A Real-Life ER Doctor Examines The Pitt

by

Watching “The Pitt” can sometimes resemble managing recurring panic attacks: You’re engulfed by a surge of dread, you push through it, and then you handle the aftermath – only for another crisis to strike again. This series, which could be seen as a spiritual successor to “ER,” although there are legal complications in labeling it as such, follows the life of a bustling Pittsburgh emergency room. Noah Wyle stars as Dr. Michael “Robby” Robinovich, the head physician who steers the department’s attempts to handle the endless stream of patients rushing in.

Intense, gruesome, and highly tension-filled, “The Pitt” retains a lot of its appeal thanks to its real-time narrative format. Borrowing from the structure of shows like “24“, this 15-episode season follows the events of an entire 15-hour shift in real-time. This approach adds a heightened sense of reality to the series, which has been so convincing that it’s sparked discussions online, and even praise from voices within the medical community for its authenticity.

To verify the authenticity of these praises, Vulture contacted a medical expert who is a fan of the show: Dr. Lukas Ramcharran from Johns Hopkins University School of Medicine. With both an M.D. and an M.B.A. from New York University, Ramcharran currently serves as an attending physician and assistant professor in the Department of Emergency Medicine at Johns Hopkins, making him a real-life counterpart to Dr. Robby. We had a conversation with him earlier this week while he was taking a break from his computer doing administrative tasks, just before The Pitt‘s eighth episode.

Have you found The Pitt to be one of the most authentic representations of emergency medicine on TV, arguably the best yet? Does this resonate with your experience?

What was the reason you ended up being part of the show? My wife and I aren’t big TV enthusiasts due to having a 10-month-old at home, with another one on the way in a month. She works full-time, and I have ER shifts. In the past, I used to watch ER, and I was fond of it when it first started as it focused on medicine, but not so much later as the series had to develop more storylines and become more dramatic. I’m not sure if I even completed the entire series.

Initially, we came across ads for “The Pitt” on HBO. However, what truly piqued my interest was the buzz from educational circles. EM:RAP, a national education platform for emergency medicine, had endorsed it. This resource is invaluable as it provides content beyond traditional lectures during our residency training program. I also suspect they were involved in the show’s production. Then, I saw promotional clips featuring Noah Wyle and medical professionals who consulted on the show discussing the intensive medical training given to actors to ensure authenticity. This aspect truly ignited my curiosity.

Despite some initial reservations, yes, I did attend the show. It’s common among professionals, regardless of specialty, to have a bit of skepticism about TV portrayals due to their inaccuracies. But The Pitt has been an exception. My wife, who isn’t in medicine, and I have been together since college, and she’s witnessed my journey from student to attending physician. I’ve always wanted our family to understand what we do on a daily basis – to see the specialty I love and have dedicated my life to. Due to HIPAA and patient privacy, family members can’t visit during work hours. So, I was curious to see if this show could give her an insight. It’s been such a delight! I find myself frequently pausing to say, “That’s what we do! That’s the thing I told you about!” I do occasionally edit my comments, like “This would be more bloody” and so on. And she often tells me to stop pausing.

What catches my interest about the series is its unique structure. I appreciate how each episode represents a single workday, offering an insightful portrayal of the various challenges and conflicts that arise in a given role. It’s not just about the medical aspects; it also deals with other pressing issues such as team dynamics, hospital politics, and the emotional strain of dealing with patients on their most difficult days.

Unlike other series, it avoids prolonged, dramatic story arcs and instead focuses on the immediate events unfolding in the ER. The fast-paced nature of the show means there’s no time for drawn-out plotlines like you might see in Grey’s Anatomy. Instead, there’s more emphasis on computer work, phone calls, and interruptions, all of which reflect the reality of working in an emergency room accurately.

Dr. Robby is always moving about, and this mirrors the bustling nature of an attending physician’s role. While focusing on patient care, he also takes time to educate medical residents. He frequently intervenes when he can assist a trainee, granting them some independence and responsibility. This approach not only showcases his mentorship skills but also trust in his senior residents as they progress in their careers. It’s inspiring to observe, yet it also reveals Dr. Robby’s humanity. The scene encompasses the entire healthcare system: from the frontline staff triaging patients in the waiting room, to the support staff behind the scenes, and the social worker – a character often overlooked but crucial, acting as a silent ally in many situations.

It seems that administrators are portrayed as being somewhat over-dramatized and unfairly criticized. However, it’s important to remember that they, along with everyone else, are striving for alignment in their efforts to prioritize the well-being of all individuals. Their role is to address systemic and operational challenges and find ways to care for more patients effectively.

How often do administrators physically drop by an emergency department during a typical day? Rarely, as their primary roles involve caring for patients and mentoring trainees. It’s the medical director, associate medical director, or administrative staff who aren’t on duty that day who handle such inquiries. The thought of an administrator showing up during an active shift to interact with you directly… that’s more fiction than fact. Such a scenario would significantly disrupt patient care.

The back-and-forth dialogue between the administrator and Dr. Robby is a recurring theme throughout the series, which seems to delve into the strained relationship between patient satisfaction, hospital incentives, and quality care. How do you perceive this representation?

In reality, it’s not usually depicted as personal conflict on an individual-to-individual level. Instead, we all experience the pressures of a stretched-thin healthcare system – crowded waiting areas, patients who are admitted but still waiting for their rooms. It’s more about collaboration and finding solutions: “How can we improve?” I appreciate why they use conflict for dramatic effect on the show, but in real life, it’s often more about teamwork.

In reality, there are genuine problems at hand. I’m not using this as a justification for extended wait times, but rather, I wish that viewing such a program might shed light on an issue we’re working diligently to resolve. Please understand that medical professionals and nurses aren’t idle or picking and choosing patients; they’re simply overwhelmed with tasks. The healthcare environment is chaotic and complex, which can occasionally make it difficult for everyone to be seen promptly. Everyone involved is consistently busy.

In response to your question, Dr. Robby seems competent in his role as head of emergency. However, he’s not without personal struggles – his mentor’s death during the pandemic has left a deep impact on him. Nonetheless, he demonstrates high clinical skills. There’s always room for improvement, and we all have days when we could perform better. For Dr. Robby, it seems that he may need to work on inspiring and leading his team more effectively.

Among our responsibilities as an attending, one of the most challenging aspects isn’t managing cardiac arrests or intricate procedures – we’re well-equipped to handle such situations. Instead, it’s the emotional hurdles we encounter, like explaining grim prognoses to family members or intubating patients while their loved ones are changing goals of care on the spot. It’s end-of-life care, abuse cases – these moments that unfold during a shift often leave a lasting impact on us.

The ethical aspect is also significant here. In the series, there’s a situation involving a mother who feigns illness to highlight her son, who might be contemplating harm at school. It’s notable that Dr. Robby wants to aid this boy, although he’s not officially registered as a patient. The question, “Did you do the right thing?” is raised by other residents. I appreciate these scenes because they underscore how crucial it is for medicine not only to focus on technicalities but also on emotional factors that impact us deeply.

In this popular series, we frequently encounter instances that reflect a recurring theme: the challenging duties of being mandated reporters as physicians. For example, we have a child with concerning thoughts, a young woman considering an abortion, and a patient under suspicion of sexually assaulting his daughter. These cases highlight the intricacy of our roles. As mandated reporters, we collaborate frequently with child protective services and law enforcement to determine what needs to be reported and when. While there are situations where the reporting obligations are clear-cut, many scenarios present a lot of ambiguity. For instance, we often encounter female patients who are victims of domestic violence, and it’s their decision whether or not to report. As healthcare providers, you may feel compelled to offer resources, such as access to social workers or police officers, but there are instances when the patient declines any assistance beyond medical care. In such cases, we want to help but must respect their choices.

In this television series episode, there’s a storyline about a woman secretly administering medication to her husband to reduce his sexual drive. However, giving such medication is against the law and can be potentially lethal. The dilemma arises as the show also hints at the possibility of inappropriate harassment towards the patient, although nothing definite has been established. In real life scenarios, we would collaborate with the mother and a social worker to discuss the situation, asking for permission to speak with the daughter. If there’s reason to suspect abuse, we can then initiate contact with the authorities, but only with the guardian’s consent. It is important to note that there are circumstances under which a minor can be emancipated from parental care, but in this case, there’s no reason to believe the mother is also mistreating the child.

Later on, the series portrays Dr. Trinity Santos, played by Isa Briones, acting outside professional boundaries and pursuing justice independently. What’s intriguing is the hint that this character, who seems unpredictable, has a complex history linked to the case at hand. Consequently, she intimidates the patient, who is in a vulnerable position. I found this scene somewhat exaggerated. It’s not common for doctors to behave in such a manner; I’ve never personally encountered a physician doing so.

Have you ever experienced a workday filled with ethical dilemmas like this one? Such days can be quite challenging, given their intensity. I don’t encounter them too frequently, but when I do, it takes a lot of effort to maintain quality and keep things engaging on screen without making it seem unrealistic.

You’re wondering if it’s a Google document? In our hub area, doctors seem to pick their next patients from what looks like a similar interface. In reality, it’s the patient tracking board within our Electronic Medical Records (EMR) system. We use Epic, a popular EMR system across many healthcare facilities. It provides patient data such as vitals, age, sex, and color-coded acuity levels, which might resemble a Google document from a distance.

At The Pitt, the typical workflow involves physicians consistently monitoring a main screen to determine their next course of action, while charge nurses announce incoming emergencies. It’s not a first-come, first-served system; rather, it prioritizes the most critical patients first, necessitating continuous triage. In contrast, Johns Hopkins operates with a comparable structure, but we have separate private rooms in our 60-bed ER instead of a central screen. Our charge nurses allocate patients to specific rooms instead. We simply move from room to room, and each room represents the next patient we’ll attend to.

Have you ever witnessed a new doctor lose consciousness due to stress or exhaustion, perhaps not directly in front of a patient?

Yes, I’ve encountered such an instance once. It was a combination of long hours of training and dehydration that led to their temporary loss of consciousness. Fortunately, they recovered quickly and were fine afterwards. It is indeed possible for this situation to occur. Sometimes, medical students who are not specializing in emergency medicine may find themselves overwhelmed by their first encounter with an emergency room scenario. I’ve even had observers from our medical school and undergraduate campus feel lightheaded and need to take a seat or leave the room during such intense situations. However, only one time have I personally witnessed a doctor fully pass out.

What are your thoughts on the scrub machine?

The two-compartment bins, their mismatched sizes, and the “does not detect” issues – I can relate to all that. The experience of Dr. Whitaker (Gerran Howell) seems quite authentic. Most of us have had to change our scrubs numerous times. We’ve all encountered different types of bodily fluids. Many of us even carry spare scrubs in our work bags, just like I do.

To clarify, there’s no dining happening in the clinical area. This is considered a Joint Commission on Accreditation of Healthcare Organizations (JCAHO) violation, which refers to rules that ensure patient safety and efficient hospital operations. Moreover, it’s insensitive to eat around patients who are not permitted to eat before surgery.

Many emergency medical professionals often skip meals throughout their shifts, opting instead for a granola bar or multiple cups of coffee. In my case, I rely on protein shakes and liquid calories, allowing me to move about during my shift without needing to stop for a traditional meal. Meal breaks aren’t always guaranteed, so it’s common to miss them due to unexpected calls coming in. As a resident, I would often let heated meals cool down untouched when an urgent call arrived. We all have our unique strategies for maintaining ourselves. Some of us eat before and after shifts, while others employ various tactics.

During such times, when nature calls and you’re on your way to the restroom, unexpected situations can occur, like a gunshot victim entering the room, forcing you to momentarily postpone your needs.

Of all the techniques shown on the series so far, the one that caught my interest the most was the refractory ventricular fibrillation arrest that was treated with ECMO. Our hospital also employs this method, and we perform a similar procedure called dual defibrillation, where two defibrillation pads are used to overpower the heart’s electrical system and restore its rhythm. While it’s much more complex in real life, I found the scene of the cardiothoracic surgeons rushing in, cannulating the patient, inserting large lines, and a resident explaining the process both to a medical student and the audience to be particularly thrilling.

Besides finding it intriguing, I too appreciate their utilization of a tool known as the LUCAS device, which serves as an automated CPR equipment. In fact, this very device is what we employ. It’s amusing that I can demonstrate its use to my wife, as my name happens to be Lucas, and it’s the LUCAS machine people often tease me about.

Have you ever encountered an exceptionally young doctor-in-training? While we’ve had trainees from Europe and Canada who are a year or two younger than the norm, I’ve never come across someone as young as a child prodigy. Although it might be possible, they would still need to complete their years of undergraduate studies focused on premedical training and then attend medical school, which takes quite some time. However, I can’t definitively rule out the possibility.

Which character from the series resonates most with you on a personal level? Most viewers might identify with Dr. Robby. Although I don’t find many similarities between us, I can understand and empathize with the struggles he faces. There are certainly areas where he could improve, and we shall see how his journey unfolds as the series continues. However, I admire his dedication to his colleagues and support staff.

Last question. Why do you choose to spend your free time watching a series that mirrors the pressures of your work?
[Laughs] If you ask any partner of a healthcare professional, who themselves are not in the medical field, they’d likely concur: when they socialize with their peers, all they seem to discuss is medicine. For many of us, it’s deeply intertwined with our self-image and sense of purpose. I am passionately committed to medicine, to my specialty. I wouldn’t be in an academic setting if I didn’t feel strongly about the mission of educating future practitioners. Therefore, this kind of content doesn’t cause me stress – it ignites my enthusiasm instead.

Read More

2025-02-20 21:55