The Italian Bureaucracy Shuffle

After almost 17 years in Italy, I certainly can’t say I’ve “gone native.” However, there are times that I realize just how second nature certain things have become in my day-to-day life here.

I had this realization recently when speaking with an American friend who had just relocated to Italy. She was expressing frustration with the runaround she was going through in order to get a certain medication that she took regularly in the U.S. to control a chronic disease. She’d seen a private specialist in hopes of getting a prescription, and he’d explained that she would have to do everything through the SSN (Servizio Sanitario Nazionale).

She was ping-ponged from her primary care doctor to get a referral for blood and urine tests (she was quite surprised when I told her she’d have to buy the urine cup herself) to the blood lab several times and then back to the specialist and the primary care doctor. Once she finally had the prescription in hand, she then bounced around to several farmacie, all of which had excuses for not giving her the medicine.

I like to call this the Italian healthcare shuffle, and it can be especially daunting for someone who has never had any experience with this system and who doesn’t speak the language. However, as my friend told me the story, I was thinking about some of the workarounds I’ve found over the years. I’m certainly no expert in this area, but I have come a long way since the days when I would slosh urine across town on the subway (when they insist on an early-morning sample, what can you do?) in my trusty container to then be told at the hospital blood lab that my primary care doctor hadn’t checked a special box on the referral indicating I was pregnant. No amount of begging or pleading or showing my bulging belly could sway the unsmiling lady behind the counter to allow me to complete the tests that day. By my second pregnancy, I had picked up a few tricks that can be applied to many forms of Italian bureaucracy. I’d like to share them here.

1) If something is not working for you, change it. Don’t fall into the “ma l’Italia e’ cosi’ “defeatist trap. Is the line too long at your current blood lab? Are you spending too much time dealing with niggling bureaucratic issues at the comune? Try to switch things up. I found a blood lab right near my house with barely any wait and where the friendly woman behind the counter doesn’t come up with bizarre reasons why I won’t be served that day (such as “Signora, everyone knows that you can’t do a blood test after 9:47 a.m.!”). Another thing I found in my neighborhood is a small anagrafe office that carries out many of the same functions that the comune does. There’s never a wait, and I get service with an actual smile.

2) Look for your “isola felice” in these situations. The literal translation is “happy island,” but Italians often use it to mean a sort of oasis of calm or efficiency in an otherwise chaotic overall situation. My older son has asthma and allergies, and it took us a very long time to get him on a program that keeps him stable. We bounced from chaotic hospital waiting room to emergency room to expensive private doctor until I found our own “isola felice.” I found one hospital not far from our house with an excellent pediatric allergy department where I can always call and talk to a human being and get an appointment within a week or two. Sadly, I’ve been told that soon this department will only take appointments via the region’s “numero verde” and that wait times will increase as a result, but we’ve had a good run there while it has lasted.

3) Don’t take “no” at the first “ma non si puo’.” Sometimes these sportello workers – bless their hearts – seem to live to make sure you don’t get access to whatever service you are seeking. It seems they take pleasure in sending you from window 1 to window 10 to window 3 and back to window 1 again. I think one of the worst things you can do is fight back and really show your frustration. I’ve gone that route, and they tend to just stonewall. I tend to hold my ground past the “no” phase and try to ask a lot of questions. I get people’s names so I can then say “Maria at window 1 told me to talk to you” and often that person will call out to Maria and they will then put their heads together to help me resolve the situation because I’ve made the situation a bit more personal.

4) Show up with everything you need along with everything you don’t think you will need. If you’ve been told, “Next time you won’t need that document,” bring it anyway. Chances are that you are going to need it. Less is not more when it comes to Italian bureaucracy.

5) Learn how to spell your name using Italian city names and other key words. So if your last name is “Smith,” the spelling would be “Savona Milano Imola Torino Hotel” (don’t aspirate that “h” in “hotel” or the Italians won’t understand you and may even “correct” your pronunciation!). This is especially helpful for trying to make appointments and get other things accomplished over the phone.

I would say to keep a good sense of humor about it all, but it isn’t always possible when you are sitting in an overcrowded waiting room with a paper number in hand and 50 people in front of you. Seek out the the things that work for you, try not to take “no” for an answer the first time around and come prepared with every last slip of paper you’ve ever been given. And don’t forget the urine cup.

Article by Michelle Schoenung
Professional Journalist and Translator