Q: The show captures a constant sense of urgency and rapid switching between patients. How accurate is that?

Very real. One of the key things about emergency medicine is that you are constantly interrupted. The average is once every 12 seconds. You are juggling multiple demands. People used to think that meant emergency physicians were great multitaskers, but that isn’t the full picture. You learn how to rapidly shift your focus, fully, from one patient to the next.

The key is recognizing that you cannot hold everything in your head at once. You have to be intentional about switching your attention and committing to the moment in front of you.

Q. How does that play out?

There are two situations where this becomes especially challenging. The first is when you have simultaneous cases that each require 100% of your focus. At a place like Stanford Medicine, we are fortunate to have resources and consulting physicians from other specialties we can call upon, but asking for help is also an acquired skill. You must know when to bring in help that enables you to optimize without adding more complexity or demands. 

The second challenge is emotional switching. There are many times I’ve left a room after a patient’s death and had to immediately give my full attention to the next patient.

In the past, people would push their emotions aside and deal with them later, if at all. Now we try to recognize that emotional impact more in the moment. If there is an opportunity, we take a few minutes to acknowledge what happened. If we cannot, we try to come back to it soon after, even briefly.

We have gotten better at that, and it helps, but it is still hard. There are times you walk out of a room off kilter and must bring whatever focus you have to the next situation, because there is no time. The next patient still requires 100% of your attention. And that is real. You see that on the show.

Q: In what ways is The Pitt limited in its portrayal of emergency medicine?

The compressed nature of the show is limiting. It has many of those attention-grabbing cases play out in a single shift or day when that’s not how it unfolds. We see those cases, but we also see many that are not visually dramatic and are still high stakes. Things like vague chest discomfort, unexplained abdominal pain or elderly patients with new cognitive changes.

Teamwork in the emergency department is critical. I appreciate that The Pitt includes nursing staff, but it still feels somewhat physician driven. Emergency medicine is fundamentally team-based. Physicians, nurses, technicians, and specialists all collaborate closely.

Another major difference is the use of the electronic health record. In the show, physicians are on the computers checking and entering in the record maybe 5% of the time. It’s closer to 50% of our time. That burden is significant.

Q: What do people misunderstand about emergency departments that the show does not fully capture?

There is still a perception that emergency departments are filled with patients who do not need to be there or are there because they neglected their health. That is not the case. Most patients are there for a reason, often for high-risk conditions that have not been diagnosed yet.

It takes testing, evaluation and experienced teams to determine who is truly high risk. If it were easy to figure that out, it would have been solved a long time ago.

Emergency medicine is also not the same in all organizations. Many physicians work in lower resource settings. When consulting specialists aren’t readily available, physicians often must figure out where a patient can go for the next level of care — and that can be a complicated, time-consuming process.

Q: Has The Pitt changed how patients understand your work?

Patients bring it up all the time. They ask, “Is it really like that?” And they often express gratitude.

There is also more understanding from patients when care takes longer than expected. The show helps people appreciate how complex the environment is and how much is happening behind the scenes.

Q: The show highlights both dramatic lifesaving and physician burnout. What are the rewarding aspects that sustain people through this difficult work?

What people find rewarding changes during a career. Early on, it is usually the resuscitation, yanking someone back from the brink of death. But that is not the most common outcome. More often, patients are very sick, or the outcome is uncertain or devastating.

What becomes meaningful instead is recognizing the pain of the patient or their family and being there for them and communicating that someone who doesn’t know them cares about them in that moment.

That matters, especially now, when so many people feel isolated. For me, the most rewarding moments are often as simple as holding a family member’s hand in a moment of crisis.

I have always felt that caring for patients is a privilege. And working in a place where the goal is to do what is best for the patient helps. It does not eliminate the emotional burden, but it does help.

One example that stays with me is a patient who arrived at 3 a.m. with advanced cancer. They had traveled from hundreds of miles away after struggling for months to access care locally. Sadly, at that stage, there was not much we could do medically. But instead of handling it alone, I called the physician who had been involved in the past, and they came in and sat with us. We could not change the outcome, but we did not leave the patient to face the inevitable alone.

That sense that we are all in it together is what makes a difference.