Dottoressa: An American Doctor in Rome

by Susan Levenstein

"Wise and witty."--Publishers Weekly

"A charming story well told."--Kirkus Reviews

"Smart, funny, charming . . . full of astute insights into the way Italy works."--Alexander Stille

"A wonderfully fun read."--Dr. Robert Sapolsky

"As funny as it is poignant. A must read for anyone who thinks they understand medicine, Italy, or humanity."--Barbie Latza Nadeau

After completing her medical training in New York, Susan Levenstein set off for a one year adventure in Rome. Forty years later, she is still practicing medicine in the Eternal City. In Dottoressa: An American Doctor in Rome Levenstein writes, with love and exasperation, about navigating her career through the renowned Italian tangle of brilliance and ineptitude, sexism and tolerance, rigidity and chaos.

Part memoir--starting with her epic quest for an Italian medical license--and part portrait of Italy from a unique point of view, Dottoressa is packed with vignettes that illuminate the national differences in character, lifestyle, health, and health care between her two countries. Levenstein, who has been called "the wittiest internist on earth," covers everything from hookup culture to neighborhood madmen, Italian hands-off medical training, bidets, the ironies of expatriation, and why Italians always pay their doctor's bills.

Genres: Italy, Nonfiction, Medical, Memoir, Biography

270 pages, Paperback

First published May 21, 2019

About the author

Dr. Levenstein was born in Manhattan and is a graduate of Harvard University, the Mount Sinai School of Medicine, and the Residency Program in Social Medicine at Montefiore Medical Center in the Bronx. She moved to Rome in 1978 and has been practicing primary care internal medicine there ever since, treating a clientele that’s featured Roman auto mechanics and British ambassadors, Indonesian art restorers and Filipina maids, Russian poets and Ethiopian priests. When not seeing patients in her office, doing research in psychosomatic medicine, or being the Artist's Wife to her composer husband, she enjoys blogging at Stethoscope On Rome, playing classical piano, performing watsu (WATer shiatSU, a form of bodywork in warm water), and walking the streets of the most beautiful city in the world.

Reviews

[Rebecca · Rating 3 out of 5]

In the late 1970s, Levenstein moved from New York City to Rome with her Italian husband and set up a private medical practice catering to English-speaking expatriates. Her light-hearted yet trenchant memoir highlights the myriad contrasts between the United States and Italy revealed by their health care systems. Italy has a generous national health service, but it is perennially underfunded and plagued by corruption and inefficiency. The tone is conversational and even-handed. In the pandemic aftermath, though, Italian sloppiness and shortages no longer seem like harmless matters to shake one’s head over.

(My full review was in the June 19th issue of the Times Literary Supplement. It is also available online.)

[Abigail · Rating 5 out of 5]

As a US —> Italy expat myself, reading this book was extremely relatable (and entertaining!) and it offers a very insightful look into the “true” state of affairs regarding Italian medicine. It will help people of any nationality make sense of the way that things are done in Italy, and adjust their expectations accordingly. When I was reading this, I was struck with many “oh so that’s why I’ve been so frustrated with doctors here” or “oh so that’s why my ER experiences here have been akin to the ninth circle of hell” moments. Thankfully though, after reading this book, I have a much better understanding of how things work here, and I feel more prepared to navigate this complex system. Even if the thought of another Italian ER visit makes me seriously wonder whether or not I’d make it out alive. I suppose it’s a small risk to take for living in the country of my dreams.

[Sarah Johnson · Rating 5 out of 5]

As an American in Italy for the better part of a decade, reading this book seriously put together the puzzle of my experiences with the Italian health care system. Sometimes it's great and amazing and wonderful and free(!) Othertimes you exit out of the weird, dark, unorganized hospital into the sun and just can't make heads or tails of the left field diagnoses and wackadoo conversations you had within. Loved every bit of this book! 10/10

[Mary Ruth · Rating 3 out of 5]

A lot of good stories crammed in here, but could use some organization.

[Catherine Henckel · Rating 4 out of 5]

Perhaps a bit niche, but as an American who has studied both American Medicine and Italian, reading this book was highly insightful, entertaining, and hilarious. I had several moments of “ooooh, that’s why Italians are like that!” after the author described odd situations she found herself in from her thoroughly American perspective. After my many, many years of Italian study, this book shed light on some of the more puzzling aspects of Italian culture for me. It was also bananas to learn how wildly different medical training is between the US and Italy, and how the practice of medicine itself vastly differs. Sometimes I fall into patterns of thinking that Western nations are more similar to one another than not, but then in moments like these I’m enthralled by how different humanity and it’s systems can be from one another if you zoom in.

[Jane · Rating 5 out of 5]

I thoroughly enjoyed this memoir/essay collection! Levenstein is an exceptional writer with an impressive edge of acerbic wit. I found the glimpse of medical practice, Italian style, terrifically interesting, as well as compelling when compared to its American version.

[Janet · Rating 3 out of 5]

This was an interesting book that compares the healthcare systems in America and Italy. I think both countries have their pros and cons, neither is better than the other.

[Liralen · Rating 3 out of 5]

Levenstein is an American doctor who has spent her career practicing in Rome, giving her a different perspective on medical systems in both countries. My biggest takeaway, if I'm honest, is that I should avoid medical treatment in Italy if at all possible—that care can be excellent or it can be a shitshow, and there's not really a good way to know what you'll get in advance. (Levenstein has worked in Rome for decades, and she talks about shifts big and small over the years—so some things have changed for the better. But still.)

I found the book to be a bit slower-going than I'd expected, I think because I'm more used to medical memoirs that go in depth into a handful of cases, and this is more of a rapid-fire series of anecdote after anecdote after anecdote (grouped by theme with broader notes), which made it harder to get invested. But that doesn't mean it's not interesting:

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Until then, the only thing I could do besides tour the Forum was take my official Italian language examination at the University. On appointment, I walked into a room where a man looked up from his desk and asked in Italian, "Are you really a physician?" and I said "Si." He asked, "What's an American doctor doing moving to this second-rate country?" I said, "Non so, I don't know." He waved me out of the door. I had passed. (6)

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As a stickler for honesty, I must have told thousands of patients no, their sniffles didn't come from a chill. That hoary theory, as all American medical students are taught, was scientifically proven on army recruits in the 1950s. Cold virus was spritzed directly into their noses during a freezing rain and then, according to the luck of the draw, half of them spent the night shivering outdoors naked, the other half tucked in under the blankets in a toasty infirmary. Both groups got cold symptoms at exactly the same rate.

One day, a retired British colonel with bronchitis asked me why I thought he had gotten sick. I was tired that afternoon, for once I didn't feel up to squaring off against a patient's preconceptions, and I said, "Well, maybe you caught a chill ..." He drew himself up and said sternly, "Now doctor, that is certainly not why. When I was a young soldier I participated in a study where they squirted cold virus up my nose ..." You can't win. (121)

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They've never been able to hack seatbelts, though. Seatbelts are for sissies. I once got pulled over by the police for wearing one—a woman driving a convertible with a seatbelt on was so unlikely as to be in itself a suspicious act. (122)

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Here in Rome, at least, I rarely receive even a terse scribble [as a consultation note]. But then, Italy rarely encourages written prolixity; within living memory, if you wrote over five words on a postcard the stamp cost more. (172)

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I once helped a docile schizophrenic woman, a former nurse, escape from the clutches of an Italian psychiatrist who as part of his treatment had her living in his house and sharing his bed. The Italians call that plagio, plagiarism, which can mean stealing either a person's words or his soul. A colleague and I escorted her personally to a Boston-bound plane. (219)

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With newbie expatriates I've learned to tailor my routine intake questions to their national origin. For Brits: "How is your new life going?" ("I love it, of course.") For Americans: "How are you managing to adjust?" ("It was awful at first, of course, but I'm past the worst now.") (224)

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One night during my residency I had a patient shipped down to my ward from the intensive care unit because he was brain dead and they needed the bed. In the morning he woke up and asked for breakfast. (244)

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A Nigerian college boyfriend told me that while traveling alone through the South in 1963 he'd had a winning strategy to avoid lynching: always wear African clothes. In one small town he'd put on his suit to go to church on Sunday and was turned away at the door. Next day, in a dashiki, he ran into the pastor on the street and received an apology: "So sorry we didn't let you in. We didn't know you were an African, we thought you were a Nigra." (254) (leaving that last word in for historical context only)

[Mark Cohen · Rating 5 out of 5]

I write this review as a fellow physician. The physician’s journal has its roots in antiquity. Often records of unusual patient presentations were recorded for didactic purposes. We are fortunate that the author seems to have maintained a personal journal (also collected from various pieces of paper as needed) from an early age, recording not only happenings in her life but her reactions to them at the time.

The intermingling of her physician and personal life roles is told in the manner of narrative story telling. We learn about her adventurous spirit, openness to new ideas, and other ways of thinking as her story unfolds. A taste of the writing found in her tale of two cities (New York & Rome) occurs as she contemplates moving to the country she has chosen to adopt, “I was ready to leave all uncertainties behind and begin a joyful adventure in chaos.”

Her memoir weaves between combinations of and conflicts between art and science and mind and body, her worries and insecurities. A sensitive reader will find that she/he can readily identify with the author.

There is an old physician adage that goes something like this: “Listen to the patient, and they will tell you what you need to know.” Dr. Levenstein is not only a good listener. She has been able to teach us how she reasons, thinks, and works with her patients towards the best outcome.

Through the book there is this pull between her and her country of origin and her adopted country. If only she could have the best of both worlds. (And I believe that she just might have.) She expresses this in several ways but my favorite regards the comparison of our medical systems.

“Health heaven: the funding, hospitals, and doctors’ education are American, the lifestyle and access to care Italian. Health hell: Italian budgets, medical training, and ICUs; American pricing, coverage, Big Macs, drunk driving, weapons-mania, couch potatodom, and streetcorner opiates.”

This is definitely an enjoyable and educational read.

[June Volz · Rating 4 out of 5]

As an American living in Italy, I found this book in part enlightening and a bit disturbing. The author shares quite a few "horror stories" of Italian healthcare. However, having worked for over 40 years in the American healthcare system, I have a repertoire of horror stories myself!
I also had to remind myself that many of her experiences date from several decades ago. Things have changed since then.
Luckily, the hospital in our town has been described to me by a friend (who received cancer treatment there) as "a jewel." It was also the regional hub for Covid patients during the height of the quarantine, so I trust that it provides quality care.
Alla fine, my decision to move here was strengthened because, like the author, I believe the Italian lifestyle, including clean air, potable water, fresh, locally grown and produced food and errands that require walking rather than driving (in a medieval hill town) has been good for my physical as well as mental health. Salute!

[Cate · Rating 3 out of 5]

I really enjoyed this book all the way up to the 17th chapter where she seems to take a different direction from the rest of the book. As someone who has worked in the American healthcare system longer than she ever did, I take offense as she propitiates misinformed ‘revelations’ about current practice is the US. It really showed how out of touch she is with current day America and as such she should have just said something along the lines of “this is how I’ve heard that it is” rather than writing as if this is a horrible thing. I agree with many of her points in how the healthcare system could be improved, but casting the role of nurses, pharmacists, advanced practice providers, and EMRs as a bad thing is just disrespectful and uninformed. Multiple times in the book she highlights how the more complex cases she sees have to go to the public hospitals or out of the country for decent treatment — maybe those elements she disparages are why those complex cases can be better handled?

[Suzanne · Rating 3 out of 5]

This is a very personal account of Levenstein's experiences as an American-trained doctor practising in Rome. It is an absorbing account, often amusing, sometimes disturbing but always easy to read. Significant differences between the American and Italian health services are revealed and, despite its shortcomings, Levenstein does not regret having worked under the Italian system, albeit as a private practitioner.

Reading as a potential patient I was struck by the hit and miss nature of much medical treatment as described by the Dottoressa. Lives are unexpectedly saved but mistakes also result in undeserved pain and suffering. It certainly contributed to increasing my wariness about any contact with the medical profession.

[Katie · Rating 4 out of 5]

This is a flurry of outrageous medical anecdotes and insight into the human condition, both of the Dottoressa herself and her patients. This is an account of evolution and devolution (in no particular order) of systems, of cultures, of practitioners. Many of Italy's mysterious ways were unveiled to me so I'm grateful and enjoyed reading this book.

As a medical practitioner myself, I particularly like what the Dottoressa says about the importance of the physical exam. I miss doing my head-to-toe exams on patients. Often I saw the intern skip it, the resident skip it, the attending skip it (but chart it nonetheless). I understood the importance of listening to my patient.

[Jeanette Nardi · Rating 5 out of 5]

Book is not only informative but very entertaining. It touched me emotionally as well as making me laugh. Reading it was the highlight of my day.

I would recommend this book to all my expat friends living in Italy as well as my American friends who wished they were

[Debbie Cohen · Rating 5 out of 5]

Grab a glass of wine, commit to the Mediterranean diet and settle in for a funny and educational doctoring adventure ... You don't need to be a doctor, patient or live in Rome to become enlightened by this book!

[Gillian · Rating 4 out of 5]

I enjoyed this tale of the expat/emigrate experience in Rome through the lens of practicing medicine.

[Lanie Tankard · Rating 3 out of 5]

Here's my review:

https://www.thewoventalepress.net/201...

[Sylvia · Rating 4 out of 5]

Very enjoyable. Susan is a great story teller.

[Charlotte · Rating 3 out of 5]

Enjoyable with some genuine out-loud laughter