This article initially appeared in the June 2010 issue of The Washingtonian.
Joseph Ricotta was an old-fashioned family doctor. He started practicing medicine in the early 1940s, seeing patients in an examining room in the back of his home right up until the day he died in 1990.
He was a first-generation American, the child of Italian immigrants who settled in Buffalo. Many of his patients were immigrants and children of immigrants. In his day, family doctors were something of a one-man medical band. Along with being a general practitioner and an ob-gyn, he did a bit of surgery or psychiatry when the need arose.
He made house calls—often with his grandson and namesake, Joseph, helping to carry his black bag. On the rare occasion when patients couldn’t pay in cash, they mowed the doctor’s lawn or offered him a chicken or some eggs or a bushel of tomatoes.
His son John Ricotta, 60, is now chairman of surgery at Washington Hospital Center. His granddaughter Lise is an anesthesiologist in Baltimore. His grandson Joseph performs state-of-the-art endovascular surgery at the Mayo Clinic.
Their family’s story embodies the arc of modern American medicine over the last half century. It’s a tale of astonishing technical breakthroughs—from organ transplants to CT scans, antibiotics, chemotherapy, statins, and other treatments that save lives. The explosion of knowledge has been so rapid that, as the physicians in the Ricotta family say, the challenge now is to manage that knowledge, not memorize it.
American medicine since the mid-20th century has also become so specialized that care can be fragmented, adding to the costs and complications of chronic diseases. There are so many new treatments and drugs and protocols that doctors don’t always know which to use, when to use them, or whether to use them at all.
Patients have become “health-care consumers” and doctors are “providers,” a change in terminology that the Ricottas say reflects new assumptions about doctor omniscience and patient autonomy. Mom-and-pop businesses—with Pop practicing medicine and Mom keeping the books—have morphed into a $2.3-trillion health-care system. Today Mom is just as likely as Pop to be the doctor.
And while one in six Americans is uninsured, it’s hard to envision many patients in 2010 paying off a doctor’s bill with a bushel of tomatoes.
The Ricotta family’s experience is the story of three generations of doctors who, despite the dizzying pace of change, are inspired by the lessons they learned at their grandfather’s knee, trying to do their best for patients in a confusing, miraculous, litigious, and rapidly changing world.
Neither Lise, 33, nor Joseph, 38, saw medicine as a family obligation foisted on them. For each, it was a choice—and a good fit.
“We were well educated, and we were very well taken care of,” Lise says. “We were raised with the assumption that we would give back to society—through medicine or something else. It just so happens the skills that run in our family manifest in medicine.”
Ride the Metro and you might see an ad for Washington Hospital Center, where John Ricotta has been chief of surgery since October 2008. In his dad’s day, hospitals didn’t advertise on billboards.
As a youngster, John respected his father’s commitment to patients but didn’t understand the lure of medicine, which often interfered with family life. As a teen, he earned pocket money by spending his evenings filing the charts of patients his dad had seen that day and pulling charts for those who would be seen the following day. It was tedious work. He dreamed about becoming a lawyer or a history professor.
While he was an undergraduate at Yale, law and history lost their allure and medicine beckoned. John Ricotta began seeing his father’s relationships with patients in a new light, understanding why his father found it so enriching—even if it meant time away from his wife and kids. John went to medical school but decided he didn’t want a general practice like his dad’s, partly because he planned on going back home to Buffalo—which he did for several years before practicing in Long Island and then DC. He wanted his own professional identity in a community where his father was beloved. “You couldn’t go someplace without someone knowing him,” John says.
John Ricotta also came of age amid a trend toward specialization in medicine. He became not just a surgeon but a vascular surgeon. The technology interested and challenged him. The ability to diagnose a problem and fix it in an operating room suited his temperament.
If you’re lucky, you don’t know what vascular surgeons do. These physicians treat abdominal aortic aneurisms, deep-vein thrombosis, carotid-artery disease, peripheral vascular disease, and other circulatory conditions that can be disabling or deadly. In his father’s day, they often were.
John tries to keep some of his father’s ethos, seeing a patient as a whole person and not as a collection of leaky blood vessels. It isn’t easy. In our current medical system, patients tend to have multiple specialists who don’t always communicate well with one another—and aren’t paid to coordinate care.
“Patients very often have many doctors, and everybody is busy,” he says. “It’s not that easy to coordinate. I try to do it for a complex patient. I try to get on the phone with the other physicians.” But there’s a lot of telephone tag.
Vascular disease does lend itself to more of an ongoing patient/physician relationship than other surgical specialties do. The patients are usually elderly, and if they have one vascular problem, they’re at risk for another. So Ricotta tends to take care of them over the years. For him, that mix of surgery and continued care, along with responsibility for patients in both the hospital and the office, is the best of both worlds.
“My father had a relatively low-tech, highly interpersonal relationship with his patients,” says Ricotta. “I’ve had less intense though very rewarding relationships.” He still has former patients from Long Island who call him, trying to find another vascular surgeon who has that same human touch.
While John Ricotta is a specialist, his children Lise Ricotta Asaro and Joseph Ricotta are part of the superspecialist generation. (Their sister is a speech pathologist in New York.)
Lise isn’t just an anesthesiologist. At Kernan Orthopedic Hospital, part of the University of Maryland medical system, she specializes in nerve blocks for orthopedic surgery. The nerve blocks give patients who may be poor candidates for general anesthesia—for instance, because of a heart condition—a chance at bone or joint repairs that can restore mobility or reduce pain, improving the quality of life.