British doctor reacts to The Pitt moments, from the tragic to the gory, and reveals differences with US system

Rarely has a series arrived in the UK with as much expectation as The Pitt. The US medical drama first debuted stateside back in January 2025, and since then has gone on to win every award going.

It has also become a firm favourite in the medical community, with a vast amount written about its accurate representation of real life experiences in a hospital emergency room.

Set in the Pittsburgh Trauma Medical Centre's emergency room, nicknamed The Pitt, the series charts a 15-hour day shift across 15 episodes, meaning it takes place in almost real time.

Noah Wyle stars as Dr Robinavitch, known as Dr Robby, the attending physician on duty. Meanwhile, other key figures include Dr Collins (Tracy Ifeachor), Dr Langdon (Patrick Ball) and charge nurse Dana Evans (Katherine LaNasa), along with a whole team of other doctors and nurses at various levels of experience and training.

It's long been established that the series is an accurate representation of medics' experiences in America, but how reflective is it of the UK experience?

Now that he's finally got to see the show's first episode, Dr David Kent, a Paediatric ST4 Registrar with experience in respiratory medicine, emergency department (ED) and intensive care unit (ICU), has spoken exclusively with Radio Times to react to some of its biggest moments, and reflect on some of the biggest similarities – and differences – with the British system.

When he last worked in an A&E practicing medicine, Dr Kent was an F2, most closely comparable to the level of Dr Mel King, a second year resident.

He notes in advance, however, that the UK has a "very different training system to the US", where they "sub-specialise very early on" comparatively.

00:01

The episode starts with Dr Robby entering the emergency room and starting his shift. He soon starts doing a ward round, checking in on the various patients and the doctors as they assess and treat them.

This is handy for the viewers from a dramatic perspective, but Dr Kent notes, at least in the UK, it wouldn't usually be something consultants (in the US known as attending physicians) would do.

"In the UK, you wouldn't necessarily do a ward round in A&E," he says. "A consultant wouldn't routinely see every patient. They'd be aware of all the patients, certainly.

"In the A&Es where I've worked, we'll do what's called a board round, so we'll all get together and talk over the list of patients and present them as a group, and you do try to do that fairly regularly – every four to six hours – just so everyone's updated on what's where.

"They'll do that in majors, they'll do that in minors, but a consultant wouldn't necessarily see every patient. They'd see the ones that people are worried about, they'd see the ones where there might be some difficulties in obtaining a shared understanding between the patient and the medical team.

"And then the consultants are probably also picking up patients and seeing patients themselves."

00:09

In the first episode of The Pitt, a group of four trainee doctors, all at different levels, are seen joining the team. Dr Robby gives them an introduction to the ER, its working and its staff. He notes that Dana, the charge nurse, is the most important person they're going to meet that day – something Dr Kent agrees with heartily.

"The charge nurse will get most of the pre-alerts through, and they'll probably have the best overall view of bed state within your A&E and within the wards," he says. "They'll know who to speak to in order to move flow around, and they tend to have the best overarching, bird's eye view of the hospital as a whole.

"They tend to be very experienced nurses, so will be clinically very competent, but also have a lot of the organisational knowledge.

"If you are a new rotating doctor into an area, you may have a more in-depth knowledge of the pathophysiology, of what's going on at a cellular level in someone's medical presentation, but actually the practicalities of dealing in that environment, they're going to be decades ahead of you.

"So absolutely, it's always worth deferring to the charge nurses for some opinions, particularly if it's organisational and structural."

00:11

Soon after their introduction to the ward, the trainees face a baptism of fire when two trauma patients arrive on the ward at once. One fell on train tracks locally, while another was trying to help her when he fell himself.

One trauma specialist arrives to help with the cases, but Dr Kent notes that in the UK, a trauma team would usually be called down to help in such a situation.

"You want a coordinated, structured response to each case that's coming in," he says. "It's very challenging when you've got two at once and it's very easy to get sucked into a task-focused approach. The guy who was worse, who's hit his head, they were replacing his breathing tube with a more permanent one.

"That's something that you can get very, very focused on, and you can lose sight of the the whole situation. The consultant's role here is difficult, because you've got to maintain oversight of those two things that are going on at once, so you've got to delegate a little bit to allow the two emergencies to be managed simultaneously.

"In the UK, you'd have a trauma team that would be called down. You'd have one person take the lead with the initial assessment, but you'd always have someone at the end of the bed who is in charge, who'd delegate specific tasks to specific people. That's the aim, that's the goal. But when two things come in at once, and people are very unwell, it can turn to chaos fairly quickly."

While attempting to oversee this situation, Dr Robby is approached by Gloria Underwood, the chief medical officer, asking to speak with him.

Dr Kent says: "It's very difficult, as someone who's trying to be a manager of the acutely unwell patient, but also a manager of a busy unit, because you will get members of the management team coming in and trying to ask you questions, trying to see what's going on, structurally, organisationally, while you're trying to acutely manage a patient. It's not uncommon."

00:15

Dr Robby's conversation with Gloria regards patient satisfaction – The Pitt's percentage of patients very satisfied with the care they have received is far lower than the target.

Dr Robby argues that most of their patients are waiting for a bed upstairs, and that the beds are available, but the hospital doesn't want to hire the staff needed to care for them. Gloria retorts that there is a nursing shortage across the country.

"Dr Robby says the hospital is saving money by keeping patients in The Pitt, calling it their "dirty little secret". He adds that people are getting "s****y care in our hallways, waiting for an ICU bed for days".

While elements of the issues faced in the US are specific – such as the fact the hospital is being perpetually threatened with closure due to its financial situation – Dr Kent notes that many of the issues raised in Dr Robby's conversation with Gloria transfer across the pond.

"Corridor care is a national crisis across the UK," he says. "It's clearly an international issue. Very rarely do you have physical bed spaces being the limiting factor for movement of patients. It's almost always nursing staff, and there's various attempts to try and solve that across the UK in terms of using nursing associates and trying to improve retention with progression.

"But there's always going to be issues with bed spaces. We work in a environment where there is inherently going to be a resource limitation on everything. So, unfortunately, you do get these issues where if you can't move patients upstairs, they get stuck in majors, they get stuck in resus.

"And if a patient's stuck in majors, stuck in resus, it means that you have patients who have sat in the waiting room, who are sat in minors, who you aren't keeping as close an eye on.

"If you're not keeping as close an eye on those patients, it's hard to know when they are becoming unstable, when they are more unwell, when they are deteriorating, and you end up with worse outcomes because you are less able to keep a close eye on them.

"So, it's not quite the exact same situations, but there are similar problems experienced in the UK, and a lot people do act as whistleblowers and bring stories like this to the press."

00:17

In one of the gorier scenes in the first episode of The Pitt, one of the trauma patients brought in previously has a broken and degloved foot, an open fracture of her tibia that was displaced.

The doctors perform a procedure to get it back into alignment, although she would subsequently need to go to an operating theatre. Dr Kent notes that an A&E team could do this, but that he would ideally want an orthopaedic surgeon, a trauma surgeon or a plastic surgeon there.

"You can do it under under a nerve block, which is what they're doing - that's a local pain relief," he explains. "But I'd definitely want some analgesia on board, some sort of painkillers on board for that, because that's going to be really difficult."

One of the trainee doctors, third-year medical resident Dr Samira Mohan, faints as she watched the procedure. This, it seems, is highly realistic.

Dr Kent says: "Most every doctor I know has got a story of a medical student standing in a operating theatre and fainting or feeling faint, at least."

00:19

One patient, Otis, suffers a cardiac arrest while being examined. The team immediately put pads on him and shock him – but Dr Kent says this exact situation is unlikely in real life.

"If you can get the pads on really, really quickly and identify a rhythm that you can shock, yes, you could probably wait for the pads to be on to start assessing the rhythm and then shocking," he says.

"But if you've got a patient in front of you who has lost cardiac output, they've got no pulse, they're unresponsive, someone should start chest compressions, someone else should get the crash cart, and then you should put out a crash call.

"A buzzer goes off, and everyone then becomes aware that you've got a patient who is essentially dead. Because, at that point, that patient is the sickest patient in the department, by definition."

Later, when he has regained consciousness, one of the doctors, Dr McKay, tells Otis that muscle breakdown and myoglobin has damaged his kidneys. This led to a buildup of potassium, which messed with the electric activity in his heart.

Dr McKay tells Otis that have given his medicine to lower his potassium and he will need dialysis to clear it all out, but he will then be OK, after a week of two's recovery.

This type of certainty in Dr McKay's reassurance is perhaps unwise, Dr Kent notes.

"I have had patients lose cardiac output very, very briefly and then been absolutely fine. But I think it's a little bit bold to tell the patient that he's just going to need a bit of dialysis and then he's going to be fine, because it's really difficult to predict what's going to happen. It's hard to know how they're going to respond to the dialysis.

"It might be that this is all a very, very acute picture, but they've got no way of knowing, if this is a guy who's previously been fit and well, that he doesn't actually have a degree of chronic kidney disease, and this has been something that's tipped him over.

"It's a bit bold to say, 'Oh yeah, you're gonna be fine,' but I have seen people make those promises. It's something which does happen but perhaps shouldn't."

00:28

An elderly patient is brought in from a nursing home attached to a LUCAS chest compression machine. The charge nurse soon informs the team they should stop, as a 'do not resuscitate' form has been found for the patient. After they have stopped and the patient dies, Dr Robby notes that the team always marks a patient's death with a moment of silence.

Dr Kent notes that, in the British A&Es where he has worked, there is a more entrenched post death tradition.

"After resus, we will try and do what's called a called a hot debrief, where you gather the team that's available and you quickly talk through through the case, saying, 'Look, are there any areas where you feel that we could have done better, any areas where you think we did well.'

"It acts as a forum for people to identify problems, to praise good practice, but also just to speak about how things made them feel.

"That's definitely more an entrenched post-death tradition in the UK. But a moment of silence is nice and when you verify death, and you document verification of death, many people often will write something like, 'May their soul rest in peace', or something similar."

00:38

Later in the episode, Otis suffers another cardiac arrest, and the team have to perform an invasive procedure to remove fluid from around his heart.

Dr Kent says he would want a larger team around him if performing a procedure right this, and believes he would be questioned as to why he didn't request one if he performed the procedure as is shown in The Pitt.

"I'd want a bigger team there," he says. "This is a man had a fairly brief cardiac arrest, and then you're going to do a invasive procedure to remove some of the fluid from around the heart. This case went well, but he is a potentially very unstable patient that you're about to do something fairly invasive to.

"There's a high risk that he could deteriorate. So if you've got the expertise, absolutely crack on and do it, but you'd want to start getting more bodies, more hands, so that if he is going to deteriorate, you've got someone whose only job is they are going to manage the airway, someone's whose only job is going to be, 'I'm going to be monitoring the pulse'.

"It might be an organisational thing of the emergency department in the US, I don't know, but certainly in the UK, if I had a patient like that, I think I would be questioned as to why I didn't inform the intensive care team."

00:44

The moment which most struck Dr Kent as being unrealistic, at least in the UK context, is the speed at which Dr Langdon is able to get a toxicology screening for a child who is revealed to have unknowingly eaten gummies containing cannabis.

"That takes ages to come out," he says. "That's 72 hours at minimum, but it can be weeks."

00:46

An obvious contrast between practicing medicine in the UK and is the US is the prevalence and legality of guns in the latter country.

When a woman is brought into The Pitt by her son due to vomiting, it is revealed she has been doing so on purpose, in order to meet medical professionals and tell them that she is worried about her son's mental state, and his potential to harm others. Dr Robby quickly asks her whether there are any guns in their house.

"I've never asked that," Dr Kent says. "Well, I've once asked that when I had a farmer come in and he was depressed, but it's not really something I have to consider."

He notes that he has never seen or treated a gunshot wound.

00:51

The final moments of the episode see Dr Robby having a flashback to treating patients during the Covid-19 pandemic, where he and those around him are in masks or hazmat suits.

Dr Kent, who worked in respiratory medicine for eight months, and ED and ICU for another eight months, during the pandemic, says: "The end of that episode was quite jarring, because I do remember that."

Wrap up

Reflecting on the episode, Dr Kent says that the difference which stuck out to him most between the UK and US systems is the fact that "there was lack of separation between the paediatric patients and the adult patients". In the UK, these are kept entirely separate.

He adds: "A&E was doing a lot more independently than I've seen in my experience in the UK. In that episode alone, we've had two major traumas, which were basically all managed by the A&E team, with a little bit of appearance from a trauma surgeon.

"In the UK, they'd have a full trauma team. That trauma team would include a general surgeon, orthopaedic surgeon, the major trauma team, an anaesthetist, and that would be for each of those. Then, for the cardiac arrest, a crash call probably should have gone out, and that would have summoned your anaesthetist, your medical registrar – even if they got sent away fairly quickly, they'd be aware of this patient, and they'd be around and supporting the management."

He also says that "some things happened quicker than I would expect them to happen, like we talked about with the tox' screen. Also, there was a very quick popliteal block, and some of the labs are coming back fast".

He accepts that this is what's required for a TV drama, and that, for the most part, it is "fairly accurate" to his own experiences.

The Pitt is available to watch now on HBO Max.

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