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What To Do If You Get Sick in Italy

What To Do If You Get Sick in Italy

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Old Dec 5, 16, 8:53 am
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What To Do If You Get Sick in Italy

A nurse friend who went to Venice when I wasn't there developed diarrhea, and asked the hotel front desk what she should do. The hotel called the "house doctor," who charged her a 150 euros to tell her she had diarrhea, and sold her Pepto-Bismol for an extra 20 euros.

In the USA, for any emergency you call 911. In Italy, there is not a single number. There is a specific number for fire, another for police, another for an ambulance. Everyone who is traveling to Italy should know if you are having a health care emergency, call 118. They will put someone on who can speak english. You should have 118 memorized on your phone.

For something that you wouldn't go to the ER for in the USA, like a mild headache, simple diarrhea, uncomplicated back pain, you should go to the pharmacy. In the USA you generally don't speak to the pharmacist. You speak to a pharmacy tech, and the pharmacist is working in the back.

In Italy, the pharmacists are trained in basic medicine. Pharmacies don't have counters with medications that you can browse. The counters have shampoo, vitamins, and things like that. For medication, even an aspirin, you need to speak to the pharmacist who will give you a basic diagnosis, and recommend a non-prescription medication provided over the counter.

If it's something you wouldn't go to the ER for in the USA, and you just need basic relief for a simple headache, foot pain from the cobble stone streets, heartburn, diarrhea, etc., go to the pharmacist. In the center of major cities they will know enough english.

If you need the help of more than a pharmacist and more than an over the counter drug, do not worry. In general, the health care that you will get in Italy is better than what you would get in the USA. The World Health Organization (WHO), a highly respected independent body, ranks the US health care system as number 31 out of 191 nations in quality. It is no where near as good as Italy, which is ranked #2, after France.

https://en.wikipedia.org/wiki/World_...ystems_in_2000

That report may be dated, but more recent reports from Bloomberg, the Commonwealth Fund, and others, indicate that things have not changed. Bloomberg Reports recently ranked the USA as #50 out of 55 large countries in health care, with the only lower ranked countries being Colombia, Azerbaijan, Brazil, and Russia.

https://www.bloomberg.com/news/artic...east-efficient

All independent reports agree that health care is better in Italy.

Emergency care in Italy is free. Actually, nothing is free, but in Europe the belief is that costs should be spread across all of society so that somebody becomes sick doesn't have to choose between not obtaining care, or going bankrupt. The cost of health care is dispersed across the entire population, because you never know if you will be the next one who will get sick. I'm not making a political statement, it's just the way it is not only in Italy, but in all modern countries except the USA.

That means that if you are having a heart attack and go to the ER, then get emergency heart surgery, then spend a month in the ICU, then spend another month in the hospital, the total cost to you will be a twenty euro co-pay. All emergency health care in Italy, for citizens and non-citizens, is free.

Don't hesitate to go to the ER if you feel you need it. Don't do what a friend of mine did. He developed chest pain and got on a plane to come all the way back to California with an ongoing heart attack, losing precious cardiac muscle on the way, because he didn't know or trust the Italian system. Go to the ER, and do not worry. The care is at least as good as in the USA.

The recent National Academy of Sciences Report, "Emergency Rooms in Crisis," made it clear that ER's in the USA have wait times as long as 18 hours, there are often no hospital rooms for patients who often have to "board" in the hallway for the first day of their hospital stay, ambulances are diverted from one hospital to another because the ER is full, and so on. That doesn't happen in Italy.

In Italy an ER is generally empty. It doesn't mean that you will be seen immediately. You might have to wait because they may need to call an orthopedist if you broke a bone, or you might have to wait for the radiologist to read your x-ray, etc. The nurses and other staff might not speak that much english, but most speak basic, and almost all doctors in major cities speak english.

The reason why ER's are generally empty is that by law, every Italian citizen must obtain a social security card, and must have a family doctor. The parents of every newborn child must choose a pediatrician within weeks of the birth. When an adult or child gets sick they don't go to the ER, they call their doctor, who either calls in a prescription, does a house call, or meets them in the ER. This approach has resulted in Italy having per capita spending on health care that is only a fraction of what it costs in the United States, with far better patient outcomes.

There is a two-tier system in Italy; public, and private. If you want more amenities and faster service, but not necessarily better care, you can pay out of pocket for the private system. It's faster, and nicer, but won't be free. You can choose a public, or a private hospital for an emergency, provided you have time to make a choice, and either not worry about a bill, or get a bill and deal with your USA insurance to cover it. Private hospitals are nicer in amenities.

In Italy, almost all doctors start in the public system. As a government employee they can retire at 30 years, with almost full pay for the rest of their life, just like a policeman or fireman in NYC. They are usually only about 55 years old when they retire, and then they go into "private practice," and charge a high fee for private patients, while also collecting their pension for the rest of their life. I'm not judging, just reporting.

I'll provide my last personal experience with the public system, since I haven't worked in a hospital in Italy for almost three years. Last year I took a kayak out of Venice to go to Torcello, an almost abandoned island that used to have more inhabitants than Venice itself. Now, it's a ghost town. It's more than half way to the airport. When I finished there, I decided to paddle to the airport to watch some planes. That's a very long way.

Almost all of the water around Venice is very shallow. That's why Venice was impervious to invasion for over a millennia. No boats carrying troops could attack them because they would get stuck in the mud of the shallow lagoon that is only 1-2 feet deep. The Venetians had dredged deep under water canals that were unmarked, and that only they knew about, and that could handle a ship. When the invaders would get stuck in the mud they would take their ships out through their hidden underwater canals and destroy invaders like sitting ducks. It worked for well over a thousand years.

In a kayak you have to stay out of the dredged underwater canals because you will be run over by a vaporetto or speeding water taxi. If you get stuck in the lagoon during low tide you will be stuck in the mud for six hours, until the high tide comes in to lift you back up. Having lost track of time, I didn't want to get stuck in the mud, so I paddled like hell to get back to Venice before the low tide would strand me in the middle of the night. When I finally got back to Venice my left wrist was severely swollen from the effort. I went to Oespedale (hospital) at Campo San Giovanni Paolo. There is a vaporetto stop called Oespedale, near Campo San Giovanni e Paolo. That is one of the most splendid places in Venice. Every tourist should visit that campo.

I went to the ER and took a number, like going to the bakery. They called me in about 20 minutes. I showed them my wrist. They said I'd need an x-ray. They sent me to another building for the x-ray. When I got there, there was only one person ahead of me. The x-ray was taken, and they told me to wait. Five minutes later the radiologist came out and went over the x-ray with me, and said it was negative. He sent me back to the ER, where they told me to wait, because they were waiting for an orthopedist to come in to evaluate me.

In 15 minutes the orthopedist was there, and he wrote me a prescription for a wrist brace. Upon leaving the ER they gave me a ticket, and told me to go outside to the Garden and pay it at the machine, which was like a parking meter. I inserted the ticket into the machine, and it asked me to insert 20 euros, or a credit card to pay that amount. The whole thing took a little over an hour, including getting the wrist brace.

I can understand people's concern about needing health care services in a foreign country, but there is no need to hyperventilate about it if you need to go to the hospital in Italy. Everything looks old, but the doctors and the services are state of the art. And if you are in a major city, their will be plenty of english speakers.

Last edited by Perche; Dec 5, 16 at 3:39 pm
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Old Dec 5, 16, 10:18 am
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A few quick notes to add to perche's fine outline.

I have on a few occasions managed to obtain a drug that is available by prescription only in the US from an Italian pharmacist without a prescription. Once a friend needed something for a specific condition, we looked up the international name for the drug (on wikipedia; note that drugs often have different names in different countries), we went to the pharmacy and I described the condition and the drug her US doctor prescribed and it was sold to us directly.

Some things that are kind of generic (e.g., aspirin or saline solution) in the US are expensive at Italian pharmacies. Prices at a place like CVS/Walgreens can be much less for OTC products, so stock up on what you think you will need in the US or be prepared to pay several times as much.

On one occasion I used a private policlinico to see a doctor about what turned out to be hives. A friend made the appointment and for 100 Euros I saw a physician who immediately diagnosed what I had. I have to say though (despite perche's assurances above) she prescribed some pretty wacky medicine that my US physician thought was not helpful.
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Old Dec 5, 16, 10:53 am
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Originally Posted by ckendall View Post
A few quick notes to add to perche's fine outline.

I have on a few occasions managed to obtain a drug that is available by prescription only in the US from an Italian pharmacist without a prescription. Once a friend needed something for a specific condition, we looked up the international name for the drug (on wikipedia; note that drugs often have different names in different countries), we went to the pharmacy and I described the condition and the drug her US doctor prescribed and it was sold to us directly.

Some things that are kind of generic (e.g., aspirin or saline solution) in the US are expensive at Italian pharmacies. Prices at a place like CVS/Walgreens can be much less for OTC products, so stock up on what you think you will need in the US or be prepared to pay several times as much.

On one occasion I used a private policlinico to see a doctor about what turned out to be hives. A friend made the appointment and for 100 Euros I saw a physician who immediately diagnosed what I had. I have to say though (despite perche's assurances above) she prescribed some pretty wacky medicine that my US physician thought was not helpful.
If you went to the ER it would have been free. I wanted to see some ER medicine in Torino, so I arranged to spend the morning at the ER of University hospital, the biggest and busiest in the city. Only one person came in the whole morning. It was someone they put a cast on a month before, and he had an appointment to come back to have the cast removed. They brought the patient back to the treatment area, and it was just two doctors, the patient, and me. They took off the cast, then we all had coffee.

Don't think the treatment was necessarily wacko. The health care system in the USA is ranked at the bottom of the industrialized world. The three leading causes of death in the USA, in order, are cardiovascular disease, cancer, and medical errors. Medical errors cause 300,000 deaths per year, about five times more than diabetes.

My daughter was stung by a bee while on an island off the Washington coast, and developed hives. She was about 8. They helicoptered her to a hospital on the mainland. The ER doctor just kept giving her shots of epinephrine (epi-pen), which is wrong. That's only for anaphylaxis.

That's basically a massive shot of adrenaline that would make my daughter panic more and more, as adrenaline does. He kept kept thinking that the adrenaline induced panic meant she was dying, and kept giving her more and more. Six, in all. When I finally arrived her heart rate was 240 and he was going to give her yet another shot. I took it out of his hand and told him to get the hell out, and held her in my arms until her heart rate came down. Anyone but an 8 year old would die of a heart attack with a heart rate of 240.

That much adrenaline also causes so much fright to the extent that the person usually develops PTSD, post-traumatic stress disorder, and my daughter did. Your doctor may have said the treatment was wacko, but I'd put my money on the treatment that the Italian doctor provided.

Also, hives just needs a trip to the pharmacy, or at most, to the ER because emergency care is free. If you are an American in Italy and you rupture your appendix and need surgery, the operation and the whole hospitalization is free.
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Old Dec 5, 16, 11:05 am
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Originally Posted by ckendall View Post
A few quick notes to add to perche's fine outline.

I have on a few occasions managed to obtain a drug that is available by prescription only in the US from an Italian pharmacist without a prescription. Once a friend needed something for a specific condition, we looked up the international name for the drug (on wikipedia; note that drugs often have different names in different countries), we went to the pharmacy and I described the condition and the drug her US doctor prescribed and it was sold to us directly.

Some things that are kind of generic (e.g., aspirin or saline solution) in the US are expensive at Italian pharmacies. Prices at a place like CVS/Walgreens can be much less for OTC products, so stock up on what you think you will need in the US or be prepared to pay several times as much.

On one occasion I used a private policlinico to see a doctor about what turned out to be hives. A friend made the appointment and for 100 Euros I saw a physician who immediately diagnosed what I had. I have to say though (despite perche's assurances above) she prescribed some pretty wacky medicine that my US physician thought was not helpful.
It is very true that what is prescription or not is very different in Italy. A typical antacid like Cimetidine, Prilosec, the drug companies fight, and say it's too dangerous without a doctor's prescription. So they remain expensive. However, as soon as the patent is about to expire, the same companies, wanting to keep sales up, start lobbying (and winning) that it is safe over the counter. So now you can buy Prilosec for 6 bucks. I don't smoke, but I noticed the costs of nicorettes, available only by prescription, become over the counter for 20% of the cost the moment the patent expired. It's only a matter of time, until patent expiration, that Viagra is sold over the counter (it's just an example).

The profit incentive is different in Italy. You can, if you are having a hard time with jet lag, get zolpidem from the pharmacist without a prescription. There is no way you will get a prescription pain medicine. The bottom line is, what is a prescription medicine in the USA is often determined by patent and profit. Italy has a different system, so medications are classified differently.
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Old Dec 5, 16, 11:32 am
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I recall a few years ago when my husband went to a pharmacy in VCE to purchase some Pepto Bismol. He was told that the active ingredient Bismuth was not available in Italy. So, no Pepto. I wonder if that has changed. In any event, we carry an ample supply when we travel to Italy.
Recently, when we arrived at our hotel in Venice, I noticed that a medication which was in my handbag was missing. It must have fallen out on the flight. The concierge told me that he could obtain the prescribed medication for me at the nearby pharmacy. He also told me that he could not add the medication to the hotel bill. When we checked out we paid our bill with a credit card but the medication had to be paid in cash. It was 10 Euros for the medication and 100 Euros for the doctor (who I never saw but apparently simply called in the scrip to the pharmacy).
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Old Dec 5, 16, 1:02 pm
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Great thread. Perche, since I suspect we're in the same boat of being Italian citizens but not Italian residents, is there any difference in billing for folks like us versus (to simplify) US-only citizens?

Knock on wood, but the most we've ever needed in Italy was a stop at the pharmacist. We're traveling with another family in January who are US citizens. I take they'd do the same as you suggested?
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Old Dec 5, 16, 1:37 pm
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Though this was about 15 years ago, I once woke up in Milan in the middle of the night with my heartbeat rapid and pounding and a general feeling of unwellness. I called my doctor at home in the US and he told me to get to an emergency room right away. The hotel (Marriott) called a taxi and my wife and I went to the emergency room of a nearby hospital. I was asked for my name and my passport, and then was seen immediately by a nurse who took my blood pressure. It turned out to be insanely high (240/200). I was admitted and immediately seen by a doctor who ordered IV blood pressure medication and sedatives. I was taken to a ward and made comfortable. I was checked on by a nurse every hour or so. At one point, I woke up with a migraine. Though no one spoke English, they knew the word "migraine." I wrote down the generic name for the medication that I took for migraines and it was administered immediately.

In the morning, my blood pressure was back to normal and the migraine was gone. A doctor found a patient who could speak English and had him translate his diagnosis and medical advice. He gave me a prescription and I was discharged.

And I was not charged a single penny for the excellent, life-saving care I received.

THIS is how a medical system should operate. I've always loved my visits to Italy but, because of this trip, Italy holds a special place in my heart.
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Old Dec 5, 16, 1:49 pm
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Originally Posted by obscure2k View Post
It was 10 Euros for the medication and 100 Euros for the doctor (who I never saw but apparently simply called in the scrip to the pharmacy).
It' a shame. There is actually a chain company of doctors who do nothing but serve Americans in hotels, and they are getting very rich prescribing them over the counter medications. The same group also has extremely expensive clinics for foreigners. They advertise on the web. I guess that makes it convenient, but people should know that all emergency medical care in Italy is free. ER's are different from the USA. In the USA people without insurance use the ER for primary care, which has them packed with people with a headache, a cold, or a flu, a sprained ankle, diarrhea, all of which can be treated in a doctor's office. In Italy, everyone has a primary care doctor, and they call them, they don't go to the emergency room. They only use the ER for medical emergencies.
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Old Dec 5, 16, 3:25 pm
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Originally Posted by PWMTrav View Post
Great thread. Perche, since I suspect we're in the same boat of being Italian citizens but not Italian residents, is there any difference in billing for folks like us versus (to simplify) US-only citizens?

Knock on wood, but the most we've ever needed in Italy was a stop at the pharmacist. We're traveling with another family in January who are US citizens. I take they'd do the same as you suggested?
Yes, for everyone, in all cases, emergency room care is free, except for a trivial co-pay.
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Old Dec 6, 16, 12:38 pm
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Addendum to above, that should not have said emergency room care, it should have just said emergency care. That would include emergency operations, emergency admission to the hospital, emergency admissions to the ICU. All emergency care is covered.
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Old Dec 6, 16, 8:42 pm
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Thanks for the very informative post. I certainly hope I don't need to use it, but will be very grateful if I do.

It reminded me of an incident in London years ago - I was leaving the hotel very early for a flight when a young man came in with a gash to his head - turns out he was a low level employee who lived in quarters at the hotel and had been in some sort of altercation. I really thought he should be seen in an ER, but was worried (being an American) that this young man would incur a large bill if I recommended this. Fortunately I was able to find out that this was not the case - so I could easily tell him the correct course of action without worrying if he followed it I might bankrupt him!
By contrast I had a patient whose son in law fell off a roof and lost consciousness, but wouldn't go to the ER b/c he knew he'd get a bill of thousands (before Obamacare) and had no insurance! Yes - the US is not in the forefront with medical costs/care.
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Old Dec 11, 16, 1:39 pm
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I think this should be a Sticky....
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Old Jan 5, 17, 5:44 am
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Heading to Italy today, I've been remiss about getting my flu shot this year. I usually get it in the fall, because Ive paid the price of being sick and coughing for a month when I don't. This time, with changes in the job, the holidays, I just kept putting it off. I finally got it yesterday, but it doesn't kick in for two weeks. That's a mistake. Every few days there is another article in the Italian news about the severe epidemic of influenza in Italy. It can mean a trip to the ER, spending days in bed, etc. This was a big mistake on my part. The flu season in Italy goes until May, so vaccination is still recommended. If your going to get sick, travel, fatigue, close places like planes are where it is likely to happen. If anyone going to Italy in the next few weeks doesn't have their immunization yet, it's something to consider.
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Old Jan 5, 17, 8:12 am
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I don't intend to scare people, but it's everywhere in Europe now, not only Italy (as a matter of fact, this post comes from a... victim: left home yesterday for the first time in many days).
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Old Jan 5, 17, 1:01 pm
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Originally Posted by Perche View Post
Every few days there is another article in the Italian news about the severe epidemic of influenza in Italy. It can mean a trip to the ER, spending days in bed, etc.
Eeeehh. The flu is currently all over Europe. Not just Italy. Moreover, you are over-dramatazing what the flu essentially is.

Originally Posted by Perche View Post
The flu season in Italy goes until May, so vaccination is still recommended
Unless you are part of the patients with risk factors, you can survive the flu season without any vaccination. I never had the vaccination and managed not to get the flu the last couple of years. I did get it a couple of years ago. But what would you expect if you walk around in ~5C weather in a t-shirt ...

Last edited by Perche; Mar 28, 17 at 10:28 am
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