number. (We now knew what the information on the paper I had been given referred to.) Finally, the third column of each row contained the time when the person entered the ER.

At intervals, a staffer would open the double-doors next to the desk and call out a color and number (the one at the top of the list on the message board), and whoever had that combination would disappear behind the doors.

We finally figured out that the color-number combination was part of a triage system. Red numbers (which always bounced to the top, no matter when the person arrived at the ER) obviously meant that the person was in extreme need of immediate treatment. Next came yellow, then green, and then white. Some of those with white numbers had been waiting since 10:30 the previous evening. Evidently, some of them had also given up and left the building, since they did not respond when their number was called.

I thought the system was good, since it allowed everybody to know where they were in the line and that those in most need were being seen first. Moreover, at certain points, the board would flash a sign “Emergency in Progress, Waiting Time Longer” which warned those in the waiting room that the regular routine would be interrupted.

Finally, around 3:30 a.m., my color-number was called and I too walked through the double-doors. We were taken into a room with a doctor sitting at a desk as well as a couple of other males who might have been nurses or technicians. The doctor asked some questions and read my medical summary. Technicians took some blood, did an EKG, and an echocardiogram. At the conclusion of all this, the doctor said he wanted to monitor me for two hours, so I was put in bed in a large room with a number of beds separated by curtains. There was a desk down from my bed and on the other side of the room where various medical personnel would come and work for awhile and then leave.

After a little more than two hours, the doctor came back. My condition, he said, wasn’t periculoso (dangerous); nevertheless, he wanted me to stay in the hospital for a couple of days just to make sure, after which, he said, we could go on and enjoy our vacation. I decided to agree to be admitted, at least “for now.”

Next: The Clinical Decision Ward
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Old Feb 28th, 2015, 12:42 PM
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I'm interested to hear what comes next. My husband and I have both spent time in the Italian pronto soccorso--each time getting very good treatment. I wasn't terribly surprised that it was free for my husband (who is Italian with Italian citizenship) but I was pleasantly shocked when it was free for me.
Note to all: some Americans are shocked that in many Italian hospitals there is no soap and no toilet paper in the rooms. These are stolen by hospital employees the way that we all steal pens and yellow pads; they do not mean the medical care is poor. In my experience, it's very good. However, if I had a major dental problem while in Italy, I'd either drug myself until we came home or go to Switzerland.
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Old Feb 28th, 2015, 01:03 PM
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Interesting post. Signing on to follow.
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Old Feb 28th, 2015, 01:19 PM
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Where does this information come from that there is no soap or toilet paper in hospital rooms in Italy -- and that it is stolen? Where were you?

Also, I have an excellent dentist Italy in the very small town where I live. In fact, he is better than the Park ave. dentist my husband and I had in NYC. This dentist has actually redone some of the work that was done in NYC that failed. There are actually 2 good dentists in my town. If you need a dentist while in Italy, you can certainly find a good one if you inquire. Italians have beautiful smiles. Haven't you noticed?
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Old Feb 28th, 2015, 01:22 PM
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Very interesting tom18. Following as well.
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Old Feb 28th, 2015, 01:24 PM
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Red code means immediate danger of life.
Yellow code means some wound or serious condition, but not immediate danger of life.
Green code means some condition, but not really urgent.
White code means you should look for your physician and the case does not really belong to an emergency room.

If the condition is serious, it is better to summon an ambulance instead of going on your own to the emergency room. Often the ambulance personnel is able to contact the emergency room triage personnel even before you get there and get you a better code.
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Old Feb 28th, 2015, 01:28 PM
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By the way, tom18, I am sorry to hear your trip was interrupted and I am sure others will find your trip report valuable should they ever need to make an emergency hospital visit. Good for providing an explanation of the color code. On my very first trip to Italy I spent 16 days in a hospital ward in Bologna, and many moments along the way felt quite surreal.
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Old Feb 28th, 2015, 02:43 PM
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There's no soap in hospital room bathrooms because people are expected to bring their own from home. They also bring their own towels, glasses and cutlery. There are no hospital gowns for those who haven't brought along their own nighties.

I've been in the hospital several times and there's always been toilet paper.

I've had excellent medical care since I've been living in Italy. I've had very complicated and rare dental problems since I was a child. (I was even an exhibit at a dental conference at the age of 12.) So I'm an expert on dentistry. The best dentist I've ever had in my life is the one I have now in Italy. I'm sure that a couple of teeth I lost years ago could have been saved by him. I also once had a Park Ave. dentist, and one of the teeth I lost was directly caused by his bungling.

I've also had a life-long mitral valve problem that was never diagnosed properly until I came to Italy. I mentioned irregular heartbeats at every physical I ever had, and it was always pooh-poohed. One doctor said, "Maybe you drink too much coffee", although I'd had this problem since long before I ever had a cup of coffee.

My one fear is that one day I'll have to return to the US and be bankrupt for inferior medical care. Yes, they do have the Mayo Clinic and Sloan Kettering, but the average person has to rely on ten minutes with a nurse practitioner in Dubuque.
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Old Feb 28th, 2015, 03:06 PM
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I have never had a private room in an Italian hospital, and I have never been totally bedridden in an Italian hospital, so I have only used the common hallway bathrooms inside the hospital. But there was always soap to wash my hands, from a dispenser. And there was always toilet paper.

But yes, during my hospital stay, my husband had to bring me pajamas and other personal things a US hospital would have supplied (and put on my bill!). A very kind relative of another patient in my ward loaned me cutlery and glasses, etc.
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Old Feb 28th, 2015, 09:30 PM
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Thanks for the info on the ED system, I work in a public hospital in Australia and would love one of those coded message boards Sandralist and bvlenci... curious about the healthcare system in Italy, is it publicly funded? (we have a public system 'Medicare' where patients do not pay for any part of their care...consultations, surgery, hospital stay, medications, allied health, rehab, etc; or a private system where you can choose your surgeon but pay for the insurance and the significant gaps between insured cost and actual fee)
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Old Mar 1st, 2015, 01:33 AM
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very interested in this please keep reporting
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Old Mar 1st, 2015, 02:35 AM
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Interesting about being expected to bring one's own nightwear. When my father was in and out of the local NHS hospital in his last years, I started with packing his own, but eventually noticed that they kept getting swept up into the communal laundry, from which he would be re-supplied with a pair from stock. Eventually we gave up trying to hang on to his, but not before I'd got the nurse to put a note on his record card (for all the good that did): as it turned out, the space she chose to write "Likes to wear own pyjamas" was under the heading "Sex".
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Old Mar 1st, 2015, 02:56 AM
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pl - lol.

tom18 - that is a very wise system, to give people such clear feedback. i bet you also were much appreciated in turn for writing down your meds.

the other day your truly would surely have been a yellow. a broken and dislocated wrist will not kill one, but let's just say i was hard put not to disturb my fellow patients.

when i had my dvt i was relieved to be waiting in er -i figured, good, this means i can't be too badly off! then they called me. uh oh.

glad it worked well for you. hope you had other happier things to report about your trip.

pl that is hilarious.
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Old Mar 1st, 2015, 06:56 AM
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Sue -- sorry about your wrist. Did you have to have surgery ?
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Old Mar 1st, 2015, 06:59 AM
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Interesting post, tom! I am following along as well. Coincidently, I am renewing my travel/medical insurance this weekend!
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Old Mar 1st, 2015, 07:10 AM
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Following along. I hope you are okay now.
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Old Mar 1st, 2015, 07:29 AM
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Well, this is definitely a report I need to follow. Thanks for posting.

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Old Mar 1st, 2015, 07:37 AM
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Thanks for sharing your medical experience while traveling. Your story will help others in many ways.

Just for my knowledge, I would like to know if Italian hospital system is free to the public?
Did your insurance cover any part of the treatment?

Adelaine--would you elaborate on the medical system in Australia.Is it also free to the residents?

How are travelers charged or medical care in Australia?

Appreciate your input, as it is good to know since we can sick anywhere at any time.

Have a good day.
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Old Mar 1st, 2015, 07:37 AM
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Thank you all for your replies.

More about the quality of Italian medical care later.

I had my mitral valve repaired when I returned to the States at the planned completion of our trip. All has gone well. Thank you.

Sandra - they supplied the cutlery and glasses for us.
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Old Mar 1st, 2015, 07:40 AM
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The area of the hospital to which I was admitted was one floor above the ER. On the second day I was there, I was given a pamphlet which explained (as best I could tell) that this section of the hospital was known as the Sezione di Decisione Clinica (roughly translated, “clinical decision ward”), where doctors have as long as 72 hours in which to observe patients in order to determine whether the patient can be released or whether they need to be admitted to a “regular” ward of the hospital. Had I been in the U.S., the ER doctor probably would have released me with directions to get a follow-up appointment with my cardiologist. (No telling how long that would have taken!)

I was rolled out of the elevator onto a long hall with windows on one side and a number of sliding doors on the other. The attendant stopped the gurney, slid open the door, and I beheld a scene which seemed to be right out of a 1950s American hospital. In front of me was a large two-room complex separated by wall, with each room containing four beds. An opening in the front of the room permitted movement between the two rooms, and a nurses’ station containing the patients’ paper charts spanned both of the two rooms.

A nurse motioned for me to get off the gurney and onto the front bed nearest the nursing station, the only unoccupied bed in the ward. The other three held males who were watching the scene with curiosity. (I soon became aware that the wards were segregated by sex.) Up to this point, I still had on all the clothes that I had worn into the ER. Once I had gotten onto the bed, the nurse motioned toward my feet and said, “Scarpi,” which I recognized as meaning “shoes.” So I took off my shoes, which seemed to be what she wanted. The nurse then hooked me up to a four-lead EKG machine and turned it on. Then she left and went back around the counter to the nurses’ station. Except for my pajamas and a change of shirt that my wife brought me later in the day, I wore the same clothes for the entire time of my hospitalization. No opening-in-the-back hospital gown in this ward! And no “care package” of a toothbrush and toothpaste that routinely gets provided in our community hospital back home.

Once ensconced in bed, still in my clothes minus only my shoes, I began to notice the rest of the dorm. The room itself was spartan, with no tables or trays or chairs for visitors - and no TV. There was, however, a crucifix hanging on the wall of this secular hospital. Only one of the four beds (the one nearest the outside wall) could be curtained-off for privacy. At the front of the room opposite my bed stood the communal bathroom complete with soap dipenser, toilet paper, and paper towels. It was, to say the least, an interesting experience.

Shortly after I had arrived, a man in a white uniform came in and asked me, “Zucchero?” (sugar) and “Latte?” (milk). Since I like them both, I said, “Si.” It turned out that the man had a number of tasks in the ward, one of which was bringing in the patients’ food trays. Pretty soon he brought in my breakfast, the major component of which was a cereal bowl filled with milk and laced with sugar!

I would soon learn that meals (served at 8 and 11:30 a.m. and 6:30 p.m), although probably healthy, were meager and unappitizing – “almost inedible,” according to one description of Italian public hospitals. No ordering from a menu here: Everybody got the same thing. During my stay, breakfast consisted of a cereal bowl filled with tea or milk with sugar that was eaten with a tablespoon. In addition, we were given two small pieces of hard toast which, as one of my colleagues in the unit mimed to me, was best eaten by dunking it in the bowl of milk. Lunch and dinner were both fairly similar in composition: a piece of tough boiled meat (e.g., chicken with skin or a small puck-size hard hamburger patty); tasteless pasta with a little sauce (I never dreamt that Italians could mess up pasta); a steamed fresh veggie; one piece fresh fruit; and a hard roll. I generally ate the vegetable and the fruit (which was the best item of all), a little bit of the pasta, and maybe a taste of the meat and part of the roll.

Next: Daily Life in the Ward
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