Reply to The Pitt, new HBO Max show w Noah Wyle

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[quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous]It's going to be hard to top this 12 hours in the second season, they'll have to kill of half of Pittsburgh. That's a lot of casualties for a lone shooter.

I'm not really sure if I bought Robby trying so hard to save that girl who was clearly gone or his step son blaming him for her death. I hate the redemption arc for Santos. [/quote]
[b]Why would Santos need a redemption arc?[/b] She’s proven to be extremely competent and caught out a doctor stealing drugs and working high.[/quote]

Because she’s annoying? [/quote]

More than annoying, she takes risks she's not authorized to take, she gives her co-workers unkind nicknames, and she's quick to accuse people of serious offenses with little proof. But the show keeps having her get vindicated for her actions. [/quote]
She keeps succeeding, in other words.

For those who don't understand the importance of the scene with Collins and the black mother who was so relieved and thankful that someone finally listened and provided appropriate treatment, there is a ton of literature demonstrating that black patients are consistently treated dismissively in medical settings. The Pitt is trying to be a realistic show, and that is a realistic scene.[/quote]

There are a few great examples of the medical providers' lived experience coming through to benefit their patients, or at least try to help beyond regular protocol and procedure. What you said about Collins is bang on. Also, Dr. King's understanding of what would help the autistic patient feel understood, the two providers who did street outreach catching the possible STI/trafficking situation, etc.[/quote]

Also, Mohan immediately recognizing the signs of sickle cell in the patient who came in with the EMTs who thought she was faking or having a mental health break -- I don't know Mohan's ethnicity but she seemed to be aware of how racism played into misdiagnosis and how important it is for ER docs to understand the signs of sickle cell (which sounds insanely painful, wow.)

I also like how Collins was shown being particularly good and insightful on the obstetric cases, as she was dealing with her miscarriage. It would make perfect sense for a doctor trying to conceive to be very focused on the medical needs of pregnant and post party women. She is the one who caught the problem with the woman who'd given birth a week before that McKay missed (and pointed out to McKay that she might have overlooked this obvious explanation for her symptoms because the patient was obese). And then Collins was also really on top of the patient giving birth, reminding Robbie of technique in getting the baby's shoulder unstuck and doing an especially good job of focusing on both the needs if the mom and baby in a situation where people sometimes fixate in the baby and ignore the mom (spoken from experience).

In general I just like how the show portrays doctors using empathy and real world, nonmedical experience to not only support patients but to diagnose. I think this is something unique to emergency medicine. It's a specialty with very specific skills, but unlike a lot of other specialties, the doctors are generalists. They treat people with a very broad range issues, have to be able to diagnose quickly and choose a course of treatment fast. This makes it extra valuable to be empathetic and insightful about people. [b]They aren't getting patients referred to them with issues already identified and histories already taken. They have to start from scratch with most of their patients (save the repeat customers like Louie and Myrna) but they also have to be careful not to make assumptions or give in to stereotypes.[/b] It's a really hard job.

After never having been to the ER as a patient before, I wound up going twice in the last year. One wonderful experience (as wonderful as that can be, at least), and one real nightmare. So I've been watching this show with that baggage, and I gotta say, I'd go to the Pitt anytime I needed an ER. They are good doctors.[/quote]

Agree with you completely, but also want to point out that this is true for general pediatricians and family medicine providers as well, and urgent care. Most docs are actually in this position, albeit without the acuity. The acuity makes it murder.[/quote]

Yeah, I thought about that, but then thought about my own experience and how the urgency of emergency medicine changes things completely. Because when I see my GP, or even go to urgent care, or take my kid to the pediatrician, what do they do if there is an issue that isn't easy to diagnose and treat? They refer me. In fact our pediatrician makes us call ahead for anything other than a well child visit and unless it's something that is basically diagnosable over the phone with a nurse, they will tell us to go to a pediatric urgent care or the emergency room. Partly because they don't want sick kids in the office if they can prevent it, and partly because anything actually urgent, they don't have the tools to treat in the office.

I have also made the mistake of going to urgent care for a problem that wasn't exceedingly simple -- they just send you to the ER. They don't have a lot of diagnostic tools at urgent care (they don't even have ultrasounds, and definitely no MRIs). Often urgent cares are staffed by nurse practitioners and there may be no physicians on site. Urgent care is basically for when you can almost diagnose yourself and the solution is a prescription or maybe very simple medical procedure. Once I went to urgent care when I couldn't stop throwing up and they gave me anti-nausea meds and an IV to rehydrate me. Even then, I probably should have gone to the ER because urgent care was not able to diagnose what was causing the vomiting.

So emergency care is really unique in this situation because it's the only situation where the docs have to quickly take a patient history, make an assessment, and make an immediate judgment. They can call for a consult from a specialist in the hospital but they need to know quickly whether something is surgical or not, and any other consult can take a long time to get, so they have to be able to treat in the meantime and know what to look for in case things head south.

And they also have to do all this without the benefit of history with the patient most of the time. Which GPs often have. So it's really unique and their ability to read a situation, communicate really well, listen to what patients are saying but also use both their medical experience and real world knowledge to know when to read between the lines or ask the question the patient might not realize is critical, is a much bigger deal.

No disrespect to GPs, they are really important to preventative care and overall health. But ER doctors are doing something really unique, IMO.[/quote]

You get everything settled in the ED, instead of just being stabilized with everything chronic (or taking more than 24 hrs to fix) being punted to specialists to assess and treat?

What ED?[/quote]

Of course you often ultimately wind up with specialists but yes I've absolutely had everything treated in the ER. My spouse was in a car accident once and the ED was definitely our main source of care for him. He didn't wind up getting referred because he was very lucky and had no internal injuries and his external injuries could be treated in the ER with follow up care with our GP. He was in the ED for over 12 hours and had to have multiple scans done (MRI, head CT, multiple X-rays) before he could be discharged because of how he was hurt. There was a surgical consult at one point and we talked to a neurologist about his head CT and I got follow-care instruction just in case since even though the scans came back clean, he was still at risk of issues for 48 ours post injury. But our primary doctor was the ED attending, who was wonderful and did an amazing job managing his case. This was at GW.

I also had to go to the ER when I was pregnant for complications and wound up staying in the ER instead of being sent to obstetrics because they were totally full with women in labor. This was at Sibley. I got wonderful care and my ER attending coordinated with my OB by phone and they were able to get me discharged fairly quickly and get the reassurance we needed on the baby's wellbeing so that I could go home for bedrest. That was a stressful visit because of the pregnancy and I was really impressed with how the ER doctors handled that aspect of my case given that they are not specialists -- they knew just what to do and also knew how to talk to a scared first time mom in her third trimester who was very scared of losing my pregnancy.

Another time I took my mom to Sibley with abdominal pain and they were able to diagnose her gall stones and get her palliative care and took wonderful care of her. She ultimately did have surgery with a specialist but the ER docs diagnosed without any consultation and were 100% right about everything. I think "mystery abdominal pain" along with "mystery chest pain" are incredibly common in ERs and there are a ton of things they can be -- appendix, gall stones, kidney stones, ovarian torsion, bowel obstruction, ulcer... they did such a great job assessing my mom and getting to the root of it.

So yes, sometimes the ED really does handle most of your case doesn't just punt you to a specialist and say "best of luck." That's my experience at urgent cares and with GPs, but since the issues you take to the ED tend to be much more acute, they can't do that so much. If you have something that is truly an emergency (or even just could be an emergency and better safe than sorry) they have to treat you. Even if it's late at night, as it was in every one of the examples I just gave.[/quote]

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