During her childhood, Jean Hoffman, MD, was captivated by “ER,” the enduring NBC drama depicting the turbulent emergency department of a city hospital. This exposure profoundly influenced her decision to pursue a profession in emergency medicine.
“It’s astonishing that my parents permitted me to view that program,” Hoffman remarks, chuckling. “I was utterly enthralled by it, and it served as a powerful motivator for me. That environment felt like my true calling, and I recognized my destiny lay there.”
The series “ER” spotlighted a youthful Noah Wyle, who began as a medical student on the verge of retching upon encountering gruesome injuries. Fast forward to his mid-50s, and Wyle now portrays a seasoned attending physician in “The Pitt,” the popular HBO Max streaming series centered on the frenetic emergency department of an urban hospital. Right from the opening episode, a medical student collapses at the sight of grave trauma, earning the mocking nickname “Crash” from a jaded resident.
Hoffman, serving as an associate professor in the University of Colorado Anschutz Department of Emergency Medicine and medical director of the emergency department at UCHealth University of Colorado Hospital (UCH), finds numerous commendable elements in the series, which is currently airing its second season. Nevertheless, she has some pointed feedback she’d love to share directly with Noah Wyle.
“I’d be thrilled to host Noah Wyle for a tour of our facility—or anyone else from the cast and crew. My office door is perpetually open,” she expresses.
Hoffman’s aim is to demonstrate to Wyle, who also acts as an executive producer on “The Pitt,” the substantial disparities between her department’s operations and the show’s portrayal, particularly the overcrowded waiting area where ill and injured individuals languish for hours awaiting medical attention.
Significant Operational Disparities
“The layout and flow of our emergency department bear no resemblance to what’s depicted, despite managing an immense volume of patients,” Hoffman explains. “‘The Pitt’ portrays an outdated model of emergency department management. In contrast, we’ve introduced cutting-edge innovations to deliver prompt care, preventing the buildup of crowds in waiting areas and averting outright pandemonium.”
The primary innovation, she highlights, involves “eliminating nurse triage”—the conventional process where a nurse conducts an initial interview to prioritize patients based on condition severity.
This shift formed part of a comprehensive overhaul of the front-end intake procedures, spearheaded by nurses who determined that their skills were most effective at the patient’s bedside. Early collaborative assessments by the team facilitated swifter evaluations and interventions. Recent research underscores that standard triage approaches often lead to misprioritization and postponed treatments.
“Paramedics and physicians evaluate you right away,” Hoffman details. “There’s no preliminary questioning about trivial details like your lunch or allergies. Instead, we focus on the core issue: ‘Why are you here?’ If the response is ‘chest pain,’ we recognize it as critical and ensure immediate physician consultation.”
“This represents the most striking contrast with the show,” she continues. “We prioritize delivering what patients seek most urgently—rapid treatment for their emergencies. By connecting individuals with doctors swiftly and providing necessary interventions, we eliminate the need for prolonged waits, such as 12 hours just to renew an asthma prescription.”
Addressing Patient Boarding Challenges
In “The Pitt,” staff frequently gripe about “boarding,” referring to admitted patients lingering in the emergency department for extended durations due to a shortage of inpatient beds elsewhere in the hospital.
“We encounter boarding on occasion, and I truly appreciate how the series elevates this as a critical hospital-wide challenge,” Hoffman acknowledges.
“No facility escapes it entirely, given the national decline in hospital beds per patient. However, we experience far less of it than portrayed in ‘The Pitt’ thanks to our superior hospital throughput,” which entails streamlining patient progression through optimized staffing, bed allocation, communication protocols, and additional efficiency measures at UCH.
Hoffman cautions that the show’s images of jammed waiting rooms shouldn’t deter those requiring emergency care. “We’re far from flawless—delays can happen. That said, our teams at every level, combined with refined processes, excel at prioritizing and delivering care with minimal wait times.”
Unlike the resigned attitude of “The Pitt” characters amid disorder and inefficiency, Hoffman’s UCH team proactively tackles issues. “We refuse to be seen as helpless bystanders ignoring problems,” she asserts. “My colleagues actively pinpoint challenges and devise improvements.”
As an administrator, she also objects to the show’s vilification of hospital leadership. “Managers aren’t the villains; we’re all striving to enhance outcomes. Our goal isn’t suffering—it’s ensuring patients receive optimal care.”
Authentic Elements and Broader Impact
Hoffman praises “The Pitt” for accurately capturing medical practices, terminology, and patient interactions. She attributes this realism to Joe Sachs, MD, FACEP, an executive producer and writer who is himself an emergency physician, ensuring credible scripting.
The show excels in illuminating provider stress and burnout amid demanding circumstances, she notes.
“We were celebrated as heroes during COVID, with public gratitude boosting morale. Post-pandemic, the narrative shifted to exhaustion. The reasons are elusive, but daily exposure to mortality, devastation, and gloom exacts a heavy price. We prioritize robust support for our providers. ‘The Pitt’ masterfully humanizes these struggles, revealing the profound difficulties we face.”
Furthermore, Hoffman values how the series’ success amplifies vital conversations. “It provides a public stage to discuss ED improvements—topics we’ve championed for years. Emergency departments signal deeper healthcare system flaws, much like the canary in a coal mine.”
She has previously worked in departments resembling “The Pitt” more closely. “Adopting our operational strategies elsewhere could alleviate many pain points,” she suggests. “I commend ‘The Pitt’ for exposing emergency medicine’s challenges, but it falls short by not showcasing successful models and solutions to systemic woes.”
What about her peers’ views? “Most skip it,” she says smiling. “They fall into two groups: those avoiding work-like content after shifts, and those echoing my critiques. I’m unaware of any ED physician who’s binged the entire series.”
