Wednesday, October 9, 2019

Malasanità: Something Rotten in the State of Italian Health Care?


Newspaper headline: “Malasanità: Wrong Diagnosis, Woman Dies.” One day in the ‘90s a young woman stumbled into an Italian emergency room talking strangely. Seeing her age and her blue jeans, the ER docs took her for a drug addict in withdrawal. Hours later it occurred to someone to take a look at her brain, but the CAT scan machine was on the fritz. It was too much trouble to transfer her to another hospital, so they parked her in a ward bed for the night. She died before dawn, from a ruptured cerebral aneurysm.
For most of my years in Italy malasanità was a regular feature on the front page. The term encompasses malpractice, but it’s used more for something broader: what Italians think of as a chronic sickness of the health care system itself.
Italians tell pollsters they trust and appreciate nurses and physicians. Seeing poor medical outcomes they tend to put all the blame on disorganization, lack of money, and governmental indifference. Of course that argument has a lot going for it, in that public hospitals are sadly short of personnel, equipment, maintenance, and supplies. But I confess as a physician what I find more unnerving is the rôle of professional unevenness, the way Italian doctors here can range, apparently at random, from genius to ignoramus. When one of my patients tragically lost a baby at term you could call it malasanità, since she was shunted from one hospital to another before a Caesarian-section was done, too late. For me, though, the real culprit was the bigwig hospital obstetrician who – I learned later – had seen her regularly throughout the pregnancy without once weighing her, measuring the size of her uterus, or taking her blood pressure.
Lately malasanità has drifted to the back pages. Since the austerity forced by the European Union in the last decade, which cruelly punishes sick Italians for the fiscal sins of their governments, wards are down to half their former staffing, whole hospitals have been shuttered, people are skipping specialist visits and diagnostic tests because of higher co-pays, and waiting lists on the public system (several months for a non-emergency sonogram) make the infamous Veterans Administration look speedy. Medical errors seem relatively trivial when you can’t see a doctor at all.