Our search for a physical therapist in Italy is a grand success

Lucy has her cast checked while in Gig Harbor
in February.

We are currently in the middle of our second encounter as official members of the Italian medical system. Last August on a trip in the Alps, Lucy tore her Achilles tendon before we came to our Montecarlo home in September. I went through a lengthy process to enroll us in the Italian health care system so that she could go to a doctor here in Tuscany (see One more small step). However, it was almost time to leave for Gig Harbor when we finally managed to see the doctor, so we decided to have the needed surgery in Tacoma in January.

Following the surgery, where they took a tendon from her big toe and grafted it onto her Achilles, Lucy spent five and half weeks in a cast and another two weeks in a walking boot. She started physical therapy in March, but now we’re back in Italy. Her therapist in Gig Harbor said it was essential for her to continue therapy so that she could gain the flexibility and strength she would need to walk normally.

On Tuesday, we went to the doctor’s office to make an appointment. We were asked if it was urgent and said no, so we were given an appointment date of about two weeks away. At that point, I explained to the secretary that we just needed a referral to a physical therapist, so she said we could come back that evening at 6 p.m. and wait for an opening in Dr. Fulceri’s schedule.

We came back a little before 6 p.m. and waited about an hour, while I mentally prepared to explain in Italian Lucy’s history and condition, but that was unnecessary. The doctor (he’s actually still in his final year of medical school) said he needed to work on his English for his coming exams, so my preparations were unneeded. Lucy explained her situation, and he told us that physical therapy would probably be covered under the system, but he needed to do a little research and get back to us the next day.

We received an email with a prescription the next morning, which we took to the pharmacy as instructed. By the way, the prescription was in the form of a pdf, with bar codes that the pharmacist was able to scan, giving all the needed information—a very efficient and modern system, it seems to me. However, after logging into her computer, she told us that there were absolutely no openings in all the province of Lucca within the next 10 days—and if I understood correctly, the prescription was only valid for that length of time. She said we could go to the regional health care office in Lucca to see if they could help us, but we got the feeling that we’d get the same answer there. Instead, since we live only five minutes from the border between the provinces of Lucca and Pistoia, we decided to drive to Pescia and try a pharmacy there—but with the same result. The pharmacist was apologetic and explained that this was a common issue in Italy. She said we could continue coming back to try again in a few days, but most people just made private appointments and paid for care instead of waiting.

So the next day, we decided to go directly to the fisioterapista in Altopascio that Dr. Fulceri had recommended, and fortunately we were seen immediately. Dr. Francesco Monachino gave Lucy a quick exam and noted that one of the reasons she was walking strangely is that her left leg was now a little shorter than her right leg. He recommended an insert of .5 centimeters, which we were able to purchase at the pharmacy. Lucy said she noted an immediate improvement in her gait and sensation of balance.

Dr. Monachino scheduled two appointments for us, one on Friday and the other on Monday. I’m writing this shortly after the first appointment, in which the doctor spent the majority of the session massaging and manipulating Lucy’s foot and ankle. He said that massaging the tendon was essential to break down and prevent the formation of scar tissue. He will do more massaging on the next appointment, he said, and also work on some exercises to improve strength and flexibility.

We were both very impressed with Dr. Monachino’s knowledge, professionalism and manner, and we’re also thrilled that we were able to so quickly find a physical therapist here. Yes, we weren’t able to get one that is paid by the state, but he actually costs less than we were paying for visits in the U.S.

It turns out that Lucy's physical therapist, shown
here, is actually semi-famous for being the PT
of world-renowned race car driver Robert Kubica.

In fact, the cost is one of the most astounding parts of the comparison between Italian and American health care. Dr. Monachino charged 35 euros for a half hour session, and he said that Monday he will charge the same for a full hour. In America, with insurance, we had a co-pay fee of $50 per visit. But the real shock came from looking at one of the EOBs, (explanation of benefits) from our insurance company. It seems that for each visit, the physical therapy clinic sent a bill that ranged from $200-300. The insurance company, of course, did not allow the full amount, instead paying around $80-110. Adding in the $50 we paid, that means the clinic was receiving about $130-160 for each visit, which lasted 40 minutes.

Lucy said that sometimes each therapist was dealing with two patients at the same time. The therapist would give Lucy some exercises to do, and then go and work with the other patient, returning to Lucy after giving the other patient some attention and then an exercise to work on—so essentially a 40-minute session only required about 20 minutes of the therapist’s time.

It’s not the intention of my blog to make value judgments on the differences between countries. We’re just relating our experiences as they occur and leaving it up to our readers to draw whatever conclusions. It’s also important to remember that experiences in Italy vary widely, so what happens to us may be vastly different than what happens to someone else. However, even with this disclaimer, I can’t resist noting that our American health care system is seriously wacked. If we had no insurance, would that physical therapy clinic in Gig Harbor really bill us $200-300 for 40 minutes of treatment?

On the other side of the coin, I noted that Dr. Monachino has an undergraduate degree in fisioterapia from the University of Pisa, and a masters degree in sports fisioterapia from the University of Siena. He has a 4.9 out of 5 rating in his Google reviews. Doesn’t that seem to merit fees of more than 35 euros per session? This could be why in the 10 years between 2005 and 2015, more than 10,000 doctors left Italy and moved abroad, according to The Italian Insider magazine. The article, published Feb. 4, 2019, went on the say: “Their departure is a damaging problem that is increasingly being felt as the National Health Service continues to lose even more professionals . . . Italy is committed to the training of excellent health professionals, spending large sums of money and then gives this heritage to others.”

Having the opportunity to observe the interesting differences between Italian and American societies is one of the pleasures of our divided existence. It would be easy to judge or complain that one country should emulate the other, but I try to avoid doing this. These countries have developed their societal systems over many years, and making sweeping changes would be like trying to change the tire on a car while it’s still moving. I prefer to observe, learn and do my best to adapt to the requirements of living in each separate world.