#447 - [Neo News] - 📌 - Why Are Doctors Flocking to HBO Max's The Pitt?

In this episode of Neo News, Ben and Eli discuss the cultural phenomenon of HBO Max’s new hit medical drama, The Pitt. Sparked by an insightful critique in The New Yorker by Dr. Dhruv Khullar, they dive into why this Noah Wyle-led series is capturing the attention of millions of Americans, including healthcare workers and patients alike. They explore how the show’s unflinching portrayal of systemic failures, from ER overcrowding to uninsured patients leaving against medical advice, mirrors their daily reality in the hospital. Tune in as they discuss whether the shared humanity seen on screen can bridge the gap between doctors and patients or simply highlight the exhausting "pit" of modern medicine!

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The Pitt: https://www.newyorker.com/culture/the-lede/what-the-pitt-taught-me-about-being-a-doctor

Transcript

Eli (00:02.252) Hey everybody. Welcome back to Neo News. This is our segment devoted to promoting the doctor-patient relationship by keeping you up to date with what's buzzing in the news today. The article that we're going to cover here in our session, the article of the week on the podcast, is about something that everybody is talking about. Everybody's talking about it. They won't stop talking about it. I have not really been part of this cultural movement. I must say my cultural consumption is woefully inadequate at this point, but everybody else is talking about The Pitt. That's all everybody's talking about, is The Pitt. If you haven't heard about it, you also should leave your apartment, or your car, or wherever you're listening to this.

Ben Courchia MD (00:55.393) Yeah.

Eli (00:58.54) Because The Pitt is now in a second season on HBO Max. It is a generational depiction of medical care in the US today. It is a show about one inner-city public hospital emergency room that tells so many stories about what it's like to get sick and seek care in this country today, and there have been lots of hot takes on this thing because everybody loves it. Everyone seems to love this show. This is the medical drama that doctors are flocking towards, that laypeople are watching. I think the general consensus is not only are the characters compelling, the scriptwriting gripping, and the scenes harrowing, and not only are the episodes tight and well put together, but it's accurate. It resonates with people because it feels real. There was a really interesting critique of the show by a physician, Dhruv Khullar, who writes for The New Yorker. I will just read Dr. Khullar's summary of his take on The Pitt, and then we'll talk about it. What Dr. Khullar writes in The New Yorker is, "What's special about The Pitt isn't that it's medically accurate. Although it is. I even learned a few things about how to insert an emergency chest tube." He says, "What's special about the show is that it offers a kaleidoscopic view of how societal problems have come to pervade medicine. In recent years, I've written about ER overcrowding, the toll that caregiving takes on family, the physical consequences of global warming, language barriers and healthcare discrimination against parents with sickle cell diseases, corporatization in medicine, and the promise and perils of artificial intelligence. The Pitt handles each of these themes and many more with nuance and grace. It's as if the show's creators absorbed every important conversation in healthcare today and somehow transfigured it into good television." Ben, have you watched The Pitt?

Eli (03:19.862) Have you heard people talking about The Pitt? Where are you on The Pitt?

Ben Courchia MD (03:22.766) Like you said, everybody's talking about it. I went in steps. The first thing that I watched was there was a reference, obviously, in the world of neonatology, that there was a scene in the series, The Pitt. I forget if I believe it's season one, where a mother delivers in the ER and a baby is born needing resuscitation. Everybody was marveling at the fact that the consultants on the show did a phenomenal job because the steps they were using to resuscitate the baby were spot on. So, as an NRP instructor, I was like, let me check it out. Let me see what they're doing. And it's true. It was a very well done scene with a very realistic baby. Sometimes in TV shows, they bring out a newborn and it's clearly a four-month-old. And you're like, okay, they did not have that baby just now. But this was a very, very cool scene. And so then...

Eli (04:11.47) Hahaha.

Ben Courchia MD (04:17.678) I started watching a little bit of season one and I think that what is making this show popular is exactly the reason why I stopped watching it, because it is very realistic. As mentioned in the article, it does not omit or abstract any of the systemic issues that we deal with in medicine. That was the reason why I was like, I'm dealing with this every day and I'm looking for a break once I get home. So for me, that was my cue to move on to something a little bit lighter. But it is true that all these documentaries that took place about taking you behind the walls of the hospital and letting you see what nobody else lets you see... Well, all these documentaries have not done as good of a job as this particular TV show has. And I think that it is quite real. I feel like even the first scene when Noah Wyle, I think is his name, right? The actor, my God, my wife's going to kill me if I don't know this. Noah Wyle. When he walks into the hospital, it resonates with how we all walk in every day to work. The interaction with the different physicians and providers, and the sign-out, and all that stuff.

Eli (05:24.128) Noah Wyle. Yep.

Ben Courchia MD (05:42.262) It is very, very real. I'm not surprised that people are enjoying this because it does probably resonate with some of their experiences in the hospital. But for physicians, it acts as a bit of a mirror. And it does shine a light on some of the things that, to me, are at the root of our collective moral distress. So did you watch The Pitt? You said initially that you were lagging behind, but... Are you just consulting in the capacity of reading The New Yorker or have you given it a try?

Eli (06:16.148) Excellent follow-up question. I have watched a few episodes of the first season. I had the amazing opportunity to interview one of the key brains behind The Pitt, Dr. Joe Sachs, who's an emergency medicine doctor in Los Angeles and the chief screenwriter for The Pitt. I'm hoping we can get him on the podcast. I'm working on it, but...

Ben Courchia MD (06:28.429) Okay.

Ben Courchia MD (06:36.578) Wow.

Eli (06:41.324) Dr. Sachs also was one of the key writers behind ER, which of course was the generational antecedent to The Pitt. Although if you ask the Michael Crichton estate, they have strong feelings about whether The Pitt is that different from ER. In preparation for that interview, I watched a few episodes and I think my sense was very much what you described, which is that this thing just gets it right. All right. Like this.

Ben Courchia MD (07:10.414) A little bit too much.

Eli (07:11.602) Yeah, a little too much. Yeah. Exactly. What I've heard people say is like, if I want to be at work, I'll just go to work. But I think it's interesting that doctors have that sense because at the same time it is that exact sausage-making that is so incredibly opaque to patients on the other side, right? So many patients will sit in their room all day. They wait for us to round in the morning. They'll wait for us to round at night.

Ben Courchia MD (07:19.938) That's exactly right.

Eli (07:39.722) And it's not clear why their kid did or didn't get an MRI that day. It's not clear why we decided to start albuterol nebs that day. These decisions are not clear. And I think this is a window, not only into how the sausage is made—in the same way that Anthony Bourdain's writing about restaurants was telling about how the sausage is made literally in the restaurant industry—but also because it provides humanity to doctors and clinicians and everybody involved. Right. That's one thing that resonated with me, is like every one of these people is imperfect in their own unique little way. As we all are. I think that piece of The Pitt, the compassion to demonstrate the humanity, the imperfections of all of these people working in clinical medicine... I hope is a way that doctors and patients can get closer in real life. When I've had conversations with patients, which I've had lots of conversations with patients about The Pitt, because by the way, it's not just a couple of people who watch this. I think the number of people who watch season two, based on when I last looked, is 50% higher than the number of people who watched season one. I think this data is somewhere on the order of 12 or 13 million.

Ben Courchia MD (09:02.913) It did. It won some awards. I think that probably also brought whoever was still living under a rock to the show.

Eli (09:13.014) Yeah, exactly. But like 12 or 13 million people, that's like 5% of Americans, right? 5% of Americans are watching this TV show. And you can sure as heck bet that if you were to propensity score those people, it is probably the people who are sitting in the NICU all day who are like, "I want to understand this crazy world that I'm sitting in." And so I think in my conversations with the patients, the themes that have come up over and over about The Pitt are not only just kind of...

Ben Courchia MD (09:17.549) Yeah.

Eli (09:41.878) ...laughing about how ridiculous clinical medicine is. But also I think it invites a shared humanity in a way that I'm not sure when we whisk in and out on rounds on a given day that we always invite patients into.

Ben Courchia MD (10:02.83) Yeah, so it's exactly right. It does capture things that, to me, surprisingly, it's taking place in an adult emergency room far away from where we work in the neonatal ICU. For example, the article mentions a scene in one of the episodes, which, to be honest, I have not seen. But basically, a physician is caring for somebody with diabetes, and they have no health insurance, and they cannot afford the insulin anyway. And the patient leaves the hospital against medical advice. I don't think even notifying the team that he or she is leaving. And the physician who was trying to get some supplies ready for the person to go home said, "I had everything ready for some home care stuff." And they discussed Ubering it to his house, and then the physician offered to pay for it. It's like this happens to us every day. Like it happened to me on Friday, right? Like three days ago. We needed some medications. The patient doesn't have a car, can't get there. It's like, "Okay, I'll Uber." And I ended up Ubering this for the patient. But this happens every day. It's the reality. And to me, with a name like The Pitt, I believe that the name of the series is really in reference to the location of the show in Pittsburgh. But it does feel like... it highlights a little bit the pit in which we are in, where we basically have a very broken system. In the show, you find how we collectively have been bending over backwards to try to make up for some of these inefficiencies. It's unclear where we're going to go from there. Because what's very depressing about this show, and probably ultimately the reason why I'm not watching it, is because... the humanity of the characters is what offers the ray of hope for health care in this country. Right. And that's us. And I have no doubt that you display the utmost level of compassion, care and humanity in the unit. I want to believe that I do as well. But it is exhausting and depressing to see that maybe is this it? Is this really what is going to save the system?

Ben Courchia MD (12:28.224) Is us going the extra mile and Ubering things to patients' houses the solution? I really hope not. I would be very happy if this show brings out the right kind of folks to advocate for our health care system and maybe finds a more permanent and sustainable solution. But Yeah, it's done quite well. I'm really excited that you were able to speak to one of the main writers of the show. I don't know if this is a chord that this show struck with you as well.

Eli (13:07.022) Yeah, I'm not sure that you needed to watch The Pitt to know how broken the healthcare system was, or to remind you of it. I think you just need to show up at sign out and pretty soon you realize, you know, the kid who didn't get the ultrasound for whatever reason.

Ben Courchia MD (13:22.722) But do you feel like you show up to sign out and it's like, okay, it's our hospital. It's our broken unit that doesn't work that well. But if I went down the street, this thing would be working well. I feel like by making it a national TV show that is so successful that everybody resonates with, it sort of rings the bell that this is how it is everywhere. It's just the reality. And I think that this is what's really depressing because to me, I feel like my unit is broken in many ways. There's lots of things we're trying to fix, but I have the hope that the folks down the road have it better than me. And it's most likely not true. Despite the prestige of any institution or anything else, or the quality of the physicians. I know this by now. I've been working in this business long enough to know that even some of the best people in our field struggle with some of the stuff that we would never imagine would be a problem for these type of caliber individuals.

Eli (14:01.464) Yeah.

Ben Courchia MD (14:22.39) And yet the system forces us into that position.

Eli (14:25.838) That resonates with me. We had a couple of things happen on night shift a couple of nights ago that I was like, wow, this is where the world comes for answers is this hospital, God forbid. Listen, I think I agree with you that there is something deeply paralyzing and perhaps disappointing that the...

Ben Courchia MD (14:29.069) Haha.

Ben Courchia MD (14:34.956) Yeah.

Eli (14:51.608) problems that we thought were just problems in the family are systematic problems that are thorny and hard to solve. On the other hand, maybe that is the invitation to say, wow. This isn't just our problem. The fact that we can't get people very basic healthcare services isn't just our problem. Obviously, where there are problems, there's frustration and potentially there's also solutions. Actually, the... If we were limited to problems that lived in our little silos that we would try to solve by hook and by crook through quality improvement committees, I think it would be harder to solve problems than the world we're in where there are some deeply patterned, deeply thorny structural problems that it feels like at least we can go after arm in arm. And maybe that's a deeply naive thing to say, but in a world where I think states have been pretty ambitious in terms of trying to step up to the plate and address certain things in the healthcare system, in a world where hopefully there are some insurers out there who are rethinking the way that we provide care. And there are some that are trying to think about, "Can we pay for quality, not for service?" "And does that mean we can do certain things that traditionally we haven't done?" And in a world where doctors are no longer staying in their medical lane and they're saying, "Wow, I have a responsibility. I have a voice. I bear witness to all of this." Maybe that's a world in which, because these problems are not limited just to our family, we can try to think about the next time we're all gathered at Delphi or at PAS or at AAP, we can commiserate about these problems. And then we can say, "Hey, let's go to Sacramento. Let's go to Albany. Let's go to, what's the capital of Florida, Tallahassee. Let's go to Tallahassee." I knew that. Let's go to Tallahassee and let's knock some doors down. I don't know. Who knows.

Ben Courchia MD (16:53.528) Tallahassee.

Ben Courchia MD (17:04.46) We will see. We will see for sure. All right. This was great. I will see you next week for another episode.

Eli (17:11.842) Thanks, Ben.