TV review

A streaming service I subscribe to offered the first season of The Pitt, so of course given my profession I had to watch it. I must admit that wasn't hard because it was pretty engrossing. But I'm not here to do drama criticism, I'm a medical and public health sociologist, so that's the take you're gonna get.

 

In case you are just awaking from a 40 year slumber, the series is set in the emergency department of a fictitious Pittsburgh hospital. Each episode constitutes one hour in a 12 hour shift, though the last hour runs overtime. If there's a lead character it's senior attending physician Michael Robinavitch, known as Dr. Robby (Noah Wyle, who's already been an emergency doctor for many seasons of ER so I guess that gave him a head start). However, it's really a deep ensemble cast and there are ongoing plot lines and vignette stories featuring residents, medical students, nurses, a couple of other attending physicians, and of course patients. The writing is intricate and there's a lot to keep track of. 

 

The series has been widely praised as highly realistic, and that's what I want to focus on. I'm not a real doctor, I'm a doctor of philosophy, so I'll take other people's word for it that the medical processes are legit: how the patients present, how the physicians respond to that and go about making diagnoses and choosing a course of action, all technically sound. The special effects are extraordinary. The actual procedures that happen in the ER, which involve a lot of cutting of flesh and inserting into orifices, are convincingly gory. There's a birth scene and the only way they could have done it, as far as I can tell, is to film an actual childbirth and intercut it with the acted scene.

 

But that's not so important. The status relationships and behavioral norms among the various castes -- attending, senior resident, resident, intern, medical student, head nurse and nurses in general, also a social worker -- are generally as I understand them to be in reality. The way the clinicians interact with patients, however, is somewhat idealized. I'm a member of the Academy of Communication in Healthcare, and we have a pretty good consensus about how physicians should interact with patients, and the doctors in the Pitt have evidently all read our books. They are even seen to instruct the medical students and interns just how I would want them to. However, if there's one thing we healthcare communicationists know for sure it's that most doctors don't really do all that good stuff all of the time, or even most of the time.

 

However, I'm pretty sure the writers know that, and their purpose isn't to make us believe that this is actually really real, but to give lessons about what ought to be. Robby and the senior resident get opportunities to give little speeches about what's wrong with the world and how to do tplhings right. More broadly, the series is unrealistic because it has to be more interesting than reality, and it has to pack a lot more meaning into an hour than you could normally get from sitting and watching reality unfold for that long, even in a busy ED. All of the cases present either an unusual and complicated medical problem, an intense human drama, or plenty of both. 

 

Oh, and by the way, the doctors and nurses view everybody with respect, positive regard, and compassion, without respect to gender, age, race ethnicity, personal comportment or behavior. As a personal note, I have written more than a couple of papers about how doctors treat people like shit because they have substance use disorder, don't take their pills the way they're supposed to, or otherwise annoy the Gods. So again, that isn't realistic, but it's didactic. The writers are trying to show us how things ought to be. 

 

This is a long enough blog post for now, I'll finish up next time.