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HEALTH

OPINION: Italian healthcare is stuck in the past – but now it has a chance to modernise

The move to digital prescriptions was one positive to come out of the pandemic in Italy, but this could soon be reversed - despite the urgent need for more reform, says Silvia Marchetti.

OPINION: Italian healthcare is stuck in the past - but now it has a chance to modernise
Paper prescriptions were the only option in Italy until the Covid pandemic. (Photo by Tiziana FABI / AFP)

At the end of 2022, Italy’s government approved a one-year extension of electronic prescription for medicines, but it is just temporary and there’s a high risk it might disappear in 2024.

The e-prescription should be made a permanent measure, alongside other urgent improvements in the Italian healthcare system that’s in need of modernization.

In recent weeks, doctors and patients held their breath as political parties debated the fate of digital prescription slips. Until the very end, it looked like the digital ricetta medica was going to be shelved, reverting in January to the pre-Covid paper slips and the nuisance of going to the doctor to fetch it.

The e-prescription has been one of the few positive outcomes of the pandemic. It proved a godsend for both general practitioners (medici di base) and patients during the Covid emergency, when social distancing was the norm and crowding at the doctor’s office was the best way to pass on bacteria and viruses.

Many Italians turned to the digital ricetta during lockdown, even those who’d normally queue up regularly at the doctor’s just to grab their prescription and go to the pharmacy.

READ ALSO: Five essential facts about Italy’s public healthcare system  

The ricetta elettronica also spares a lot of paper waste and precious time, allowing people to go shopping or to the gym instead of waiting hours in line. It has helped to boost the digitalization of Italian health care.

Before Covid, even patients with chronic diseases who needed a monthly prescription had to knock at their doctors’ door.

If next year there is no radical reform that makes digital ricetta the rule and a structural measure, it would be a major step back. 

Photo by Marco BERTORELLO / AFP

The truth is that not all doctors, nor patients (particularly the elderly), are digital savvy. Many doctors I know still prefer to write by hand the paper prescriptions with their personal signature.

My medico di base really needs to retire. He is 70 and even though patients call him by phone to order prescriptions he is able to send just some ones via email while others for specific medicines they still have to pick up at his office, getting in line as if they had to be visited. It is a major nuisance.

When I was living in Holland back in 2005 doctors were accustomed to sending digital prescriptions straight to the pharmacy nearest to the patient’s home, who just had to stop by after work. 

Patients with chronic diseases would regularly drop by the pharmacy next door and pick up the monthly prescribed dose. I wish it worked the same way in Italy.

READ ALSO: How bad is Italy’s north-south ‘healthcare gap’ really?

There are many other aspects of healthcare that should be modernised permanently in Italy. 

And this can be done by boosting online centralized services, which citizens could have access to through their fascicolo elettronico sanitario (electronic medical file), which is like their ‘health passport’ where all health information should be stored, from prescribed medicines to allergies, hospitalizations and results of exams. 

The fascicolo was launched with Covid to download test results and green passes, but it has enormous potential. It is linked to a personal tessera sanitaria (the health card), otherwise known also as the codice fiscale (tax identification number).

The electronic fascicolo should allow the booking of medical appointments and exams at public and private hospitals, and the ordering of medicines at your pharmacy that do not need a prescription. An SMS could be sent to alert patients when medicines and exam results are ready.

Much-needed healthcare improvements also include more efficient online bookings of doctors’ appointments, check-ups and exams. Many hospitals and clinics have online platforms for private booking, but these seldom work well due to internet glitches so patients have to revert to call centers which are always busy, leave their number and hope to be called back. Online platforms are also useful if one has to cancel an appointment.

READ ALSO: Who can register for national healthcare in Italy?

There should be online tickets for blood tests at medical labs and hospitals, downloadable on smartphones with a precise time. It’s crazy that people need to queue up early in the morning, without breakfast, just to take the bigliettino (ticket with their number) and wait to be called by the nurse for the blood test.

In Italy everyone knows that national healthcare waiting lists for surgeries, exams and day procedures can be months-long, but private facilities, where patients are willing and can afford to pay, cannot be as slow as the public sector. I remember once having to book an emergency private allergy test by phone and finding out I had to wait four months, despite it being at one of the biggest hospitals in Rome. 

Private appointments at public hospitals, which can cost up to €300, need to implement faster appointment procedures and boost the number of available doctors.

Italian public healthcare is one of the most democratic in the world, willing to treat anyone in need for free. But when it comes to modernisation, there are many challenges yet to overcome.

Member comments

  1. My doctor does use electronic prescriptions sent to the pharmacy, but then I need to go to the pharmacy to show my copy so they can order. the medication as the government does not allow them to keep a stock. Admittedly it’s not a standard medication but you would think the pharmacy could place the order without my confirmation .

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LEARNING ITALIAN

The key Italian vocabulary you’ll need for a doctor’s visit

Seeing a doctor can be a challenging experience if you’re new to the Italian healthcare system, but possibly even more so if your 'dottore' doesn't have a good command of English.

The key Italian vocabulary you’ll need for a doctor’s visit

Seeing a doctor is usually seen as a fairly uncomplicated task but everything gets a little harder when you’re in a new country, and Italy is really no exception as its healthcare system can be fairly tricky to navigate at first.

Additionally, not all Italian doctors are competent and confident English speakers, which means that their vocabulary may not be enough to cover the full extent of medical terms and procedures involved in an ordinary visit and they may naturally switch to talking to you in their native tongue when asking questions or providing information. 

As such, having some handy vocabulary under your belt can be a big help when trying to bridge any language gaps during your first appointments.

Making an appointment

In order to get an appointment (visita) with a public general practitioner (medico di base), you must be registered with the Italian national healthcare system (Servizio Sanitario Nazionale, or SSN) and hold an Italian health card (tessera sanitaria).

READ ALSO: Italian healthcare: Should you switch from public to private insurance?

Further, while in some countries you may call the local clinic (ambulatorio) and book an appointment with any doctor on duty, that is not how things usually work in Italy.

In order to see an Italian GP, you must be under the care of that particular doctor. Info on how to register with one of the professionals operating in the area covered by your local health authority (Azienda Sanitaria Locale, ASL) can be found here.

Doctor speaking on the phone

A doctor speaks on the phone while inside his office. Photo by Nicolas TUCAT / AFP

Once you’ve registered with a GP, you can go ahead and book your first appointment. You can generally do so via phone, email or, in some cases, online.

When booking by email or phone, you may be given an overview of the doctor’s office hours (orari di apertura) and asked what day (giorno) and time (ora) you’d like to schedule the appointment (fissare la visita). Should you need to reschedule the appointment later on, you could ask: Sarebbe possibile spostare la visita?

Remember: if you’re in need of an urgent appointment, you can ask to see a doctor from Italy’s Guardia Medica, a medical care centre that operates outside of GPs’ normal working hours and on weekends, or visit your local hospital’s ER (pronto soccorso).

Seeing your doctor

Though they provide patients with a set appointment time, Italian clinics tend to run a little late, so you may have to wait for your turn in the waiting room (sala d’attesa).

Also, new patients are usually handed a form (modulo) to fill out with general information about themselves and their overall health (stato di salute) just before their first appointment. 

Once you’re in their office (ufficio), your doctor (dottore for a man and dottoressa for a woman) will enquire about the reasons behind your visit. 

If you’re there for a routine checkup, you could say that you’re visiting for a simple controllo. But if you’re there for any type of health problem, you’ll likely be asked what your symptoms (sintomi) are. 

You may have fairly common symptoms – for instance, a cough (tosse), a sore throat (mal di gola), fever (febbre) or headache (mal di testa).

READ ALSO: Coughs, colds and flu: What to say and do if you fall sick in Italy

But if you don’t really know what you have or don’t exactly know how to describe it in Italian, don’t worry: you can just indicate where the pain is coming from by saying mi fa male followed by the part of your body that’s aching (stomach, or stomaco, abdomen, or addome, chest, or petto, etc.).

Doctor speaking with patient inside his office

A doctor speaks with one of his patients inside his office. Photo by PASCAL POCHARD-CASABIANCA / AFP

At this point, your doctor may ask you further questions on the type of pain you’re feeling – for instance, whether you have a throbbing (pulsante) or stabbing (lancinante) pain – and ask you to lie down (stendersi) or sit (sedersi) on their table (lettino) to perform a physical examination. 

Among other things, the doctor might measure your heart rate (battito cardiaco) and blood pressure (pressione sanguigna), look in your throat or ears with a torch, or listen to your heart or lungs with a stethoscope (stetoscopio).

Further tests and medicines

Depending on the outcome of the physical examination, your doctor may refer you to a specialist for further diagnostic exams and tests (esami diagnostici), including blood tests (esami del sangue), an MRI scan (risonanza magnetica), an ultrasound (ecografia) or an ECG (elettrocardiogramma). 

But if the source and nature of your health problem is already clear to your doctor, you’ll likely be given a prescription (ricetta) for the purchase of medicines (medicine) as well as some instructions to follow to achieve full recovery (completa guarigione).

READ ALSO: Why are medicines so expensive in Italy?

Medicines may come in the form of powder (in polvere), tablets (pastiglie or compresse), drops (gocce) or syrup (sciroppo).

Remember: Italian doctors tend to have fairly bad handwriting (locals often jokingly refer to it as ‘hieroglyphs’), so make sure you know exactly what you need to get at the pharmacy (farmacia) as well as how many times a day (volte) you need to take each medicine. 

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