The Pitt Resuscitates Medical Drama Genre with Bold Innovation
After a wait more interminable than most spells in an A&E reception area, the medical-drama-of-the-moment The Pitt finally made it onto UK screens last month via the arrival of streaming service HBO Max. Just about everyone seems to have spent the following weeks hoovering it up, with some viewers already up to speed with its second season finale that aired recently on US television.
I've been a little slower off the mark – mainly because it took so long to figure out if I actually had access to HBO Max as part of my bafflingly arcane Sky TV package – but I'm racing through it now and ready to share observations that others made weeks or even a full year ago in the US.
A Revolutionary Blend of Medical Drama Formats
The most striking observation is this: how did not one television producer have the idea to mash together ER and 24 before? The concept was right there, staring everyone in the face. Jed Mercurio, whose forgotten 2015 medical drama Critical also had a real-time element, might have a finger raised in objection at this point.
Beyond The Pitt's formal innovation – each season follows, to the second, a 15-hour shift at an under-resourced teaching hospital in Pittsburgh – what's striking is how familiar it feels. In part, that is down to the comforting presence of Noah Wyle, who as the show's lead plays big-hearted, sad-eyed senior attending physician Dr Michael "Robby" Robinavitch. Wyle essentially portrays a continuation of his ER character John Carter, the fumbling junior MD who became that show's inspirational figurehead.
Rooted in Medical Drama Tradition
But the familiarity doesn't begin and end with Wyle: it's there in the show's very foundations. With its jarring tonal shifts between soft relationship drama and intense, claret-spilling operation scenes, The Pitt plonks itself unapologetically in the lineage of the modern medical drama. This strange stew of comfort television and high-tension unpleasantness seems endlessly appealing to viewers across generations.
In both the UK and the US, early medical dramas were often soap operas, a genre that tends to prioritise formula and a sense of the familiar over formal daring. This isn't to say they were conservative – one of the first interracial kisses on British television occurred on the ITV soap Emergency Ward 10.
The Evolution of Medical Dramas
In the 1980s, the medical drama started to evolve significantly on both sides of the Atlantic. In the US, there was the arrival of a new generation of gritty, layered workplace dramas including the hospital-set series St Elsewhere. Now remembered largely for its completely crackers ending, the show was revolutionary in its use of multi-strand plot lines and of-the-moment subject matter – among other landmarks, it was the first show to feature an AIDS storyline.
Meanwhile in the UK, the BBC launched Casualty in 1986, a show that might feel hopelessly traditional to viewers today but was anything but when it debuted. Conceived by creators Paul Unwin and Jeremy Brock as an unflinching look at how Thatcherite reforms were destroying the original vision of the NHS, Casualty prompted hoots of complaint from the Conservative government of the time.
The show rarely seemed to be out of the headlines in its first decade: most famously, a 1993 episode where a gang of violent youths burned down the hospital had to be moved past the watershed and received record complaints due to its violent scenes.
ER's Transformative Impact
At around the same time, ER emerged in the US and changed everything, becoming a blockbuster medical drama that fully modernised the genre. Its storylines – opioid addiction, mental health crises, institutional racism – were remarkably bold for its era. With its heightened commitment to medical accuracy, verité filming style, sprawling casts, sudden tonal shifts and so much more besides, it set the template for every similarly minded show that followed.
You can see ER's influence in everything from the gentler likes of Grey's Anatomy and The Good Doctor to pricklier takes on the format such as House. And of course, you can see it in The Pitt – a show that was reportedly conceived as an ER reboot and is now subject to a lawsuit from ER creator Michael Crichton's estate.
Why The Pitt Resonates with Modern Audiences
So why has The Pitt chimed with viewers when so many other ER-a-likes have been memory-holed? Much of its success is down to that conceit where minor storylines from early episodes spiral off into something unexpected and major, turning the medical drama's procedural format into something satisfyingly elongated.
But The Pitt also has the same nettle-grasping spirit as the landmark medical dramas. It is unafraid to take on live issues – ICE agents descending on hospitals, post-Roe-repeal abortion restrictions – and unwilling, like Casualty with the NHS, to gloss over the risible state of US healthcare. One particularly grim storyline shows the ramifications of a patient's insulin rationing, highlighting systemic failures in the healthcare system.
Perhaps my year-late observation is actually this: The Pitt is a show that captures the medical drama at its very best, blending innovation with tradition while tackling contemporary issues head-on. It leaves the genre in safe hands, demonstrating that hospital dramas can still evolve while maintaining their core appeal to audiences on both sides of the Atlantic.
