Italian Medicine

With no more clinical requirements for medical school and 5 – five! – glorious weeks of free time before graduation, I took myself to Italy for much needed farniente and treats that do not include 6am biscuit and gravy from the hospital cafeteria.  Gelato, cappucino, exuberant glycine draped over old city walls – the flower, not the amino acid -, re-tracing the footsteps of the Gods in The Forum: essential ingredients for the perfect vacation.

My immune system also decided to go on vacation and no amount of fresh pasta was going to fix the brewing UTI – urinary tract infection – I felt the moment I landed.  A few internet clicks searching for English-speaking doc and a cab ride across Rome later, I found myself in front of a residential apartment building.  Dr. W’s office was on the first floor, in a large apartment that had been converted into medical offices.  The dining room was the waiting room, the kitchen was the laboratory, and the living room and a couple of bedrooms had become doctor offices.  This came to no surprise to me, as this is how all the doctors I had gone to when growing up in France had set up shop.  Private practices are rarely in medical office buildings here like they are in America.  My family physician in France has a solo practice and actually lives and works in the same apartment.

Dr. W. was a soft-spoken man with carefully coiffed white hair.  He was born in Germany and had gone to medical school there, but had done residency in New York and was board certified in Family Medicine.  He had settled in Rome, no doubt because it is a lot sunnier than Germany and the cannoli are better than in New York.  After I filled out a simple contact sheet, he brought me back to his office.  A modern desk, a nice rug on the floor, an antique cabinet in the corner, beautiful paintings on the wall.  And no exam table.  I told him my story.  He took notes on a little card.  I saw him wrote “PMHx”, our common American abbreviation for past medical history.  He came around the desk, taped my back looking for costovertebral tenderness, a sign of pyelonephritis or kidney infection due to an ascending urinary tract infection, and also palpated my belly – all while I was sitting.  I peed in a cup and in under 10 minute he had dipped my urine and looked at it under the microscope.  It had the tell-tale signs of a UTI: white blood cells, leukocyte esterase (an enzyme released by white blood cells or leukocytes while fighting infection), and red blood cells.  I asked for Nitrofurantoin antibiotic because I had taken it before for a UTI and it worked.  He was amenable to it but told me that in Italy, both Bactrim and Nitrofurantoin had not been used in almost 10 years and Ciprofloxacin (Cipro) was the drug of choice.  However, both were now being suggested as first line again.  Does this have to do with resistance patterns in Europe vs US?  I have no idea.  According to his formulary, Nitrofurantoin is to be taken QID or four times a day.  In the US, we prescribe it BID or twice a day.  Wake up at 4am to take a pill?  Nobody wants to to do that.  So instead he prescribed Cipro.  On the prescription sheet, he also wrote for 1) Bactrim, should I not get better after a few doses of Cipro, 2) probiotics, should I get antibiotic-associated diarrhea, and 3) topical anti-fungal, should I get antibiotic-associated yeast infection.  He also wrote for 1 refill of Cipro should I have residual symptoms after the first course.  I was amazed at this level of forethought.  I will most likely not get antibiotic-induced diarrhea or fungal infection, but the fact that he planned for it and educated me about it was simply outstanding care.

He charged me 140 euros: 110 for the visit and 30 for the urinalysis.  140 euros seemed like a lot at first, but I was so very glad for the excellent service.  Besides, how many of us actually know how much physicians charge for an office visit in the US?  We only see a tiny fraction of the cost in the form of our copays.  He said that many of his American patients manage to get reimbursed by their insurances.  He gave me a receipt and a copy of the urinalysis.  I thanked him profusely for seeing me on such short notice (3 hours).  He walked me to the door – the same door he had personally answered – and apologized for there being no receptionist.  He said that the office was closed today because he was on his way to re-take his Family Medicine board exam so he could stay certified.  However he knew how painful UTIs are and wanted me to be seen promptly.  Would you have seen a patient on short notice the morning before sitting for your board exam?

Italian medicine: prompt, comprehensive, and humanistic, all under the watchful eyes of what probably were two hundred year old paintings on the wall.  Oh and guess how much Cipro cost in Italy without insurance?  6.75 euros.

Sometimes it takes being the patient to be reminded how to the kindness of a medical provider makes all the difference.  Va bene.

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