how real is hbo's the pitt? emergency doctors all-too familiar with realities portrayed in hit tv show
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from left to right: alexandra metz, patrick ball, noah wyle, gerran howell and amielynn abellera all play different doctors and nurses on hbo's hit show, the pitt.
warrick page/hbo max
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what if you couldn’t watch an emmy award-winning tv series that everyone’s talking about because it felt too real—just a bit too close to the high-stakes job you do every day?
the pitt is a real-time hbo drama that captivates viewers with unexpected and sometimes gruesome events in an overcrowded emergency department at a pittsburgh hospital. there are wins and losses, student doctor missteps and physician rivalries that are addictive to watch, especially when a code black from another hospital sends an influx of trauma patients their way. and while themes of the hardships of being short-staffed and underfunded run throughout, it’s the personal struggles and relationships of the staff and patients that drive the storylines.
the show has received high marks for its realistic portrayal of hospital workers and the emotional turmoil of healthcare today. but for some er doctors, the realism is too real when they’re looking for a mental break to relax.
“i have watched the show just to see what it was like and to be honest, it’s so realistic that i actually don’t enjoy watching because it’s too much like watching work,” says dr. sarah mcclennan, chief and medical director of emergency and urgent care with trillium health partners in ontario.
dr. mcclennan says the show is an honest depiction of what she and her team go through in the er, although she’s not sure how the show’s senior attending physician, dr. robby, sees almost all patients, helped by medical resident doctors. dr. mcclennan would share the duties with two other lead er doctors. (that said, actor noah whylie is well-acquainted with the demands of emergency medicine. he played dr. john carter on the medical drama er for 15 years.)
the pitt resonates with emergency room doctors
“i feel like a lot of the storylines really resonate with the things we see daily in the emergency department,” dr. mcclennan says. “and so i do think the pitt is very realistic to the point of the individual stories we’ve seen, like the patients that present to the pitt are the mental health patients, the substance abuse, the people who are under-housed, the pregnant teenager. these are patients we see on our shifts.”
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her department manages more than 300 patients that come through each day, so an individual doctor on a shift would see about 10 per cent of them. a patient is seen every two minutes.
“but when i read the charge nurse reports every day as the chief, even though i might have only seen two or three of the sickest patients, you know, there were 40 that came in that day that fit all of the descriptions that were seen on the pitt.”
dr. fazila kassam is a first-year emergency medicine resident doctor in the same emergency department, who trained in british columbia. prior to medical school, she worked as a physician navigator, which is a personal assistant to an emergency physician on shift. she was in a rural facility during the pandemic’s strangeness and intensity, where everyone had to step up.
“i was really impressed with what the emergency department offered to the population. and i think the pitt really brings that to the forefront. the physicians handled distressing events with grace and patience, and it was really rooted in teamwork. i think that comes through in season one with the mass casualty and then in season two with the code black, where every single individual has a role to play, which is no different than what we have to do day-to-day,” she says.
“we need our clerks, we need our housekeeping staff to help with room turnover. we need our medical students, our residents and everyone in sync and on the same page toward a shared purpose. and i feel that is really well expressed.”
while some healthcare workers exited the profession because of pandemic pressures and burnout, her service didn’t deter her from her goal to become an er doctor, and she’s clearly thriving now. medical residents rotate through other specialties, including pediatrics, internal medicine, sports medicine and surgeries that are relevant to emergency medicine because anything and everything shows up at the door. “we need to know a little bit about every single specialty.”
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dr. kassam started watching the pitt when it first came out, but found, like dr. mcclennan, that it resonated a little too much. instead, she enjoys “trash reality tv,” crime shows or personal favourites white collar and fringe, but she returned to the pitt as a fan.
“in terms of the atmosphere, the dynamics between the different healthcare staff that are involved in the emergency department, are very well portrayed. and i think dana evans, who is the charge nurse in the show, really embraces the personality and persona of a charge nurse so well. it’s so accurate. they just know everything, like if you need something done or if you need to know what’s going on in the department, they’re your touch point.”
from her perspective as a medical resident, she appreciated the portrayal of dr. samira mohan’s approach, where she focuses on getting things right, sometimes at the cost of speed. “at the beginning, we really are (cautious and slow) because we’re so focused on patient care and trying to really get to know our patients and do the best for them,” she says, adding that what doesn’t ring true for her is how the medical students know so much on the show and often work independently.
“you always have a staff with you before you’re going in or doing something. as a medical student, at least as a resident, you’ve got more of a leash.”
what about medical students fainting in the or setting (that happens on the show)? yes, it happens. dr. kassam admits that during one rotation in b.c., she worked on an empty stomach after a night shift. a patient came into the er with a deep laceration that was “quite gruesome and i felt queasy,” she says, needing to excuse herself to vomit. “i realized i can never go into shift on an empty stomach.”
the pitt spotlights passion and dedication of er doctors
dr. mcclennan talks about her love for her role as er doctor and her role as chief. “i am never sad to go in and work in the emergency department. i just still love it every time i go in. i also really like the chief role in that you get to think about how do we improve the system for our patients? how do we make it a better patient experience? how do i make the experience for our providers, our med students, our learners, our staff a place where people want to come to work and have that joy,” she says.
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that love for the job has to be admired, given the very real tensions of financial security of the department and “trying to provide care within a cost-constrained public system in a way that you know it keeps improving patient care without increasing resources,” she says.
there’s also the tension the show chronicles of no bed admits, which is called “boarding” in the u.s. in canada, the problem is referred to as “no bed admits,” considered a huge problem in emergency departments.
“the show replicates that stress for the doctors and learners and nurses that we’re caring for, sometimes, an entire ward of patients in our emergency department, while also caring for all the patients that come in,” because beds in hospital wards aren’t available. “the administrator’s always trying to be like, ‘how come you can’t see more patients?’ and we’re just saying, ‘well, we’re caring for icu-level patients down here, and they’re not going up and you’ve got to give us more beds.’ it’s a tension for sure.”
there’s also the diversity of patients presented in the show and observed in the real world, where dr. mcclennan and dr. kassam see important steps forward in recognizing differences, like newcomers who may have language barriers and cultural preferences or the custom now to note pronoun preferences in admitting, so that patients feel welcome and treated with dignity. the approach builds trust and engagement in their therapeutic relationship with you that helps with their treatment and ability to heal, dr. kassam says.
“the priority really lies in engaging these folks in a conversation just like any other patient. opening it up in such a way where they recognize, like ‘i am being seen for who i am and accepted for the way i show up,’ goes a long way because then they’re more open about their symptoms as well,” she explains.
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“patients come in, and they are talking to you at one moment, and the next, they’re totally deteriorating and unconscious. it’s quite well represented in the show. that is the nature of emergency medicine where you’re dealing with very limited information.”
emergency medicine is about teamwork and support
most reassuring about emergency medicine is the teamwork and the ability to refer patients to other healthcare professionals for further investigation. in the moment, there’s always another staff member or resident around as a sounding board during a resuscitation, dr. kassam says. in other specialties, healthcare providers can feel siloed.
“sometimes we also have our internist sitting in the department. so if we’re worried about something, we can easily just go around the corner and be like, ‘hey, do you think i need to do xyz or be concerned about this?’”
most important, great emergency care is about people, treating patients and their families with kindness—and finding satisfaction and joy.
“there are funny things that happen, too, like when i read charge nurse reports, sometimes i just laugh,” says dr. mcclennan. “i read one not that long ago where the nurses had to look after a patient who brought their dog in because they had nowhere to bring the dog. and the nurses were taking the dog out to use the washroom. and there was one day with cats. i think you have to see the humanity of the department and the fun of the department as well.”
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