What “The Pitt” Taught Me About Being a Doctor
“The Pitt” easily could have felt like one long sequence of overstuffed, heavy-handed scenes. It’s a testament to the show’s artfulness that, most of the time, it doesn’t. Instead, we learn to care about issues that might otherwise feel abstract because we see them affecting characters’ lives. An anti-vax mother fights the doctors treating her son for measles. A resident’s health-equity research is defunded by the Trump Administration. A social worker talks with a child whose parents have been deported. A doctor encourages a woman to share a story of abuse by divulging her own.
“The Pitt” is not above a dose of cliché. In the first hour of a shift, a medical student passes out, earning the nickname “Crash.” Another keeps changing his scrubs because he (and he alone) is repeatedly doused with patients’ bodily fluids. The show also packs a year’s worth of unusual emergencies into a single shift. A patient’s heart seems to stop beating every fifteen minutes or so. (Even in the busiest E.D.s, this might happen once a day.)
And yet, if I had to pick one show to explain the challenges of my profession, this would probably be it. I felt, while watching, that I had worked with versions of virtually every character: eager medical students, knowing nurses, cavalier surgeons. There are trainees whose confidence exceeds their abilities and those whose abilities exceed their confidence. In one scene, a patient is told that many people who report penicillin allergies don’t actually have one, which needlessly restricts the antibiotics that they can be prescribed—a point I often raise with my own patients. In another, viewers learn that Medicare generally requires someone to remain in a hospital for three nights before it will cover a stay at a skilled-nursing facility. Hospital administrators keep reminding doctors that if they exhaustively document the care that they deliver, the hospital will be able to bill for it at higher rates. Violence against health-care workers is on the rise; midway through the first season, an angry patient punches a nurse in the face.
Michael “Robby” Rabinowitz (Noah Wyle), the grizzled head of the emergency department, tells one doctor, “We are a safety net, but nets have holes.” Doctors must accept the limits of what they can offer. Later, a resident protests the injustices faced by a patient of hers. “It’s not right,” she replies.
“A lot of what happens to people around here isn’t right,” Robby replies.
To the extent that “The Pitt” is a kind of public-service announcement, it delivers a complicated message. By leaning heavily into the heroism of nurses and doctors, the show reveals how much of the system is kept afloat by the dedication of health-care workers. But this emphasis suggests, as well, that the system can persist largely as it is if only doctors and nurses work hard enough. In reality, such heroism softens—but is also eroded by—a broken system. Real clinicians are often forced to cut short conversations with patients to catch up on mountains of charts; it’s common for doctors to stop recommending potentially useful treatments that they know insurance won’t cover. The many instances of camaraderie, courage, and self-sacrifice I witnessed during the pandemic have largely given way to a grinding routine: prior authorizations, burdensome documentation, heavy patient loads, an increasingly skeptical public. “The Pitt” excels at capturing medicine as it is. We witness deeply engaging and committed characters trapped in a dysfunctional system from which they can’t extract themselves. But, as a result, viewers can’t extract themselves, either. In this sense, the show’s greatest strength is also a significant limitation.
What would it mean to heal a system that serves as the destination for so many of society’s ills? The challenge feels impossible. Even if you solved the insurance crisis and workplace violence and frivolous malpractice suits, there would still be child abuse and xenophobia and climate change and vaccine hesitancy and the endless box-checking of the electronic health record. Even when the show’s characters gesture at possible solutions—universal health care, a strong social safety net—these ideas tend to be met with cynicism rather than conviction. The mere notion of a nurse getting a raise feels like a wry joke.
Still, “The Pitt” underscores that a good place to start—in the show and in life—would be to adequately staff health systems. Much dysfunction and dissatisfaction is downstream of the fact that often there are simply too few professionals caring for too many people. Disgruntled patients wait for hours in a triage area before boarding for days on a stretcher in the emergency department; doctors are torn from one patient to tend to a second, and then a third arrives. In the show, Robby’s requests for more nurses, more beds, and more security are repeatedly denied. In the real world, research has found that staffing shortages, which are often exacerbated by corporate ownership of hospitals and practices, place patients at higher risk of falls, infections, and death. Meanwhile, clinicians who feel stretched have lower morale and are more likely to quit. One of the most dispiriting things a doctor can feel is that she could have helped a patient if only she’d had the time.
