In the first minute of the first episode of The Pitt, two Filipino nurses corral the show’s star, Dr Michael “Robby” Robinavitch, as he enters the emergency department (ED) to start his shift.

“Is it true?” one asks. “…the hospital is up for sale?”

“They might turn it into an ortho center with no ER?” asks the other.

“Oh, they’re always threatening to shut us down,” says an already-weary Robby, “but they never do.”

Switching to Tagalog, a language Robby doesn’t understand, one nurse asks the other: “Do you believe him?”

“I never trust the doctors,” she replies.

It’s an ironic way to kick off a medical drama set in a trauma center with a packed waiting room. Those people showed up because they trust doctors. But as the show’s 30 riveting episodes unfold, you begin to understand what the nurse meant.

Viewers witness physicians breaking down from exhaustion, delegating excessive responsibility to trainees, stealing medications, defying hospital rules, and lashing out at patients. It is a highly realistic, hour-by-hour portrayal of life in an urban ED, but when it comes to patient trust, could the show’s depiction of doctors be doing more harm than good?

The Evolution of TV Doctors

In the 1960s and ’70s, TV physicians were infallible. James Kildare (Dr. Kildare), Marcus Welby (Marcus Welby, M.D.), Joe Gannon (Medical Center), and Steve Hardy (General Hospital) were handsome, compassionate, and heroic. In fact, they were so idealized that their shows had to focus on patient struggles because they had so few faults of their own.

That began changing in the 1980s when the doctors themselves took center stage. They grew more human and far less heroic. St. Elsewhere, one of the first more realistic medical dramas, followed the frantic lives of doctors, nurses, and interns at a Boston teaching hospital. And who can forget MASH with Hawkeye Pierce and Trapper John, who used humor as the antidote to war’s horrors?

The 1990s and 2000s continued the trend of vulnerable doctors in realistic settings. Neal Baer, MD, who co-directs the Media, Medicine and Health Program at Harvard Medical School in Boston, was a physician-writer for the hit show ER. He remembers how the Steadicam captured the pace of the ED for the first time, allowing viewers to race through the halls with the gurneys. The show’s medical dialogue and graphic procedures — vetted by on-set physician advisors — added to its impact and authenticity.

Not every case had a happy Marcus Welby ending. “In our first season of ER,” said Baer, “in an episode called ‘Love’s Labor Lost,’ Dr Greene, through his hubris, thinks he can manage a difficult pregnancy in the ED. The baby lives, but the mother dies a horrible death. It really showed the vulnerabilities of doctors and nurses.” The episode won five Emmys.

Physicians’ personal demons materialized, too. Dr Greene’s cancer diagnosis, Dr Gregory House’s Vicodin-fueled cynicism on House, Dr Richard Webber’s alcoholism in Grey’s Anatomy, and Dr Randolph Bell’s narcissism and corruption in The Resident showed viewers that physicians were fallible and needed healing too.

Since its debut in 2025, The Pitt has taken all of this to the next level.

Is The Pitt Tanking Patient Trust?

According to the annual Gallup Trust Poll, the number of Americans who perceive medical doctors as highly honest and ethical dropped from a historic high of 77% in 2020 to 53% in 2024. Physicians are now at their lowest level of public trust since the mid-1990s. As trust has fallen, the stakes have climbed — with the federal government backing away from some vaccine and treatment recommendations, instead directing people to “talk to your doctor.”

Beth Hoffman, PhD, studies trustworthiness at the University of Pittsburgh School of Public Health in Pittsburgh. “In the ’70s and ’80s, most people came into the doctor’s office with an inherent trust of the profession,” she said. “But in the last few decades, patients have more autonomy. They have Google at their fingertips, and our one-patient-every-15-minutes healthcare system has reduced doctor-patient communication.”

What hasn’t changed, however, is what trust means to the doctor-patient relationship. “Trustworthiness goes beyond an individual treatment, diagnosis, or visit,” Hoffman said. “It comes down to the patient believing that the physician is being truthful and has their best interests at heart.” And that is still foundational.

It is well established that TV medical dramas can have significant impacts on viewers. Baer’s groundbreaking research in 2002 showed that ER storylines were powerful teaching tools. Prior to the airing of an episode on human papillomavirus, only 9% of survey respondents said they knew the sexually transmitted disease could cause cervical cancer. After watching the episode, 60% made that connection.

“We were shocked by the knowledge acquired from just a few minutes of television time,” said Baer. The data prompted networks to prioritize accuracy and hire more physician consultants, and it validated these shows as effective public health education tools. (Episodes of The Pitt have dealt with measles, vaccine hesitancy, generative AI in medicine, and racial health disparities.)

So if these shows are so impactful, could they be affecting the trust patients place in doctors? A 2018 survey of 983 US adults found that watching medical dramas is “positively associated…with trust in physicians in the real world.”

But that was nearly a decade ago. A lot has changed in healthcare and in these shows. The Pitt is still too new to have been intensively studied, but Hoffman has been tracking Reddit comments about the show and sees rising empathy for clinicians. “It’s purely anecdotal,” she said, “but if people are seeing that doctors are doing their best, that increased understanding can lead to increased trust.”

Sylvia Owusu-Ansah, MD, MPH, is an associate professor of pediatrics and emergency medicine at the University of Pittsburgh School of Medicine. She is a medical advisor for The Pitt and contributed numerous storylines. “Some people may assume that showing the vulnerabilities of doctors would lead to more mistrust,” she said, “but I’ve found the opposite. Patients are telling me, ‘Oh my gosh, I get it now. I appreciate what you do in the ED.’ One parent even told me, ‘Now I recognize the wait times for what they are…you’re taking care of the sickest patients first.’ I’ve been doing this job for over 20 years, and I’m getting more compassion, empathy, and sympathy than I ever did.”

“I’m not worried about The Pitt eroding patient trust,” Baer added. “I’m worried about the internet spreading inaccurate, unscientific information. Trust comes out of accuracy. Because of politics, we’re seeing stories being told that do not embrace the empirical evidence. That causes a trust breakdown. TV medical dramas can fight that by telling stories that support the science.”

How Trust Reduces Patient Pain

In medicine, trust is more than a touchy-feely sensation — research shows it can improve treatment adherence and strengthen collaboration and may even influence physiologic response. Elizabeth Losin, PhD, is a neuroscientist at Penn State University in University Park, Pennsylvania. She researches how various factors in the healthcare system affect patient pain levels. One of those factors is clinician trust.

In a 2017 study, she found that people receiving heat-pain stimuli on their arms rated that pain about half a point lower (on the standard 0-10 pain scale) when they trusted the person administering the stimuli. In a 2022 study utilizing fMRI, Losin found evidence of a potential neural mechanism for trust-related pain reduction via the modulation of pain-related brain circuitry.

“Ultimately, we may find that higher levels of patient trust in doctors not only impacts pain but also other medical outcomes,” she said. “Doctors may be social placebos, playing the same role as a sugar pill. So, factors such as trust may not just be icing on the cake; they may be the cake.”

Losin added: “Although it’s possible that showing the problems and mistakes that arise in healthcare can decrease people’s trust in the competency of doctors, I think TV medical dramas also show us that doctors are people too, and feelings of similarity can lead to feelings of trust. We naturally trust people who are more like us.”

How to Restore Patient Trust

Dhruv Khullar, MD, is a physician at Weill Cornell Medical College in New York City who often writes for The New Yorker. In a recent article, he discussed “What The Pitt Taught Me About Being a Doctor.”

“Sometimes I felt that the show was reminding me of the doctor I used to be,” he wrote. “Throughout my years in practice, I have surely gained skills, but I can’t help feeling that I’ve also lost something. Early in my career, if a patient was hospitalized on their birthday, I’d try to pick up a balloon from the gift shop. On occasion, if someone was struggling through a prolonged hospitalization, I’d ask them for their favorite cuisine and bring them takeout from a local restaurant. At some point during the pandemic, I stopped. Subconsciously, perhaps, the flaws of ‘the system’ became an excuse for a thinning of empathy. The Pitt reminded me that it doesn’t have to be this way.”

Research shows that when it comes to trusting a healthcare provider, interpersonal skills dominate. One survey found that 75% of patients who didn’t trust their doctor cited reasons that had nothing to do with medical knowledge or the prescribed advice. Instead, they gave reasons such as “they spend too little time with me” (25%), “they don’t know me” (14%), “they don’t listen to me” (14%), and “they don’t make eye contact” (3%). These behaviors can prompt patients to seek alternative care.

A 2021 survey of doctors and patients conducted by the American Board of Internal Medicine Foundation as part of its Building Trust initiative found that 98% of physicians said that spending time with patients was important, but only about 25% of patients said their doctor spent enough time with them.

If you value patient trust, you don’t have to rely on TV medical dramas to build it or wait for the healthcare system to fix itself. You can begin in your practice tomorrow. It can be through little acts of kindness like Khullar suggests, or it can be by increasing your trustworthiness. Do you embody the four components of patient trust, as Hoffman defines it: empathy and caring, competence and expertise, honesty and openness, and dedication and commitment?

“Doctors have often relied way too much on the expertise leg of that chair,” said Hoffman. “Even if you don’t have all the answers, honesty, openness, empathy, and caring are all really important.”

Baer sees storytelling as another way to proactively build patient trust. That’s why he teaches med students at Harvard how to be better storytellers. “You can provide your patients with lots of supporting data,” he said, “but data doesn’t move people. Listen to their views with compassion; then tell them stories that support the data and have an emotional impact. That’s a way to build trust.”

This article is part of an ongoing, year-long Medscape series examining the decline of public trust in medicine. More content is available here.