What Max’s ‘The Pitt’ Gets Right & Wrong About ERs, From A Real ER Doc

Emergency medicine is a field that has been glamorized and sensationalized in popular TV shows like ER, Chicago Hope, and Grey’s Anatomy. However, HBO Max’s The Pitt takes a different approach by portraying a realistic and gritty depiction of a busy Pittsburgh ER. While the show still has its fair share of drama, it tackles many of the real issues facing hospitals today. Here are four areas where The Pitt gets it right, and four where it diverges from reality.

Here’s What The Pitt Gets Right:

1. The Operational and Emotional Grind Of Emergency Medicine
   The show accurately portrays the operational struggles of emergency medicine, including staffing shortages and throughput constraints. Patients are often cared for in hallways, and boarding—keeping admitted patients in the ER for extended periods—is a common issue. The emotional toll of making tough decisions under pressure is also highlighted, reflecting the concept of moral injury experienced by many clinicians.

2. The Normalization of Violence Against ER Staff
   The Pitt doesn’t shy away from depicting violence against ED staff, a harsh reality in many real-life ERs. The normalization of workplace violence and the lack of adequate support for staff after such incidents are accurately portrayed. The show sheds light on the rising trend of violence in ERs, particularly since the onset of the COVID-19 pandemic.

3. The ‘Real’ ER cases of The Pitt
   Unlike many medical shows that sacrifice clinical accuracy for dramatic effect, The Pitt maintains a level of realism in its portrayal of medical procedures and cases. The resuscitations, airway management, and trauma responses in the show closely mirror real emergency practices, earning praise from medical professionals for its accuracy.

4. The Inter-Professional Conflict
   The Pitt doesn’t shy away from showcasing the conflicts and egos that can arise between different staff members in a high-stress environment. The show accurately captures the sometimes dismissive attitudes towards emergency medicine from other specialties, highlighting the tensions that can exist within a hospital setting.

   Here’s What The Pitt Gets Wrong:

5. The Relentless, High-Acuity, High-Complexity Action
   The show tends to focus on complex and high-acuity cases, creating a non-stop stream of dramatic medical emergencies. In reality, ERs deal with a mix of high and low acuity cases, as well as the logistical challenges of patient flow, which are not always accurately represented in The Pitt.

6. The Luxury of Undivided Focus
   The Pitt often shows doctors being able to focus on one case at a time, without the interruptions and distractions that real ER physicians face on a daily basis. The constant barrage of phone calls, alarms, and administrative tasks that ER doctors juggle is not fully depicted in the show.

7. A Glaring Absence of Chart Documentation In The Pitt
   One of the most significant inaccuracies in The Pitt is the complete omission of chart documentation, a task that occupies a significant portion of an ER physician’s time in real life. The show fails to show the reality of EHR data entry and the administrative tasks that are part of a doctor’s daily routine.

8. The Pitt’s Myth of the Maverick
   The show occasionally portrays characters bending or breaking the rules to achieve a positive outcome, which may not reflect the collaborative and regulated nature of modern healthcare. In real-life ERs, such maverick actions would be met with pushback from colleagues, nurses, and risk management, highlighting the importance of following protocols and guidelines.

   In conclusion, The Pitt succeeds in capturing the essence of emergency medicine and the challenges faced by ER staff, even if it takes some creative liberties for the sake of storytelling. Its realistic portrayal of the operational struggles and emotional toll of working in a busy ER sets it apart from traditional medical dramas, making it a compelling and thought-provoking watch.