THE PITT: 10 MEDICAL DETAILS THE SHOW GETS WRONG, AND 10 DETAILS THEY GET RIGHT

2 Apr 20262 Apr 2026THE ANESTHESIA CONSULTANT

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Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group

Richard Novak, MD is a Stanford physician board certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California.
emailrjnov@yahoo.com

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The HBO series THE PITT won the Emmy for Outstanding Drama Series in 2025, with Noah Wyle winning the Emmy for Outstanding Lead Actor in a Drama Series for his portrayal of superhero ER attending Dr. Michael “Robby” Robinavitch. THE PITT serves up hour after hour of hectic emergency room cases, in addition to the emotional trials and tribulations of its appealing characters. The show is heavy on medical jargon, which doesn’t seem to annoy its fans. Sick patients arrive one after another, and faculty doctors, residents, medical students, and nurses try to practice sound medicine while weathering the stress of their emergency room shift.

Is THE PITT medically accurate, or is it merely another medical entertainment drama populated by actors portraying good-looking hospital staff members?

I was a fulltime faculty member in my university’s emergency room for one year prior to entering anesthesia training. I also trained in a busy inner-city emergency room on the South Side of Chicago during medical school. Here’s my assessment of 10 important medical details THE PITT gets wrong, and 10 important details the show gets right:

10 medical details THE PITT gets WRONG:

Robby tells resident Dr. Langdon to “go home” when Robby discovers Langdon has been stealing benzodiazepines in the ER and consuming them himself. (Season 1, episode 10, 4:00 P.M.) Stealing controlled substances like benzodiazepines is a crime, and always needs to be reported to the hospital administration and the state medical board. The appropriate management is to suspend the doctor and refer him or her to a drug rehabilitation program. Sending Dr. Langdon home, and then seeing him back on the ER front lines within hours that same day treating patients after the mass casualty event is blatantly wrong. By 8:00 P.M. (Season 1, episode 15, 8:00 P.M.), Dr. Langdon is back in the ER treating patients again, despite his known benzodiazepine theft. This would never happen.

When there’s a shortage of O negative blood during the arrival of mass trauma patients, ER resident Dr. Mel King donates O negative blood from her own arm into a transfusion bag, which is then dripped into a patient’s bloodstream. (Season 1, episode 12, 6:00 P.M.) This could never happen. While O negative blood is the universal donor type, all blood products must undergo rigorous blood bank laboratory screening, including typing, screening for viruses, and crossmatching, to guarantee safety, even in an emergency. No one donates their own blood into a bag and then transfuses it into a patient without blood bank testing.

The lack of time spent with the Electronic Medical Record (EMR) in the ER. In a hospital setting, all charting is documented in the patient’s EMR. This is a tedious, time-consuming process that contributes to the feeling of “burnout” that all doctors must confront. In THE PITT, on a rare occasion you’ll see a doctor order a lab test by typing into a computer terminal, but you almost never see anyone typing doctor’s notes (history and physical, or progress notes, or procedure notes) into a computer screen. Why? There’s no entertainment value in watching a doctor type into a computer terminal for a prolonged time. It would be a different world if all hospital doctors had to do was to listen to patients, talk to patients, examine patients, and perform procedures on patients. Unfortunately, the EMR looms over our lives in all hospital settings, including during acute care in an emergency room. In Season 2, episode 5, 11:00 A.M., Dr. Santos is shown trying to catch up on her back charting on the EMR, and is shown dictating into the computer while her colleagues are taking care of patients while they urge her to get back to clinical care. This would never happen. EMR charting is done patient by patient, right after the clinical care is done, so the charting is accurate and not surmised days or hours in the future, with the MD trying to remember what he or she did hours ago. Comically, in Season 2, episode 8, 2:00 P.M., the internet is down, and the doctors have to chart with paper records as in the pre-EMR era. The young doctors are puzzled with how to function without the EMR, as onerous as it is, they’ve never known medical care without an EMR.

Families present at the bedside while an ER doctor is administering a general anesthetic followed by intubating the patient’s trachea. This is a glaring inaccuracy. In multiple episodes we see the spouse, parent, or significant other of a critically ill patient standing at the bedside in the ER while Dr. Robby or another MD places an endotracheal breathing tube, inserts a pacemaker, or carves a scalpel into the patient’s skin. An example is Season 1, episode 2, 8:00 A.M, where a young overdose patient named Nick requires endotracheal intubation, and this invasive procedure is done while the family watches. This would never happen. Family members are not observers during critical interventions in the ER.

Robby educating an attending anesthesiologist how to place an endotracheal breathing tube in a patient with a difficult airway. (Season 1, episode 12, 6:00 P.M.) I wrote about this episode in a column last year available HERE. It’s a glaring indictment of Dr. Robby as a superhero doctor who can do amazing things, while the anesthesia specialist, who is by definition an airway expert, stands by and watches with apparent naïve amazement. ER doctors are said to be “Jacks of all trades and masters of none.” Anesthesia attendings are airway experts who give talks on airway management. Receiving advice from an ER doctor would be unlikely.

After a patient’s blood is splattered all over a yellow gown worn by each MD, the MDs continue wearing the bloody gowns as they walk around the ER and talk to family members and other awake patients. (Season 1, e13, 7:00 P.M.) This would never happen. ER doctors may at times have blood splattered onto their gown or uniform, but they would change into non-blood-stained clothes as soon as the situation stabilized, and certainly before they would meet and interview family members.

The measles patient who presents to the ER. (Season 1, episode 14, 8:00 P.M.) Dr. Robby states that the other MDs are too young to have ever seen a patient with measles, since the disease is currently all but eradicated. The truth is that measles was eradicated around the year 2000, twenty-five years prior to this episode, but it’s unlikely that 50-something-year-old Dr. Robby would ever have seen a case of acute measles in the USA prior to 2000 either.

Robby takes the father of a teenaged patient into the morgue to see a collection of dead bodies from a mass shooting event, in an effort to convince the father to allow doctors to perform a spinal tap on their son who has coma and fever. (Season 1, episode 15, 9:00 P.M.) This may work as startling entertainment, but no ER doctor would do this in real life. Providing a viewing of the dead bodies of other patients has nothing to do with quality medical care.

Treating patients without performing X-rays or lab tests to establish a correct diagnosis first. This happens repeatedly in THE PITT. In Season 1, episode 1, patient Otis Williams reports feeling unusually fatigued and short of breath after participating in the Rochester Marathon two weeks earlier. Though he has no significant medical history or medications, he suddenly loses consciousness during the assessment. His ECG rhythm is ventricular tachycardia. The doctors deliver a shock to attempt to restore his heart rhythm, but he experiences a second episode of ventricular tachycardia after being revived. Dr. Robby administers calcium gluconate while awaiting the potassium concentration result from the lab, guessing that the cause of his ventricular fibrillation is hyperkalemia due to rhabdomyolysis from intense exercise. Otis recovers, and indeed his potassium result is elevated over 7 MEq/L. An entertaining scene, and a lucky guess by Dr. Robby. This would never happen. The treatment algorithm for ventricular tachycardia includes repeat shocking of the VT, while managing Airway and Breathing. Amiodarone, lidocaine, or magnesium sulfate can be administered as well. Calcium is reserved for known hyperkalemia, after the stat electrolyte result is back. Insulin and glucose are also indicated for the treatment of known hyperkalemia, after the stat electrolyte result is back.

Dr. McKay doing a rectal exam and “tailbone realignment” on a male patient, and then not taking the glove off, instead wiping off her gloved finger with a gauze pad and then waving her hand in the air afterwards. (Season 2, episode 4, 10:00 A.M.). Rectal exams happen. Then doctors take the glove off and discard it. Doctors don’t leave the glove on and point their finger in the air afterwards.

Top 10 medical details THE PITT gets RIGHT:

The persistent level of intense stress on the ER staff. The emergency room is a stressful place. The next patient may be a bleeding victim of a motorcycle accident, a victim of a stab wound to the heart, a tiny baby choking on a penny, a hemorrhaging mother in her sixth month of pregnancy, a suicidal psychotic screaming patient, a disoriented 100-year-old woman, a 350-pound man with chest pain from an acute myocardial infarction, or a teenage drowning victim. Each of these patients requires urgent stabilization, rapid treatment, with minimal delay in diagnosis. The emotional stress on healthcare workers can be extensive, and burnout from the unrelenting pace of the workload can be prohibitive. The intense stress level is one of the reasons THE PITT is suspenseful and entertaining. The intense stress level is real and is well portrayed.

The characters are terrific. Each doctor, medical student, or nurse has specific strengths and weaknesses. We love watching any of them triumph, while observing any of them fail is cathartic. Factor in the fact that many of the characters are attractive actors and actresses—no doubt better looking than most of us real world doctors—and you have a recipe that keeps viewers fascinated.

3. The jargon. The writers make no effort to explain the complex medical terminology and verbal abbreviations. As a physician, I understand the conversations, but there’s no way that laypeople can comprehend 50% of the jargon. For example, in Season 1, episode 1, 7:00 A.M. we hear this sample of dialogue between doctors: SAMIRA: “Check his medical record., see if he’s on a DOAC. Stand by with four factor PCC if there’s a brain bleed.” ROBBY: “What’s in the PCC, Mel?” MEL: “Clotting factors two, seven, nine, and ten in case he’s bleeding in his brain.” One might have guessed this level of complex medical terminology would lead viewer to change channels, but people seem to enjoy the jargon, or at least tolerate it, even though there’s no way viewers know what’s being talked about. In the example above, “DOAC” refers to Direct Oral AntiCoagulants, such as the drug Eliquis, and “PCC” refers to Prothrombin Complex Concentrate, which is used to treat certain abnormal bleeding disorders. Perhaps the jargon makes the viewer feel like medical insider, even if they have no idea what the actors are talking about.

“Huckleberry” and Santos

The relationships between the characters. Art succeeds when it evokes powerful emotions in those experiencing the artwork. Watching the characters joke with each other, argue with each other, flirt with each other, and struggle to understand and be understood, is at the heart of THE PITT’s success. The Emmy awards for actors Noah Wyle and Katherine LaNasa are validations of the acting, the portrayals, and the interaction between the actors.

5. Management of Airway-Breathing-Cardiac, in that order, for acutely ill patients. Anesthesiologists place breathing tubes every day as part of their job, and I’m happy to see that the doctors on THE PITT freely apply the medical fundamentals of Airway-Breathing-Cardiac for acutely ill patients who need a breathing tube to save their lives. Many patients get intubated. That’s life in a busy inner-city ER.

6. The important role of the social worker in the lives of patients and families who present to the ER. Medical doctors diagnose and treat, but the variety of social ills that present to the emergency room is vast. Doctors need social workers to sort through the emotional problems and the eventual placement for many sick patients and their family members.

7. The reality that all the hospital beds are often full, requiring ER patients to remain in the ER for prolonged times, being treated and stabilized by the ER staff while doctors are waiting for a room in the hospital to become vacant so the patient can be admitted. Most of America’s ERs and hospitals are overcrowded, and the hospital floors above the emergency rooms often have inadequate numbers of nurses and vacant beds for new patients. This turns the ER into a medical ward, where patients wait for a bed on the real wards upstairs.

8. The hospital administrator demanding fiscal profit and good public relations from the ER attending, while the ER attending is fixated on stabilizing patients, healing the sick, and teaching students and residents. In Season 1, episode 1, 7:00 A.M., the administrator Gloria criticizes Dr. Robby for his ER’s low patient care metric results. She says: “I’m talking about Press Gainey scores—patient satisfaction.” Robby responds, “We’re an emergency room, not a Taco Bell. . . If you want people happier, don’t make them wait twelve hours.” Gloria responds, “We don’t have the beds.” Robby answers, “That’s bullshit. The beds are up there. You just don’t want to hire the staff you need to care for them.” In Season 1, episode 3, 9:00 A.M. the administrator criticizes and confronts Dr. Robby about long ER wait times, patient flow, documentation and liability concerns, and in episode 7, 1:00 P.M., she criticizes the ER for its overcrowding and boarding of patients. She implies that the ER doctors need to “do better” than they’re doing. Robby, and all doctors, continue to do their jobs and take care of the needs of their patients, while the hospital administrators, with their clipboards, their spreadsheets, and their balance sheets, do theirs.

The potential for belittling behavior of higher-ranking MDs toward lower ranking MDs, nurses, or staff, with THE PITT demonstrating the modern-day lack of tolerance for this sort of abusive behavior. This is exemplified when senior resident Dr. Langdon is verbally abusive and condescending to intern Dr. Santos (Season 1, episode 5, 11:00 A.M.). Dr. Santos is then chastised by Dr. Robby for her behavior. In decades past, the medical pecking order of faculty > fellows > residents > interns > medical students resembled the military ranking of general > colonel > major > captain > lieutenant > sergeant, with the higher-ranking individual feeling entitled to verbally abuse those with ranks below them. In the modern day, medical centers have staff wellness programs which aim to reduce burnout and improve retention by supporting physical, mental, and emotional health of doctors and employees.

10. Performing a cricothyrotomy with scalpel-bougie-endotracheal tube. When a patient needs an emergency surgical airway cut into his neck (Season 1, episode 13, 7:00 P.M.), Dr. Robby performs a textbook procedure to save the patient’s life. This is the preferred fastest and safest method for establishing an emergency surgical airway—better than a tracheostomy, and safer than tracheostomy cannula kits or needle/catheter jet ventilation options.

In another excellent portrayal of complex airway management, in Season 2, episode 8, 2:00 P.M., the doctors perform an awake nasal intubation on a supra-morbidly obese patient. This scene is very accurate, and is exceedingly well done.

******

THE PITT is entertaining and mostly accurate.

Dr. Robby is an appealing superstar with potential flaws of burnout and PTSD from previous COVID patient deaths, much like Dr. Gregory House was an appealing superstar medical diagnostician/detective with flaws including narcotic addiction in the television show House from 2004 – 2012.