Dottoressa Quotes

“What American Healthcare Can Learn from Italy: Three Lessons It’s easy. First, learn to live like Italians. Eat their famous Mediterranean diet, drink alcohol regularly but in moderation, use feet instead of cars, stop packing pistols and dropping drugs. Second, flatten out the class structure. Shrink the gap between high and low incomes, raise pensions and minimum wages to subsistence level, fix the tax structure to favor the ninety-nine percent. And why not redistribute lifestyle too? Give working stiffs the same freedom to have kids (maternity leave), convalesce (sick leave), and relax (proper vacations) as the rich. Finally, give everybody access to health care. Not just insurance, but actual doctors, medications, and hospitals. As I write, the future of the Affordable Care Act is uncertain, but surely the country will not fall into the abyss that came before. Once they’ve had a taste of what it’s like not to be one heart attack away from bankruptcy, Americans won’t turn back the clock. Even what is lately being called Medicare for All, considered to be on the fringe left a decade ago and slammed as “socialized medicine,” is now supported by a majority of Americans, according to some polls. In practice, there’s little hope for Italian lessons one and two—the United States is making only baby steps toward improving its lifestyle, and its income inequality is worse every year. But the third lesson is more feasible. Like Italy, we can provide universal access to treatment and medications with minimal point-of-service payments and with prices kept down by government negotiation. Financial arrangements could be single-payer like Medicare or use private insurance companies as intermediaries like Switzerland, without copying the full Italian model of doctors on government salaries. Despite the death by a thousand cuts currently being inflicted on the Affordable Care Act, I am convinced that Americans will no longer stand for leaving vast numbers of the population uninsured, or denying medical coverage to people whose only sin is to be sick. The health care genie can’t be put back in the bottle.”
― Susan Levenstein, Dottoressa: An American Doctor in Rome

“US hospitals may be excellent, but there must be something profoundly wrong with our health care system if we fall near the bottom of the heap among developed nations on life expectancy, infant mortality, maternal mortality, self-reported health, obesity, drug overdoses, suicide, homicides, disability rates, traffic deaths, almost any indicator you can think of. Lack of access to medical care deserves much of the blame, but even educated, insured, well-off Americans are less healthy than their peers in other rich nations”
― Susan Levenstein, Dottoressa: An American Doctor in Rome

“Italians are blessed with long healthy lives nonetheless, thanks to the combination of a world-class lifestyle and universal access to health care, however unreliable it may be. They also benefit from a more uniform distribution of income and wealth, which has been shown to improve health outcomes. In the US, the world’s most unequal country, the average income of the top ten percent is nineteen times the average income in the bottom ten percent; in Italy that ratio is only eleven to one. Plus, Italian labor laws ensure that parents can take time off to bond with their children without losing their job, sick people don’t have to drag themselves back to work prematurely, and retirement doesn’t equal poverty.”
― Susan Levenstein, Dottoressa: An American Doctor in Rome

“The Italian medical landscape features crumbling hospitals, doctors trained on books rather than patients, pervasive corruption, and per capita spending one third that of the US. But, by any criteria, Italians are healthier. Because of their top-flight health care system? Hmmm. That stellar World Health Organization ranking was based entirely on two criteria, system fairness (access and cost distribution) and population health, ignoring quality-of-care measures such as medical competence or emergency room efficiency. This credited the system for outcomes far beyond its control.”
― Susan Levenstein, Dottoressa: An American Doctor in Rome

“Most Italians consume alcohol every day, but it’s not what we call drinking. For Americans and northern Europeans alcoholic beverages are mind-altering drugs, used as tranquilizers, sleeping potions, inhibition-looseners (“Candy is dandy but liquor is quicker”—Ogden Nash), or roads to inebriation. That is to say, to getting tipsy, high, drunk, plastered, smashed, sloshed, sozzled, soused, crocked, wrecked, juiced, stinko, tight, pie-eyed, crosseyed, shit-faced, blitzed, fried, wasted, gassed, polluted, pissed, tanked up, ripped, loaded, pickled, bombed, blasted, blooey, blotto, blind drunk, roaring drunk, dead drunk, falling down drunk, drunk as a lord, stewed to the gills, or feeling no pain—and that’s just my own personal vocabulary. Italians reach that state so infrequently that their language provides only a few tame options—ubriaco (drunk), brillo (tipsy), alticcio (high), sbronzo (drunk)—with at most perso (lost) or fradicio (rotten) tacked on for a touch of color. They don’t even have a proper word for a hangover, though if pressed they’ll come up with the stately postumi della sbornia, aftereffects of overindulgence. For Italians, wine and beer are foods. If they provide a little buzz that’s just a pleasant side benefit, improving the sparkle of the conversation. When I first traveled in Italy, parents regularly fed wine-laced water to their kids (“acquavino”), vaccinating them against later dipsomania. And at lunchtime in the cafeteria of my Nuovo Regina Margherita Hospital the docs would jostle to sit at the chaplain’s table, because he’d always bring a bottle of good country wine. Even the harder stuff fits into a culinary protocol: a seven p.m. Campari is meant to whet the appetite, and the cognac or amaro at the end of a large meal to aid digestion. Which is why, in proportion, Italy has one-tenth as many problem drinkers as America.”
― Susan Levenstein, Dottoressa: An American Doctor in Rome

“Italians’ undying gastronomic love affair is with the vegetable world and with their platefuls of boiled-up little strings (spaghetti) of flour and water, so by now many have amputated the “main course” and returned with relief to their traditional low-meat Mediterranean diet, which is locavore ante litteram.”
― Susan Levenstein, Dottoressa: An American Doctor in Rome

“Italy generally shows its worst colors with tasks that require organization, vigilance, scrupulously-followed protocols, and attention to detail, such as creating web sites and running ICUs. How Italians become world-class air traffic controllers and Formula 1 pit mechanics is a mystery.”
― Susan Levenstein, Dottoressa: An American Doctor in Rome

“One of the crucial documents for the Ordine dei Medici, it turned out, was an Italian passport. Until then nobody had bothered to mention this potentially insurmountable obstacle. It happened I did have a right to citizenship, but since it would be bestowed on me automatically by my Italian husband (Italian husbands are less powerful nowadays), the passport logically hung on Italian recognition of our American marriage, which was in turn predicated on Italian recognition of my husband’s American divorce from a prior marriage. The divorce certification, based on various Byzantine legal fictions, was a long time coming. One time there was a false sighting of his Italian divorce, and I optimistically went down to the Anagrafe or Central Registry to see whether I could get my citizenship papers. At the end of the forty-five-minute line a small man with slicked-down hair took my documents with a yawn and disappeared into the dark forest of files. When the clerk emerged, the bored look was gone from his face. He invited me to follow him along the long bank of teller windows, he on his side me on mine, and then pass through a little gate to the employee side. He sat me down, then paced between piled-up dossiers for a minute, no grille window to screen him off, before speaking. “Ms. Levenstein,” he said kindly, “You have applied for Italian citizenship on the grounds of being married to a certain Andrea Di Vecchia.” I admitted that was true. He paced a little more, lit a cigarette. “Ms. Levenstein,” he said again, even more gently, and I should have caught on from the way he repeated it. “I must tell you something. This Mr. Di Vecchia—he is already married to another woman!” His hand was already out to give a comforting squeeze to my shoulder, but it dropped when I laughed and explained that the problem was red tape, not bigamy. I thought later, high drama must be rare behind the certificate window, and he had risen to its call. How many American file clerks would have been so ready for their unexpected moment of glory? Another problem involved my residence papers, a crucial component in any pile of documents. All residents in Italy must communicate changes of address to the State within three months, and when we left my mother-in-law’s for our own place eight months earlier we had duly registered the move. But when I went to pick up an identity document I was told it couldn’t be issued because I was still listed at my old address. I slyly told the clerk in the cage to hold on, scurried over from his Identity Card window to the Certificate window three paces away, had the printer spit out a Residence Certificate bearing my name and the new address, and carried it back in triumph. He wasn’t impressed. “Oh, that certificate. That’s from the computer, it’s not worth anything. Your address has been changed in the computer, but the computerized part of the system doesn’t count.”
― Susan Levenstein, Dottoressa: An American Doctor in Rome

“In Rome, the person in charge of equipollenza, or training equivalency, was located at the Foreign Ministry. I got into that mass of marble by depositing my passport at the front desk, and was escorted through dimly-lit halls wearing a temporary ID badge on my lapel and clutching my little pile of documents. The diminutive official took a glance at my grimy Xeroxes and harrumphed a little laugh through his moustache. The colleague at the New York Consulate had unfortunately gotten several things wrong, he said. First a procedural error: the “authenticating” squiggles on the back of the copies were meaningless. They didn’t even vouch for the accuracy of the photocopying, much less prove the validity of the originals. All the documents would have to be sent back and scattered around the USA for proper authentication, by local Italian consulates. For example, the Italian Consul in Boston had to testify that Harvard was a degree-granting university. Second, the Consular list had omitted a crucial document, the Certificate of Existence in Life. No, the mere observation of me stamping my foot and tearing my hair was not, for the Italian government, sufficient proof that I existed. Yes, a nonexistent person was unlikely to be asking for an Italian medical license, but rules were rules. The Consulate’s final error was a bit of misinformation, bred, perhaps, of tenderheartedness. All these documents couldn’t possibly get me an Italian license. They would merely get me a toehold in the University where they might, at best, be alchemized into an Italian medical degree, but an actual license would be another and rather more difficult question. This was my first lesson in Italian bureaucracy. The Consular official in New York clearly hadn’t had the faintest idea what she was doing and no intention of trying to find out, but she had found me too simpatica to disappoint—a sentiment not strong enough to keep her from abandoning my application to gather dust. By this time various shady sources such as Italian medical professors and representatives of international foundations had suggested an alternative to my quest for the holy grail of doctorly legitimacy: just hang out a shingle and to hell with the license. Unfortunately, I’m such a coward that climbing on a bus without a ticket gives me palpitations, so practicing without a license would be a degree of “transgression” (as the Italians call it) far beyond my talents.”
― Susan Levenstein, Dottoressa: An American Doctor in Rome

“Glossary: pazienza Patience squared. An essential Italian virtue, often invoked as a gentle reprimand for a foreigner’s loss of cool. When the grocery is out of milk, or an unannounced bus strike cancels your next patient’s appointment, the word to say (with palms upturned) is pazienza. It extends beyond the prosaic “keep waiting” to the philosophical: you have just experienced yet another reminder that the universe is fickle and, if not haphazard, certainly not designed with your benefit in mind.”
― Susan Levenstein, Dottoressa: An American Doctor in Rome

“Months beforehand I started focusing my Manhattanite efficiency on getting registered in Italy, Andrea leading me by the hand through the wilderness of Old World red tape. The first step was “getting my documents together,” an Italian ritual repeated before every encounter with officialdom. Sticking to a list kindly provided by the Italian Consulate, I collected my birth certificate, passport, high school diploma, college diploma, college transcript, medical school diploma, medical school transcript, certificates of internship and residency, National Board Examination certificates, American Board of Internal Medicine test results, and specialization diploma. Then I got them transfigured into Italian by the one person in New York authorized by the Italian Consulate to crown his translation with an imprimatur. We judiciously gave him a set of our own translations as crib notes, tailored by my husband to match the Rome medical school curriculum. I wrote a cover letter from Andrea’s dictation. It had to be in my own hand, on a folded sheet of double-sized pale yellow ruled Italian paper embossed with a State seal, and had to be addressed “To the Magnificent Rector of the University of Rome.” You have to live in Italy a while to appreciate the theatrical elegance of making every fiddler a Maestro and every teacher a Professoressa; even the most corrupt member of the Italian parliament is by definition Honorable, and every client of a parking lot is by default, for lack of any higher title, a Doctor (“Back up, Dotto’, turn the wheel hard to the left, Dotto’”). There came the proud day in June when I got to deposit the stack of documents in front of a smiling consular official in red nail polish and Armani. After expressing puzzlement that an American doctor would want to move to her country (“You medical people have it so good here”), she Xeroxed my certificates, transcripts, and diplomas, made squiggles on the back to certify the Xeroxes were “authentic copies,” gave me back the originals, and assured me that she’d get things processed zip zip in Italy so that by the time I left for Rome three months later I’d have my Italian license and be ready to get a job. Don’t call me, I’ll call you. When we were about to fly in September and I still hadn’t heard from her, I went to check. Found the Xeroxes piled up on Signora X’s desk right where I’d left them, and the Signora gone for a month’s vacation. Slightly put out, I snatched up the stack to hand-carry over (re-inventing a common expatriate method for avoiding challenges to the efficiency of the Italian mails), prepared to do battle with the system on its own territory.”
― Susan Levenstein, Dottoressa: An American Doctor in Rome