The Revival of Medical Drama as a Driver of Change: from 'Emergency!' to 'The Pitt'

We take it for granted now. Someone collapses, we dial 911, and within minutes trained professionals arrive with equipment, medications, and the expertise to stabilize a dying patient before they ever reach the hospital. It's so routine that we don't give it a second thought.

But this system—the entire infrastructure of emergency medical services as we know it—didn't exist until the 1970s. And remarkably, the creation of our modern EMS system was largely inspired by a television show.

"Emergency!" premiered in 1972 as not only the forebearer for the medical drama genre, but also the vehicle which introduced Americans to a radical (at the time) concept: non-physicians could be trained to deliver advanced medical care in the field. Week after week, millions of viewers watched paramedics Roy DeSoto and John Gage rescue people from fires, treat cardiac arrests, and save lives with dramatic interventions that worked with Hollywood reliability. The show was sensationalized, often unrealistic, and wildly successful at shaping public opinion. By the time it ended in 1977, the paramedic profession had been legitimized not through medical evidence or policy arguments, but through narrative—through the power of television to make the impossible seem essential.

The question we should be asking now: if "Emergency!" created the modern EMS system, what will "The Pitt" create?

America Before the Paramedic Era

In the 1960s, if you had a heart attack or other life-threatening condition outside of a hospital setting, your prognosis was grim. Sure someone could have thrown you in a car and raced to the nearest hospital, hoping you'd survive the trip. The 'ambulances' of the time were a far cry from the modern image of an ambulance that you're likely to conjure in your mind's eye. They were not stocked with medical equipment nor staffed by personnel with medical training; rather they were hearses, often still owned and operated by funeral homes. If the patient survived long enough to make it to the hospital, the hearse/ambulance driver would deliver the patient to the hospital's medical team. If the patient died before reaching the hospital, the driver would just adjust course and bring the body to the funeral home—a not-so-subtle misalignment of incentives to be sure.

However, when minutes, and even seconds count, this 'transport only' pre-hospital care is functionally worthless. Critical interventions like CPR, defibrillation, administration of naloxone, and placement of a tourniquet to control hemorrhage can't wait 10 minutes, or even 5 minutes. They need to be initiated as soon as possible, and ideally this is at the first moment of contact with the patient, and by an appropriately trained medical professional. This is why the paramedic as first-responder system works so well.

However, while this system is the current status quo which we all expect and rely upon, at the time the idea that non-physicians could start IVs, administer medications, or perform advanced interventions wasn't just novel—it was illegal in most jurisdictions. Antiquated laws, born of the era of patent medicines and itinerant "snake oil salesmen," prohibited anyone other than licensed physicians from delivering medical care. These weren't arbitrary rules; they reflected a genuine (albeit misguided by the time of the 1960s) concern about protecting patients from unqualified practitioners.

Let's be honest about what else was happening: doctors and nurses actively opposed the paramedic system concept—and their resistance wasn't entirely about patient safety.

Loss Aversion and Professional Territorialism

The medical establishment in the 1960s feared that expanding the scope of non-physician providers would dilute professional authority and, yes, potentially cost them their jobs. Physicians worried about losing control over medical decision-making. Nurses had similar concerns about their professional boundaries being eroded as the distinctions between the scope of paramedics was poorly understood and seemed eerily overlapping with that of RNs.

It's the same pattern we see playing out today with nurse practitioners and PAs. The same territorial impulses. The same loss aversion disguised as concerns about "patient safety." This is not to say that rigorous attention to appropriateness of supervision and scope of practice for APPs is not justified; it most certainly is. However, an honest appraisal of the situation would reveal that fear of being replaced permeates many physician organizations' messaging around the role of PAs and NPs. These bear an uncanny resemblance to the dire predictions made in the 1960s about what would happen by letting non-physicians practice medicine (i.e., paramedics).

Here's what history has consistently demonstrated: when genuine unmet healthcare needs exist, doctors seem to always have jobs. The creation of the paramedic profession didn't eliminate physicians—it created a system that made emergency medicine viable as a specialty and saved countless lives. The resistance was never really about safety. It was about change. Humans hate change, especially when they perceive that it may threaten their livelihood.

A Personal Tragedy and Political Will

In the early 1970s, public sentiment towards paramedics mirrored professional skepticism. The concept seemed radical, even dangerous. Furthermore, the lobbying voice representing physicians and nurses was strong, whereas any similar voice advocating for paramedics was non-existent. In fact, paramedics largely had to operate in clandestine fashion as they were on the wrong side of the law if they intervened with any attempts at life-saving maneuvers that crossed the line into "medical procedures."

Then-Governor Ronald Reagan of California was among the skeptics until he learned that an ambulance in LA County staffed with paramedics could cross city lines to ensure patients were delivered to hospitals appropriate for their condition. Many years earlier, Reagan's father suffered an out-of-hospital cardiac arrest and, due to arbitrary and antiquated law, the ambulance/hearse would not respond to the scene because it could not cross city boundaries. Reagan's father would not survive the incident.

After the moment Reagan realized that the paramedic proposal would create a system that could mitigate the risk that experiences like he had had with his father would happen to others, he was quickly transformed into an advocate for EMS reform. But political will alone doesn't change public perception. That required a different kind of intervention.

Emergency! and the Birth of a Profession

"Emergency!" was not the first televised medical drama, but it did set the stage for the sensationalized storytelling seen in shows ranging from ER to House to Grey's Anatomy that would follow; this form of storytelling, in fact, has essentially defined the genre of medical drama until now. Emergency! was heroic, dramatic, and wildly optimistic about what paramedicine could accomplish. Nearly every patient survived. Dramatic interventions worked with perfect reliability. The paramedics were unfailingly competent, compassionate, and successful—a far cry from the messy, uncertain reality of emergency medicine.

But it worked. America fell in love with the concept of the paramedic as first-responder. How had we ever lived without them? Suddenly, having trained emergency medical professionals seemed not just reasonable but essential. By the mid-1970s, laws were changing, training programs were proliferating, and the 911 system was expanding nationwide. The entire infrastructure of emergency medical services—the thing we now take completely for granted—was born largely out of public awareness created through the adventures of Johnny Gage and Roy DeSoto on Emergency!

The Cost of Sensationalism

Sensationalized drama, however, is a double-edged sword. Its efficacy at imprinting a message on the audience through vivid narrative is desirable when it draws attention to true problems and deficiencies within the healthcare system. However, these unforgettable stories shape the public's perception of the healthcare system—especially for the millions of Americans with limited health literacy and/or contact with the medical establishment.

By presenting wildly unrealistic survival rates and sensationalizing medical interventions, these shows have fundamentally distorted what Americans expect from emergency medicine. The most glaring example is CPR. On television, CPR works about 75% of the time. Patients "code," get shocked once or twice, and bounce back to normal.

In reality, survival rates for out-of-hospital cardiac arrest hover around 10%. For in-hospital cardiac arrest, it's roughly 25%. And many survivors have significant neurological deficits. When elderly patients with multiple comorbidities suffer cardiac arrest, survival approaches zero. But television has shown them recovering hundreds of times, creating expectations that affect everything from end-of-life care decisions to malpractice litigation.

Families are genuinely shocked when their 89-year-old loved one with metastatic cancer doesn't survive CPR. They've seen it work on TV. Diagnoses happen in 42-minute increments. Rare diseases are common. Brilliant insights trump systematic workups. It's compelling television and terrible health literacy.

For fifty years, medical dramas have prioritized storylines over accuracy, entertainment over education. They created heroes and miracles instead of showing the messy, constrained, often frustrating reality of modern healthcare. And, most importantly, they overlooked the ability of medical drama to shape public sentiments and focused exclusively on the entertainment value of their productions.

The Pitt: A Return to Educational Purpose

Which brings us to "The Pitt."

This is not "Emergency!" for the 2020s. This is something different—a medical drama that's resuming the tradition of using entertainment to educate rather than mislead. Where "Emergency!" showed a heroic, sanitized version of emergency medicine that bore little resemblance to reality, "The Pitt" is unflinching and brutally honest in its portrayal of the American healthcare system's failures.

The show depicts what happens when patients can't afford medications. It illustrates the impossible triage decisions when boarding has consumed every bed. It shows the moral injury inflicted on healthcare workers by a broken system. It doesn't shy away from deaths that can't be prevented, diagnostic uncertainties that can't be resolved, or the grinding exhaustion of professionals doing their best in impossible circumstances.

This approaches actual medicine so closely that many of my colleagues say they can't watch the show because "it reminds them too much of work." Emergency medicine (and medicine in general) is messy, imperfect, resource constrained, embroiled with bureaucracy, and practiced by fallible humans who are rarely given the support they need to adequately do the job that hospital leadership expects of them. Moral injury is compounded when healthcare workers also fail to live up to the unrealistic expectations for miracle-making that the public has been indoctrinated with via the television medical drama.

Critically, "The Pitt" is raising public awareness about the real issues facing American healthcare: long wait times, mental health and substance use disorders, administrative burdens placed on clinicians, violence against emergency healthcare staff, and futile care for patients with serious chronic diseases who are approaching the end-of-life. These aren't sexy topics. They don't make for dramatic television in the traditional sense. But they're the reality that healthcare workers face every single day, and they're the issues that desperately need public understanding and political will to address.

What We Have Learned from Success of 'The Pitt'

"Emergency!" created awareness that led to the modern EMS system. However, it did so with a sensationalized, often inaccurate portrayal of paramedicine, which was indeed effective at generating the political and public support needed to overcome professional resistance and legal barriers. The show's lack of realism was almost beside the point because it drew attention to a critical deficiency in America's emergency response system. And the awareness created was real, and the modern EMS system was born from that increase in awareness.

"The Pitt" is attempting something arguably harder: educating the public about complex systemic problems without the benefit of simplistic narratives. It's less evident who is the hero and who is the villain. The consequences of medical decisions are multi-faceted and far reaching, and there are no miraculous interventions that can restore a moribund, chronically ill patient back to a state of vibrant health. Instead, there is just the grinding reality of a healthcare system that's failing patients and clinical staff alike. Happy endings in the ED are quite rare and stories from emergency medicine are more aptly categorized as unfortunate or very unfortunate.

Counterintuitive as it may seem to Hollywood, the Pitt's hyperrealistic portrayal of medicine is captivating audiences—and doing so without tidy, "happily ever after" endings. This is proof that, contrary to the conventional wisdom of the entertainment industry, the public not only can handle the truth, they're clamoring for it.

More importantly, the Pitt's audience is not merely entertained by the show; the compelling stories are actually reshaping their opinions and behaviors around healthcare. A recent study conducted by the Norman Lear Center at USC found that among over 1,400 viewers of the show, participants who had seen the show were 2-3x more likely than non-viewers to seek additional information about blood or organ donation and end-of-life planning. Objectives that the medical establishment has sought (and largely failed) to find creative ways to move the needle on for decades. (Read my post here for deeper dive into the study.)

Edutainment for the Masses

"Emergency!" proved that medical drama can drive real-world transformation; however, the sensationalized storytelling began a trend that also resulted in the less-than-desirable consequence of instilling an unrealistic understanding of the nature of healthcare. "The Pitt" has broken from this tradition and is attempting something more ambitious: driving transformation through truth-telling. It turns out that the truth may not only be tolerable to the lay population, but also more powerful than fiction in shaping public opinion.

I often wonder how many of the bad choices—those that result in an aftermath that lands a patient into my hands—result from a distorted vision of what medicine is capable of achieving. To that end, I see the Pitt as a public educational service as much as it is a television drama. This is a heavy responsibility to bear, but one that I hope the creators do not shy away from. Our healthcare system and our patients deserve to have our stories candidly delivered and the Pitt's meteoric early success is proof that nothing is more persuasive and compelling than a true story well told.

The as-yet unanswerable question then becomes: what will be the unintended consequences of this new era of true-to-life medical drama? Only time will tell.