The show’ s clinical accuracy is striking— so is the burnout.

Dr Sarah Whitelaw Emergency Physicians Speciality Group representative on the AMA Federal Council.

As an emergency physician,

I’ ve never seen my work so accurately

portrayed: the clinical cases, the colleagues and the system issues that define emergency medicine. The Noah Wyle – led hospital drama has earned critical acclaim for its realism, and I’ m often asked about the show:“ It’ s only like that in America though, isn’ t it?”

I’ ve shocked quite a few friends now by explaining that almost everything you see in the show is happening right now in EDs across Australia— the overcrowded waiting rooms, the occupational violence, the shortage of inpatient beds.

The clinical accuracy is striking, even if compressed into a single shift for TV, and sadly, so is the burnout and moral injury among staff, especially senior emergency physicians, who feel helpless watching patients slip through the cracks of an underfunded system.

I viscerally felt the familiar vigilance required for potentially critically ill and dying patients stuck in waiting rooms, lined up in corridors or ramped in ambulances and the pressure to find space where none exists.

Delayed transfers from ED to inpatient beds have been linked to excess deaths. The UK’ s Royal College of Emergency Medicine found one extra death for every 82 patients waiting 6-8 hours.

In Australia, more than 1.4

million patients waited more than four hours in EDs in 2023-24, with 90 % of those waiting 18-plus hours.

That is a significant number of excess deaths and might partly explain why emergency physicians have the highest rates of burnout among all specialties and why main

protagonist Dr Michael‘ Robby’ Robinavitch( Wyle) finds Dr Jack Abbot( Shawn Hatosy) on the hospital roof in the first episode.

The show’ s realism owes much to its medical consultants, including Australian Dr Mel Herbert. They’ ve insisted on clinical accuracy— no

added melodrama or blood, just what we manage every day.

COVID-19’ s lingering shadow is present too. Although our experience was different, putting N95s back on after wearing them every shift for almost three years stirs unresolved memories.

‘ This place will break your heart … but it is also full of miracles.’

The show does well to capture the relentless pace of emergency medicine— case after case with no decompression, although the characters seem to have more time for individual patients. In reality, we divide our time much more thinly between multiple patients.

PICTURE CREDIT

ALAMY

The characters also never seem to write notes, jostle for a computer, wrangle a fax or wait for a page to be answered.

What is missing from the screen, for obvious reasons, is the thousands of hours of non-clinical work, such as the continuous research, training and study required to lead a large ED team. But the camaraderie, dark humour and coping strategies are all there. So is the pressure on doctors-in-training, many of whom must balance parenting, financial stress and the pressure of exams.

Also heartbreaking in its accuracy is the scene where Dr Heather Collins( Tracy Ifeachor) experiences a miscarriage and then continues her shift. I’ m sure this will resonate with so many Australian female doctors.

I paused the show many times,

overwhelmed by memories of patients. I think my tears were from relief, that somewhere they’ re all still there— deep in my heart and my mind. At times, I’ ve worried they weren’ t, that my coping strategy was just to move on unaffected.

My lovely director once asked if I was okay after a neonatal death in my care. I was surprised— both by being asked and because I had nothing to say. I felt fine; we had managed the case as well as we could, and we needed to get back on the floor because it was busy.

I’ ve wondered about us as a profession and all first responders. What does the job do to us that means we can move on so quickly? How do we snap back into being partners, friends, parents and carers for the other people in our lives?

I’ m nowhere near the level of burnout as Dr Robby, but I have been, and I see it in our specialty.

A sabbatical, long service leave and coaching helped me rediscover my love for emergency medicine. It also helped me accept that I can’ t fix the system while I’ m on shift— that’ s what my work with the AMA is for. I don’ t think I could continue my clinical work if I didn’ t have the opportunity to try to improve the system issues that affect all our patients.

Despite the chaos, The Pitt is also a love letter to patients— to their grace, patience and resilience. It honours our pride in our teams, our commitment to care and the strength of our diversity. It celebrates the satisfaction of bringing order to chaos and the importance of leadership.

Being an emergency physician is one of the best jobs there is, but I’ ve never been able to explain why or why it contributes so significantly to who I am as a person, even when I know it doesn’ t define me.

The Pitt helps explain why— through raw storytelling.

“ This place will break your heart … but it is also full of miracles,” Dr Robby says to his ED team.

It really does, and it really is.

This article was originally published on AMA Insider.

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