The Pitt continues to shine a light on the horrors of the US healthcare system | US television

IIf you were stuck in the waiting room of the fictional Pittsburgh Trauma Medical Center (PTMC) – and, as is the case in most real emergency rooms, being at “Pitt” almost certainly means waiting for hours (unless you were imminently dying, but even then…) – you’d at least have plenty to read. Administrative formalities and registration forms, for example. Signs warning that “aggressive behavior will not be tolerated”, in response to the real increase in violence against health workers. A memorial plaque to the victims of the mass shooting at PittFest, which soaked the back half of the popular HBO Max show’s first season in incredibly harrowing, bloody, and very American trauma. Labels on the many homeopathic remedies carried, in Ziploc bags, by a potential patient deeply skeptical of Western medicine and big pharmaceutical companies. Promotional literature about the larger hospital system, for which The Pitt is the cash-strapped, bare-bones, and constantly under siege gateway.

And, in its second season, which debuted earlier this month, “patient passports” meant to help you understand the procedures and expected wait times in an urban emergency room. The flyers are the brainchild of Dr. Baran Al-Hashimi (Sepideh Moafi), the tech-loving, norm-defying attending physician introduced this season as a nod to the more conventional Dr. Michael “Robby” Robinavitch, the show’s host played by recent Golden Globe winner Noah Wyle. Dr. Robby, the reason for the show’s existence and the heart of viewer sentiment, is skeptical of patient passports because he seems to be the most changeable at Pitt; their introduction is one of many seeds planted in what will surely become a larger thematic battle between tradition and innovation, emotion and rationality, between the haunted old attending physician and his upstart replacement.

But I took The Ridiculous Passports as a sort of metaphor for why the medical drama, with its busy plotting, real-time pacing and occasional didacticism, seems somehow fresher in its second season than its Emmy-winning first — like a viewer’s passport, of sorts, to the combustible and confusing world of American health care. A window into a constellation of work and care that is constantly in the news and yet difficult to understand, beyond personal contact with a system that will charge you an arm and a leg for even a brief visit.

The Pitt has been touted, rightly, as the most accurate medical drama ever developed for American television (although the bar is low), a show that largely does not sacrifice scientific realism for the sake of entertainment. Created by R Scott Gemmill and executive produced by ER showrunner John Wells, The Pitt finally cracked the code to a medical drama for the streaming era, seasoning the old recipe of network television procedural with nudity, profanity, and standard HBO graphic details; the recently aired second episode included the syringe drainage of a (visible!) eight-hour erection, the discovery of (real!) maggots living under an unhoused man’s cast, and the relocation of a protruding arm bone I observed between my fingers.

But the show won its audience less through its copious (and convincing) fake gore than through its attention to details and mundane challenges usually cut out of time, with a broader scope of the healthcare ecosystem than television usually allows — the traditionally glorified doctors, of course, but also the nurses, administrative staff, guards, EMS drivers and social workers. What other medical drama has devoted time to compassionately explaining the process of draining fluid from an alcoholic’s distended abdomen?

Even in such quiet moments, the Pitt seethes with a combustible anxiety: at any moment, something could go catastrophically wrong, and often does. Such is the nature of procedural entertainment, which, even when it strives to be precise, demands artificial stakes, juicy timelines, and routine drama. But the creators of The Pitt, who openly tout this accuracy, know that this is also the state of America’s healthcare system, a dangerously precarious system where individual heroism and systemic cruelty coexist, whose inherent vagaries have been exacerbated by the current administration.

The Pitt depicts realities of health care work that transcend nationality — the psychological weight of caring for another person, the routine presence of death — but it is essentially a show about the United States, where health care remains a for-profit system. The most medicalized country in the world, spending about twice as much per capita on health care as comparable countries, while excluding millions of people from it and suffering higher rates of illness and mortality at all income levels. A country where tech companies and ungodly rich CEOs like OpenAI’s Sam Altman pour money into life-extending technology — some $12.5 billion over the past 25 years — while the vast majority of Americans can’t afford a visit to the emergency room. A place where average life expectancy is shorter today than it was in 2010. A country facing a looming wave of hospital closures in rural areas and financial distress for urban “safety nets.” Pitt’s sophomore season began just as insurance premiums were skyrocketing for about 20 million people, following the Trump administration’s decision to end federal subsidies. America’s patients and providers experience utter chaos almost daily, with billions in critical funding – for mental health care, substance abuse programs and more – now political footballs subject to rapid reversal.

All of this is well beyond the scope of The Pitt, which remains focused on the system’s ever-shrinking ground floor (literally – Pitt’s affectionate nickname refers to its location in the basement of the largest hospital) and serves primarily as agitprop for the healthcare profession. But it greatly influences the overall tension of the series and the larger project. After playing Whac-A-Mole with America’s societal issues in the first season – state-level abortion restrictions, gun violence, medical and anti-vaccine racism, to name a few – the second season settled on two looming long-term specters: insurance and the rapid adoption of generative AI in healthcare. The first, represented by nurse Noelle Hastings (Meta Golding), a case manager at PTMC who tackles the typically American problem of finding patients a hospital that accepts their coverage; the latter, from Dr Al-Hashimi, who is optimistic about the potential of AI transcription services to help combat physician burnout, free them from the drudgery of documentation (the dreaded “mapping”) and allow them to spend more face-to-face time with patients. (Or, as Robby points out, one reason why hospital administrators require doctors to even see more patients.)

There’s something cathartic about watching a TV show even attempt to resolve this colossal mess, no matter how brutal the conversation about AI may seem (to be honest, that’s what any conversation about AI feels like). Like most Americans, I have friends and family in the healthcare field. I’m up to date with current events. I worry about the cost of routine exams, medications, and procedures, and endure the intentional frustration of insurance claims. I care deeply about the availability and affordability of healthcare in my country and those who work there. Yet there is so much I don’t understand, on every level. So many things are infuriating. It touches every facet of our lives – it literally is our lives – and still remains largely invisible, seemingly impossible. So I log on to The Pitt, like a passport to a million harder, more complicated daily realities, a safe window into a tense system disguised as entertainment. The simulation may be simplified, turbocharged, brilliant, but the anxiety that runs through it is hyper real.