Doctors are often medical shows’ harshest critics, but “The Pitt” seems to be the one they actually like. Doctors credit Max’s scripted medical drama, which spends a season exploring 15 hours in a Pittsburgh ER, with capturing the experience of working in a 2025 emergency room.
“The other thing that’s really great is the emergency workers who say, ‘For years, I’ve tried to explain to my family what I do in the emergency department, and I can never put it into words,’” said co-executive producer Dr. Joe Sachs. “ They could never explain, ‘What I go through,’ and when they watch an episode of the show, they get it and they understand.”
For decades, real-life cops, lawyers, and doctors have helped TV procedurals with their stories. So what does “The Pitt” do that’s different? That’s the question IndieWire posed to Sachs as well as medical consultants Dr. Jacob Lentz (eps 103, 106, 109, 112), Dr. Elizabeth Ferreira (eps 104, 107, 110, 113), and writer’s intern Dr. Ariel Wu. Short answer: Doctors shaped every aspect of “The Pitt.”
The Team
For Season 1, “The Pitt” employed seven residency-trained, board-certified emergency physicians: four for the writing process, and three on-set medical advisors. Six nurses and physician assistants also served as specialty background players throughout production.
Overseeing it all was Sachs, who received his master in film studies while going to medical school — a combination motivated by his interest in public health education. While working for 30 years as a TV writer, Sachs continued to work part-time as an attending emergency physician at a teaching hospital and trauma center.
“I worked all during COVID, all during the peak of the pandemic, intubating the sickest patients in full protection gear, so I know what it’s like,” said Sachs.
The Boarding Crisis
“The Pitt” creator R. Scott Gemmill, executive producers John Wells and Noah Wyle (who plays Dr. Michael “Robby” Robinavitch) shared the goal of realistically capturing an ER in 2025. In their first conversations with Sachs they asked, “What’s new? What’s going on today?” Sachs’ immediate answer was the Boarding Crisis, which took off during COVID and never went away.
“In a 40-bed ER, there may be 30 patients taking up beds in rooms, on gurneys on every available wall spot waiting for admission, so your ability to see new patients suffers,” said Sachs. “The waiting time is terrible. And the horrible solution is that you have to practice waiting-room medicine. From the waiting room, as we portrayed, you get your labs drawn, you come back, you go to x-ray, you come back, and sometimes you never make it back to a bed.”
The opening sequence of episode 1 of “The Pitt” grounds the audience in that new normal. Dr. Robby walks through a hundred patients in the waiting room and briefs the new medical students and residents on the reality of boarding and waiting-room medicine. Said Sachs, “I think in the first few minutes of episode 1, healthcare workers knew this was a show that’s real and different from your typical medical show.”
The ER Set
Another reason “The Pitt” is instantly recognizable to doctors, and it could shoot in a realistic way, stemmed from early planning and collaboration between Sachs and production designer Nina Ruscio. She created a set that was not only grounded in modern medicine, but was also built for unique production needs.
“I gave Nina a book of the 20 newest, greatest emergency departments,” said Sachs. “It’s curvilinear, there’s open doors, there’s depth — our set has a ceiling that allows for a documentary-style walk for a half a mile where you see everything. Most sets don’t have ceilings and our lighting is built right into that.”
The Stories: It’s Still Drama First
“We never start with a medical case,” said Sachs. “It stems from the dramatic needs of the characters, and when we have the dramatic needs, then my job is to go to the well.”
In the search for the specific medical condition that will serve the dramatic needs, that well of story options is deep. Beyond his own three decades in the ER, Sachs brought aboard Dr. Mel Herbert, CEO/Founder of continuing medical education organization EM:RAP; it comes with its own network of medical professionals. Joining Sachs and Herbert in the story development was Dr. Greg Moran, the retired chair of emergency medicine at Olive View Medical Center, and Dr. Ariel Wu, the chief resident in emergency medicine at UCLA who brought the perspective of what the ensemble of medical students and resident characters experience.
“The Pitt” also benefits from an army of more informal consultants. One example of this was hosting “nurse’s nights,” where the show feeds working nurses dinner and lets them tell their stories. Sachs offered an example of how this deep well can lead to finding just the right medical case to fit dramatic and character needs.
“A writer wanted to do a scene that showcased Mel King’s (Taylor Dearden) special abilities to relate to patients, especially patients with special needs,” said Sachs. The team settled on a patient with SD Autism Spectrum disorder who had an ankle sprain but frustrated Dr. Langdon (Patrick Ball) with his endless questions. Said Sachs, “And Mel comes into the room, sits down quietly, turns off the lights, closes the door, and gets everything she needs out of him.”
The case allowed character to be expressed in action and conflict. Without a need for backstory or medical exposition, the viewer knows a great deal about Dearden’s character and the medical drama is de-escalated, while Mel’s relationship with Langdon takes a new turn.
Technical Dialogue and Procedures
Sachs, Wu, Moran, and Herbert also gave script notes at every step of the writing process, including a list of vocabulary and medical terminology.
“We don’t shy away from complex technical dialogue,” said Sachs. “If it’s crazy technical and the audience doesn’t understand it at all, it’s fine because the emotion, the conflict, the humor comes through performance.”
Trusting the audience will follow the drama, and won’t stumble on jargon and procedures they don’t fully understand, is a driving ethos of the writers room. Doctors who watch “The Pitt” love characters who talk like professionals, especially when featuring a particularly cutting-edge scenario. Sachs’ favorite example came during episode 14, the mass casualty episode.
“Dr. Langdon places a supraclavicular, subclavian line and calls out all the appropriate landmarks and pointing to the ipsilateral nipple. The cast reading it were going, ‘Are you kidding me? What is this?’” said Sachs. “It’s a procedure that isn’t taught, that frequently was featured on EM:RAP as a way to do a central line when you don’t have ultrasound. Anyway, that show just aired and when that scene came on, Mel Herbert, who’s the CEO of EM:RAP, his phone blew up with about 300 texts and emails saying, ‘Oh my God, did you see what they’re doing?’”
On-Set Medical Consultants
The 15 episodes of Season 1 were divided among the three on-set medical consultants, Drs. Jacob Lentz, Elizabeth Ferreira, and Fred Einesman. Each medical consultant begins prepping their episode as soon as the scripts are ready, sitting in all production meetings and working with directors and department heads. They follow their episodes through production and are on-set for every shot.
“You’re responsible for every medical part of everything for the entire episode,” Lentz told IndieWire. “There’s a huge amount of prep time and then a huge amount of legwork mapping these things out. And you have to answer every single medical question for the entire episode.”
Makeup and Craft Collaboration
Medical consultants break down the script to outline what each department will need ahead of time. This is especially key for the art department and props, which must return the medical tool or equipment “back one” as if it hadn’t just been used every time.
The doctors learned how, with proper prep and information, filmmakers can produce incredibly lifelike and detailed results. Sachs was particularly impressed how makeup department head Myriam Arougheti created open fractures, the dislocation of a lower extremity, a fasciotomy with tissue bulging out, open chest surgery with a beating heart, third-degree burns, and a vaginal delivery.
“The biggest compliment her work has ever had was someone [who worked on ‘The Pitt’] was at a cocktail party and a real-world surgeon said, ‘Don’t you know it’s a HIPAA violation to use real footage of real patients? Who gives you that footage? Because it’s against the law,’” said Sachs. “So to fool a surgeon with our makeup and our procedures is pretty great.”
Working with Cast
Each of the principal cast went through a medical boot camp to learn the basics of suturing, intubation, and how to hold an ultrasound. “[For each shooting] day, we write extensive sides, [outlining the] choreography, to make sure these trauma scenes look as legitimate as possible,” said Ferreira of her role as on-set medical consultant.
During down moments, Ferreira, Einesman, and Lentz would pull an actor aside to review the mechanics of aprocedure to create the right physicality. Said Lentz, “All three of us [the on-set medical consultants] have the muscle memory of how things feel when you pop into a lung. There’s a distinct feel to a lumbar puncture, and so you’re trying to like explain that and show them how they can best physically mime it — your shoulder jerks a little bit as you pop through the chest wall into the lung when you’re putting in a chest tube.”
Ferreira was impressed by how dedicated the cast was to getting it right and how quickly they learned how to mirror each act. According to Ferreira, the actors’ muscle memory improved as the season progressed and they slipped more quickly into the physicality of playing ER doctors. The medical consultants learned thatphysicality was only half of the equation.
“One thing that Lizzie [Dr. Ferreira] is really good about is thinking about where their head is at when you’re about to do something,” said Lentz. “If you’re doing a crazy procedure, the actor doesn’t know if this is routine or a very rare thing. We have to tell them, ‘You rarely do this and it’s super high stakes, so this is a hair on fire situation, you’re secretly panicked, you’re trying to seem calm.’”
Blocking and Collaborating with Directors
Actors getting their actions down is only part of accurately portraying medical procedures. Who stands where, who is responsible for what, who hands what to whom — there’s a coordination and choreography in doctors and nurses trying to save lives. Medical consultants shared videos of real-life medical procedures with their episode’s director to provide a sense of the action involved, but ultimately it has to be staged and rehearsed to get it right.
“I think the directors are very kind because sometimes we do things that I feel typically the director is in charge of,” said Ferreira. “But because of the nature of the situation where it requires a lot of technical knowledge, they give us a lot more freedom into creating the scene and then they [see] what we’ve done to create their shot.”
Lentz said the series allowed consultants to first stage and rehearse medical procedures. “I would always say, ‘Here’s what I came up with. It’s your show. It’s your episode. Tell me what you think. If you’re okay with it, great. If you wanna change anything, let me know,’” said Lentz. “It was a symbiotic, cooperative thing.”
Professional Background
Professional background extras know how to portray everyday things like busy New Yorkers walking down the street, posh guests at a cocktail party, or workers to board a bus. “It turns out that it’s very difficult to teach background actors how to be nurses,” said Lentz.
In the busy ER, the realism of nurses how move and do their job is vital. Each episode had six nurses as background performers: Melette LeBlanc, Ambar Kaiser Martinez, Jordan Farrand, Tim van Pelt, and Jamie Watkins.
“It’s interesting,” Lentz said. “Someone says, ‘Oh, I’d like to be a background on the show,’ we’d have to say, ‘Oh, can you work Monday through Friday for seven months? Because it all happens in one day.”
Van Pelt was also in charge of background choreography. At any point, there are up to 21 boarded patients on the walls in “The Pitt.” Van Pelt mapped out each patient’s symptoms and care minute to minute.
“Tim worked out a spreadsheet for every hour and every episode,” said Sachs. “Each boarding patient has a different appropriate activity, whether it be a breathing treatment, IV antibiotics, meals, physical therapy unique to their condition, And this is the part that I love: Tim looked after the fluid in their IV bag, making sure it went down an appropriate amount every. The attention to detail was phenomenal.”
