Editor’s note: This article mentions suicide and other topics related to psychiatric distress. If you or a loved one is in crisis, call 988. Additional resources are available here.
As the doctors, medical students and nurses on “The Pitt” made their way through the TV show’s second season, their mental health challenges have been impossible to ignore.
Each season of the HBO Max medical drama follows staff through a single shift at the fictional Pittsburgh Trauma Medical Center’s emergency room, led by attending physician Dr. Michael “Robby” Robinavitch (played by Noah Wyle).
The most recent season spotlighted the pressures emergency providers face that can lead to burnout. It also highlighted patients being treated for mental health conditions.
Since its premiere in 2025, the show has sparked discussion about what it gets right and wrong. The day after the second season’s finale aired, The Seattle Times talked with local emergency medicine providers about the show’s portrayal of mental health.
Conversations have been edited for length and clarity and contain spoilers.
What has watching “The Pitt” been like as someone working in emergency medicine?
Providers said they were impressed by the show’s medical accuracy, to the point that they sometimes can’t watch it after work because it feels too real.
Dr. Gregory Lopez, an emergency medicine physician and chief of staff at MultiCare Auburn Medical Center who watches the show with his teenage daughters, said “I think I finally got some street credit for what I do every day at work.”
The show also highlights societal issues present in the emergency room: health insurance challenges, understaffing, limited bed availability.
“I think ‘The Pitt’ does a really good job demonstrating the chaos of the emergency department, and also illustrating how a lot of the stuff that we deal with is not as simple as the medicine,” said Dr. Arvin Akhavan, an emergency medicine physician who practices at Harborview Medical Center and the University of Washington.
There was one point nearly every provider brought up: The shifts shown in the show aren’t representative of an average day in any emergency department, they said.
“You could take all the cases in one episode and make somebody’s entire career out of it,” said Dr. Andrew Young, an emergency medicine physician at Providence Swedish in Issaquah. “But those are all almost to the letter, real diagnoses, real clinical presentations and procedures, including the mental health aspect of the show.”
This season, we see a college student showing signs of psychosis. He’s evaluated for potential bipolar disorder or schizophrenia. Tell me more about the collaboration between emergency providers and mental health specialists in cases like this.
Before determining that erratic or aggressive behavior is caused by a mental health condition, emergency medicine providers said they work to rule out substance use and other potential causes.
If there isn’t a clear cause, then a psychiatrist, social worker or other mental health specialist will come try to learn more, the providers said.
Nick Escobar, the nurse manager for Harborview’s psychiatry emergency room, said the show’s depiction was “the textbook story” of a young man experiencing the onset of schizophrenia and bipolar disorder.
“It’s kind of a tragic story that happens quite often in mental health,” Escobar said. “That initial first encounter with the health care system can be as dramatic and horrible as that story.”
“I think they did a really good job of portraying the stigmatization that comes with behavioral health, and how upset the family was to find out there was a strong possibility their son had a condition like schizophrenia,” Young said.
The show touches on involuntary commitment throughout the season. In one case, a mom tries to walk into traffic after her young son needs medical attention after falling asleep in a hot car. She’s placed on an involuntary hold for being a danger to herself. What do you think the show gets right or wrong about these discussions?
Laws and procedures around involuntary commitment vary widely by state. In Washington, the process is more complicated than in Pennsylvania, where the show takes place; if doctors think a patient is a danger to themself or others, they can’t make an order for an initial evaluation. They must call a designated crisis responder, a specialized mental health professional, to determine whether the patient meets criteria for an involuntary hold.
Providers said these decisions come down to trying to do the most good and the least harm. Dr. Jacqueline Chipkin, an emergency room psychiatrist at Harborview, frequently has to decide whether to call a designated crisis responder.
Involuntary holds can help in some cases, she said: if someone is psychotic and missing dialysis, or actively suicidal with a gun at their apartment. But some cases, like the mom depicted in the show, aren’t as clear cut, she said.
“The question is, would an involuntary hold help her?” Chipkin said. “I think it’s realistic we would take her into the hospital and she would get a psych evaluation. The question of, would we go the extra step of forcing to admit her to the hospital, is one that we wouldn’t know until we talked to her.”
Throughout the second season, we’ve seen providers struggle with stress, burnout and mental health challenges. What do you want the general public to know about the pressures emergency medicine providers face?
The challenges shown in the show are real, providers said, and they’re glad the show is bringing light to them.
“They do a really good job of portraying the burnout at different levels,” Young said. Dr. Robby, he said, “is beyond burning out; after 30 years of working in a high-stress job, he’s struggling with suicidal ideation. The new residents are just trying to find a way to get through the shift and bond together afterward. And then the character who develops substance abuse issues — I think it runs a good gamut of the different levels of stress and how it takes a toll on our physical and personal lives.”
As a young attending physician, Lopez remembers treating a trauma that was “absolutely shattering” and being told: Take 30 minutes, and when you feel ready, come back for the next patient.
“What makes people want to go into medicine, and what makes people great doctors, is also what makes these stories stick with us,” Chipkin said. “You don’t want to harden yourself, because you want to care. But you also have to find a way to separate it out, and that balance is so hard.”
It’s not just tough cases that lead to burnout, providers said. It also comes from trying to help people in a flawed system in which there aren’t enough resources to get people the care they need.
“Burnout doesn’t always show up as depression,” said Dr. Lucy Goodson, an emergency medicine physician at Providence Swedish Redmond. “It shows up as cynicism or the sense that, I don’t know that I’m really changing anything — this feeling of powerlessness in a greater system where you don’t always have a lot of control.”
What keeps you working in this field despite the stress and challenges?
A sense of purpose, helping people on their worst days, trying to improve systems: All of these are reasons providers say they keep coming back to work.
“Like in the show, the medicine is cool, but the relationships are cooler,” Goodson said. “I have so many memorable moments with people where I learned something about life from them. I want to have a long and healthy career so I can continue to experience that, so managing burnout is a deeply personal goal of mine.”
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