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The second season of the series The Pitt, available on HBO Max, has just wrapped up. Its first season earned, among other accolades, four Emmy Awards, four Television Critics Association Awards, three Writers Guild Awards, and two Golden Globes.

Alison Herman, a television critic for the prestigious magazine Variety, has described this second season as a “triumphant return with an even larger cast and greater social consciousness. It feels good to be back in the capable hands of The Pitt.” John Anderson of The Wall Street Journal wondered in his review whether the series is an accurate portrayal of emergency medicine. He answered that he had no idea, but that he devoured the series, which has just become the most-watched show on global streaming platforms, with 15 billion minutes watched in its second season.

Univadis Spain, part of the Medscape Professional Network, interviewed Iria Miguens Blanco, MD, an emergency physician and a member of the Secretariat for women of the Spanish Society of Emergency and Urgent Medicine, about the series’ realism.From the very start, she gave her approval: “I loved it, both as an emergency physician and as a viewer. I think it’s a very well-made series, with constant intensity. And I believe that, overall, it reflects very well what a hospital emergency department is like.”

She noted that “perhaps too much happens in a single shift, but I understand that you have to keep the viewer’s attention. There are many critical incidents, with so many patients that the entire department is mobilized, and as a viewer, it compels you to pay close attention. The reality is that in the ER [emergency room], there are competing priorities. And what happens in a single episode — a nonstop sequence of a mass casualty incident, a cardiac arrest, anaphylaxis, and gunshot wounds — is actually quite rare in real life.”

Among all the cases depicted in the series, the one that has caught her attention the most is one from the first season, in which a trepanation must be performed right in the ER due to an intracranial hemorrhage.

Maintaining Humanity

Another aspect she highlights is that, amid so many cases involving critically-ill patients, there is a constant effort to maintain humanity — for example, with a moment of silence following a death. “I was pleasantly surprised; the series really captures how every patient is unique, and it’s the chief — the deputy — who conveys to the residents and students how to handle it every time a patient dies.”

She also emphasized the importance of having a mentor, of being able to take care of oneself and others, and of maintaining that human connection in a way — as it must be — that’s two-way. It is also essential to create a support network among ourselves and with patients, which comes across very well in the series: the commitment that exists and the social-healthcare component within the emergency department of seeing beyond the immediate.

Support Network

The fact that healthcare professionals look out for one another and the importance of caring for the caregiver are other issues heavily emphasized in the series. As she noted, “among us there is a network that becomes very visible in the episodes, with constant support, a colleague who checks in on you.…In the series, you see that they look out for one another, as in the case of the assistant with an addiction: All the colleagues not only spot it but also come up with solutions, and then, in this second season, they take him in. And, in day-to-day life, throughout that shift, you see how one tells the other to rest, to disconnect for a while. Or having a conversation on the rooftop among the professionals who also share, in different ways, that care for one another.”

It’s very striking, in the second season, how immigrants are treated and how Immigration and Customs Enforcement agents come in to take them into custody. “As an emergency room doctor, what stands out to me is that humanity: they’re your patient; you don’t see past their irregular or undocumented status. What they’re looking for is the patient’s well-being — how can I help? Luckily, that doesn’t happen here; healthcare is universal. When they’re taken into custody in the series, you see the helplessness it creates for the professionals as well,” she emphasized.

Key Role of Nursing

“The role of nursing is fundamental throughout the healthcare system. But especially in the ER. And the show reflects that very well. It’s something that caught my attention from the first episode because it highlights the importance of that teamwork. In fact, you can really see the workflow and how nurses notice things that the doctor might not pick up on at that moment. It also shows very well the connection between them, day-to-day, even when emergency services arrive and patients are transferred from another hospital. That interconnection among everyone is portrayed perfectly.”

But one of the most striking aspects of the second season — spoiler alert — is the cyberattack, which brings the hospital to a standstill. As she recalled, “In the emergency department, we have contingency plans in case the technology fails. And it’s true that it’s a critical moment because of the difficulties it entails. Because, ultimately, in the ER, the fewer clicks we have to make on a computer, the better. Being able to access information, request tests, or see how reports come in is also portrayed very well. Because as soon as something like this happens, it’s immediate, and we ask ourselves: Where can I view that patient’s history, how do I order the lab work, how do I receive that report, how long will it take, or how do I reorganize that service. I think the term ‘contingency plan’ doesn’t carry the weight it deserves because it truly signifies a moment of crisis in an emergency department.”

For the third season, the emergency medicine specialist suggests a chemical or nuclear attack, “to see how it would be managed, with hospitals referring patients to a referral center, with all the professionals working — just as happened during the COVID pandemic, when people worked double shifts and didn’t mind. Let’s keep our fingers crossed that it never happens in reality, only in fiction.”

Another striking theme the series addresses is that patients lack health insurance and cannot be treated. From her perspective, she cannot imagine “what it must be like to work that way. It seems to me that the essence of emergency medicine is lost: When patients come to the department, it is a very vulnerable moment for them. But it’s also a vulnerable moment for us, as we want to complete the process and give them everything we can. And how do you address that part? You feel helpless because you want the best for your patient. And that also involves follow-up care after discharge that’s covered, so they can somehow be cured. And, in the end, that helplessness speaks to the burnout as well. I understand that this has a very negative impact on healthcare professionals.”

Training in Communication With Patients

She highlighted how well communication with patients is reflected. In a cubicle, we have 2 or 3 minutes at most, and we have to establish a connection with the patient while, of course, also weighing the severity of the situation. It’s a structured interview that you practice and work on, establishing a connection that allows us to get the information we need to do our job, but without forgetting that this is a human being who often just needs us to listen. It’s a very fine line — you’re the emergency room doctor, but you’re undoubtedly human too. You see in the series that, sometimes, doctors seem worried because they think the information hasn’t been understood. It’s true that it’s a moment of stress and vulnerability for patients. It’s more than understandable that they have doubts or that, after receiving the information, they think it over and ask you something else. I insist that this requires training and that we must never, ever, ever lose that empathy and humanity with our patients.

Finally, she said she would recommend the series to residents without hesitation: “They must watch it because it captures so well a beautiful and unique aspect of emergency medicine: that time pressure does not, in the slightest, diminish what it means to be human, to be empathetic, and, ultimately, to be an emergency physician. I would absolutely recommend it, of course.”

This article was translated from El Médico Interactivo on Univadis, part of the Medscape Professional Network.