Friday, November 12, 2010

Certifiably insane

Dear Readers,

After living in Italy nearly a decade, I am certain--though they would cagily deny their own existence, like the mafia--that there's a secret cadre of fiendish bureaucrats locked away in a dank room in a crumbling palazzo somewhere, smoking cigars and guzzling grappa, their flat, brittle, octogenarian bums scraping against cracked leather upolstery, plotting ways to make everybody's lives ten-thousand times more complicated than they need to be. They're the kind of villains you'd see in old silent films, curling their handlebar mustaches and rubbing their hands together with Machiavellian glee.

There are many, many examples I could give to illustrate their dastardly deeds, but I am going to focus on only one at present: the certificato medico (medical certificate). Italians love to certify just about everything--from acts of Parliament to acts of God. To this end, notaries do a brisk business (while making a killing, their fees being notoriously exorbitant), and you practically need a marca da bollo (official stamp) just to pass gas. But the medical certificate has to be one of the cruelest punishments ever inflicted on the Italian populace.

Let's say I fall ill. I'm wracked with fever, my nose is gushing, I feel like I've been run over by a bus. Naturally, I call off work. But do I get to crawl back into bed, perhaps with a hot cup of honey-laced tea, and slip into a restful coma? No! I have to haul myself over to my doctor's ambulatorio and wait two hours in an unheated antechamber with a bunch of ancient hypochondriacs who prattle on endlessly about their aching vertebrae and loose bowel movements, while inside my skull aboriginal rhythms are pounding themselves out mercilessly. I need to get my doctor to certify that I am indeed sick enough to miss work--even for just one day (apparently bringing my employer an enormous pile of slimy, used tissues is not proof enough). The process of certification entails the doctor listening to me say "I'm sick" while observing my variously oozing bodily humors, after which she fills out an official slip of paper and hands it over to me. Ah, but it doesn't end there, dear Readers! This piece of paper has two sections, one of which I am to give my employer upon my return to work, and the other is to be dispatched immediately to INPS (Istituto Nazionale della Previdenza Sociale), the government arm which pays out sick leave. This must be done--under penalty of death--by registered mail, which means (oh, joy!) a trip to the post office. So, after enduring the doctor's office, I'm forced to drag my flu-ridden mass of molecules over to the nearest branch of the Poste Italiane, take a number (usually #101 out of 500), and stand and wait, praying that I infect the dour-faced employees who move slower than indolent, dyslexic sloths.

Exhausted, I return home after 3 or 4 hours of divertimento. All this to absent myself from a five hour work shift. Complicating the whole endeavor is the fact that my doctor has her ambulatorio in my vicinity only four times a week--three miserly morning slots, and once, more amply, in the evening (though the place is usually teeming like a leper colony). The post office closes adamantly at 1pm, so you really have to hustle if you want to be beaten down and tormented in timely fashion.

Here's another example: recently, I wanted to enroll in a yoga class, having decided that I ought to start looking after my well-being and de-stressing in a way that doesn't involve popping a cork. I went for a free trial lesson at a lovely yoga studio, tried not to blanch at the enrollment fees, and was given a brochure that explained their policy. When I got home and read it, I was surprised to see that a certificato medico was required before one could participate in classes. "A medical certificate for an hour of beginner's yoga a week?" I thought to myself, "We're not talking rugby, pole-vaulting, or the four-minute mile here--this is downward dog, the sun salute, the corpse pose for god's sake!" So I did what I usually do in these cases of bureaucratic water-torture--I narrowed my eyes, clenched my jaw and prepared to submit. I dropped by the pharmacy the next evening and asked the pharmacist if she would leave a note for my doctor (who'd be in her office next door the following morning) asking for a certificate saying something along the lines of "Ms. Petrosian is unlikely to drop dead of cardiac arrest if she were to do a wee bit of yoga."

"Ah, but for the certificato medico sport non agonistico [non-agony-inducing?] you have to pay," said the pharmacist. "Oh! Ah, um, much is it?" I asked, with trepidation. "Usually around 35-65 Euro." I nearly went into cardiac arrest right there. "Does that mean she has to examine me? You know, give me an EKG, stress test, repeated flagellation with a yoga strap?" "Typically no--it's just for the certificato itself." I see. Just to have a simple piece of paper from my primary-care physician, for whose service and the national health service in general I render lavishly and unfailingly unto Caesar, I was being asked to shell out an extra tithe. Disgruntled and fuming, I went home and tallied up the total real cost of doing yoga (I discovered that these certificati for sports have to be renewed every year) and thought, to hell with it. I ordered some yoga dvds from Amazon UK instead.

(By the way, in order for children to participate in any remotely sporty after-school activity, they need to have a medical certificate--which needs to be re-issued every year, of course. If you have two or more children, doing at least one activity each, you can see how the costs swiftly add up. If you add in parents who might like to join a gym or something profligate like that, there's some serious lining of pockets going on).

One last anecdote and then I'll leave you in peace, dear Readers. My son suffers from a few food allergies, and in order to eat at the mensa every day at school, he needs--you guessed it!--a certificato medico attesting to the fact. Naturally, as his mother, I am the last person on earth qualified to communicate a health condition to the school (though, apparently, I am deemed responsible enough to pay the lunch bill of €140 for two children every month). This certificate has to be re-submitted every scholastic year, though thankfully it is free of charge. So, at the beginning of September, I girded my loins and set out to procure this year's certificato for Giacomo.

Our pediatrician only takes calls from--get this--8:15-9:15am, Monday thru Friday. Not a minute before, not a minute after (always tricky, given that I have to squeeze my work commute into this time-frame).  Usually the line is busy because 400 parents are trying to reach him simultaneously, and I have to hit re-dial, oh, maybe 62 times before getting through. (You could call during his afternoon ambulatorio, interrupting him during office visits, but only if a kid's on their death bed--and be prepared to grovel). Anyway, eventually I get through, ask for the certificate, he agrees to have it ready for pick-up the following evening, my husband brings it home. I hand it over on the first day of school, quite pleased with myself.

Well, two days ago the school called because Giacomo ate something with egg in it and had a mild reaction. Egg wasn't included among the allergens listed in the medical certificate, I discovered--apparently the doctor forgot, and I, being so distracted from running around after all these damn certificati, didn't catch the omission. I was told that a NEW (and improved) certificato was needed immediately so my son wouldn't be served any more egg.

If this is all starting to sound like a play by Beckett or Ionesco, then you're beginning to understand what it's like to live under this uniquely Italian form of bureaucratic despotism.


An enlightened Italian pediatrician--bless his subversive soul--wrote a wonderful article railing against useless medical certificates.* In it he makes the following calculations:

--Italy has around 7,000 pediatricians, who are writing on average 10 medical certificates a day, thereby producing some 70,000 certificates per day (these certificates are needed for many absurd reasons besides sports and food allergies), and consuming an estimated 14,000 reams of paper per year.

--He supposes that for every certificate issued, a parent must spend at least a half-hour in getting it, which adds up to some 35,000 hours per day. This in turn adds up to a conservative estimate (based on 200 days) per year of 7,000,000 wasted hours, or the equivalent of one year of work by 4 full-time employees.

--He rightly assumes that most of these trips required to pick up and deliver medical certificates are made by car. Estimating a minimum of 2 km distance per certificate, on any given day, then, some 140,000 km are being traveled! That's 28,000,000 km per year, with a consumption of gasoline estimated at 2,000,000 litres.

He concludes by saying that maybe--just maybe--this "festival of idiocy" will one day end, and that all the time and energy expended over medical certificates (requesting them, producing them, procuring them, distributing them, reading them, organizing them, filing them, saving them, etc.) can then be invested in things that are infinitely more useful and gratifying.**

So lest you wonder why Italy's economic growth rate is something like minus 22%, or why we're not producing any more Nobel Laureates, the answer is easy: everyone is far too busy chasing after certificati medici.

My best regards,


*"Tutto bene: ecco il certificato medico inutile," di Vincenzo Calia, in Un Pediatra per Amico, n.1, gennaio-febbraio 2007. For those of you who read Italian, it's worth a google.

**I would add that if you're reading this it means you are at least minimally computer-literate. And therefore you--like me--may very well ask yourselves why, in this the 21st century, Italy doesn't avail itself of technology and have these interminable certificati simply wing their way through cyberspace, granting us all--our much-suffering environment inlcuded--some relief?


  1. Elizabeth, this post made my evening. Especially after an entire day of dealing with tax issues (let's not talk about it).
    I had NO IDEA you needed to get a cert for a yoga class. Am definitely popping a cork instead. Or dragging out my DVD, either one.
    BTW my doctor will let you call in for a certificato when you're sick and someone else can pick it up. Want in? I can hook you up, man. Call me.

  2. Sarah darling, given the current state of Italian bureaucracy, I have come to the conclusion that popping corks is de rigueur, and shall no longer feel guilty about it. And by all means, please hook me up with your Dr. Feelgood!

  3. Wow.... I'm speechless. Loved the detailed calculations made on the actual cost of all this gov. shuffle of paper...

    I hope you are feeling better. I would be popping that cork too and doing yoga by DVD... I read your complete post - it was wonderfully written xo HHL

  4. This medical certificate business is also in practice in Belgium - but only if you're sick more than one day - but it looks like bureaucracy in Italy has been perfected into a fine art!

  5. You could have also... phone the doctor. It shouldn't work differently from my region, over there.

  6. Matteo dear, yes, sometimes you can just phone your doctor, it's true. But someone STILL has to pick up the certificato, and send it off registered mail, etc. My point is that it's all a lot of wasted time moving around little bits of paper, like ants carrying crumbs to and fro. Only ants have a larger purpose, I would argue.

  7. Hi there,
    I came across your blog recently and have been having some laughs. We were on an expat posting in Florence two years ago for a year but are now back in Australia.
    I loved living in Florence but this post made me remember why i love now living back in a very organised country!! I hated the post office with a vengeance!And lets not talk about going to the questura (and we had an Italian lawyer with us and still got nowhere!)

  8. Thank you, Monika! Wow, I'm shocked (but not surprised) that even having a lawyer doesn't save you from the clammy tentacles of Italian bureaucracy...

  9. I too am speechless, without speech. I guess there is no going to work sick and taking a sick day to play. And all of this from the home of my the words of Gemma..."Vaffanculo!"

  10. Lisa, thanks for commenting. And yes, I fear Gemma would indeed have much to say about all this if I were to tell her!

  11. tmassimo9:00 AM

    wow! this is nuts and would drive me crazy! This makes me change my mind about socialized medicine!

  12. Great post and all too true! I'm snorting aong with Patricia. Let's not forget to mention that most Italian farmacies are closed on Sundays (at least in the hinterland of Tuscany) and if you are without a ricetta you don't stand a chance with the only one open for miles until you start sobbing something unintelligible in English with you feverish child in your arms.

  13. Thanks, Papaya! The situation you describe is, sadly, altogether too believable!

  14. Martin1:39 AM

    Just another example to show how Italians keep Italy for themselves. The barrier of state documentation is a test that protects the Grand Old Lady of il bel paese from the almost pestilential infestation of admiring outsiders.

  15. Martin, you've put it wonderfully and cast things in a light I hadn't considered--bureaucracy as barrier! It's certainly true that you have to be born into it or be a die-hard in order to survive it.


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