When Noah Wyle stood before the London press last month to launch The Pitt on British screens, he professed that he finds the NHS an enviable institution. The star of one of America’s most decorated medical dramas told journalists that the U.S. needs ‘some sort of national healthcare service…we need universal coverage for everyone’.
The Pitt follows the staff of a Pittsburgh emergency department through a single fifteen-hour shift, one episode per hour. It has been praised by the medical community for its unflinching realism. And notably, one of Wyle’s co-stars is the American healthcare system itself. A system that is shown to be underfunded, overwhelmed, and haunted by the morally fraught logic of for-profit medicine. The Pitt’s success in the U.K. raises a complicated question: how has a drama set in a healthcare system so unlike our own come to feel so prescient to British audiences?
America’s ‘hero’ doctor
The answer to this question lies in how medical television in the U.K. and U.S. represents a convergence of systems under pressure. In their infancy, medical dramas on both sides of the Atlantic served a function that was as much dramatic as it was political. American shows including Dr Kildare and Marcus Welby presented doctors as noble and self-sacrificing, with a seemingly endless well of time and empathy for their patients.
This was no happy accident. As American medicine became increasingly profit-orientated in the 1960s, with tales of patients being turned away from casualty departments due to lack of insurance, these medical dramas served as an opportunity for reputational rehabilitation. Many of the early dramas depicted a practice where insurance fees were rarely discussed, and patients were almost never rejected for an inability to pay. The fantasy was calibrated precisely as an antidote to the reality that it was observing.
This creative direction had institutional backing. The American Medical Association formally endorsed the shows Dr Kildare and Ben Casey, while the American Academy of Family Physicians collaborated with the producers of Marcus Welby. This wasn’t a shadowy endorsement; it was mutually beneficial as a partnership. The programmes benefited from technical consulting while the medical bodies were able to help define the public image of the physician.
Nonetheless, this image of the hero doctor formed a hegemonic narrative. As Joseph Turow has argued, by presenting healthcare as a utopian and inexhaustible resource, these shows established a model in which the system recedes while the heroic doctor is brought to the fore. The difficult question of who pays and who goes without was dealt with infrequently.
Later American dramas such as ER did begin to foreground administrative limitation, and even the uneven realities of access to care, all the while its storylines remained anchored in the emotional lives of individual clinicians. Yet, tensions began to arise between the desire for medical realism and the demands of commercial television. As noted by Lesley Henderson, in ER, characters were only able to use generic names for medicines lest drug companies become associated with any negative side effects the drugs were shown to have in the programme. The dual purpose and undeniable tension of the genre became clearer.
How do British medical dramas differ?
British medical television has not been interested in this same fantasy. When Casualty arrived on BBC One in 1986, it was not designed to reassure audiences, it was designed to agitate. Its producers, Paul Unwin and Jeremy Brock, developed the show under the working title Front Line. Their original programme outline began: ‘in 1945 a dream was born in the National Health Service. In 1985 that dream was in tatters’.
The show was conceived after Unwin and Brock respectively spent time hospitalised and said that they were ‘deeply concerned by what [they] saw as the Thatcherite attack on our National Health Service’. The show was so widely disliked by Thatcher’s cabinet that Conservative MPs compared it to a Labour Party meeting. While the plot lines of early U.S. medical dramas orbited around a set of heroic doctors, in Casualty, the strain visible on those working within the NHS was central. The show frequently depicted emergency personnel turning to alcohol, substances, and smoking to cope with the extreme pressure of working within the system.
This tradition found its rawest expression in the BBC’s 2022 adaptation of Adam Kay’s Memoir, This is Going to Hurt. Dr Adam Kay is not a hero, he is one person being slowly and inexorably worn down by a job he once enjoyed, in a system that cannot protect him. Kay, played by Ben Wishaw, is surrounded by colleagues in various stages of the same deterioration. The NHS is shown to be on its knees; its junior doctors forcibly operating within what we might call a hierarchy of exhaustion, where the most senior staff are merely less destroyed than those below them. No act of individual heroism or last-minute intervention can compensate for the structural conditions in which these characters are operating.
What emerges in the comparison between U.S. and U.K. medical dramas is less a strict divide than a difference in emphasis. American medical television has leant on personal drama precisely because the system has been largely evacuated of political content; without the institution as antagonist, tension is manufactured from character. The love affairs, rivalries, and God-complex surgeons are load bearing for the plot. British medical drama has a lesser need for them because the institution is doing the dramatic work already. There is no place for a subplot about a surgeon’s secret lovechild when the NHS is itself the crisis.
As critic Tom Beasley suggests, British audiences possess a far greater sense of collective ownership over the NHS, rendering it inherently political. ‘It’s almost impossible to talk about the NHS without involving politics’, he notes, whereas American medical dramas are often able to sidestep those questions entirely. Whilst private healthcare can be framed as a transactional service, the NHS resists such abstraction. It is, by nature, a political institution and British medical drama reflects that reality.
The Pitt
In The Pitt, healthcare is shown as deeply political as the system is dragged into the garish light of a Pittsburgh ER. Throughout Season One, Dr Robinavitch (Noah Wyle) – ‘Robbie’ to his colleagues – is plagued by the hospital’s falling ‘patient satisfaction scores’. This marks a departure from the tradition of the American medical drama which has historically kept the system at arm’s length. Whereas the 1960s doctor was a noble healer whose time was limitless, Robbie’s clinical judgement is managed by a system of care that is quantified, audited, and ultimately made profitable.
When hospital administrator Gloria Underwood (Michael Hyatt) warns Robbie that if these scores don’t begin to improve she will entrust the Pitt to a corporate management firm, Robbie retorts that this would be no aid to the overcrowding and understaffing that blisters this emergency department.
By Season Two, the arrival of Dr Baran Al-Hashimi (Sepideh Moafi) represents a new wave of challenges: namely the automation of care. Al-Hashimi’s ‘patient passports’ (a digital system designed to track treatment and time) are at once shown to be forward-looking as well as representative of a new wave of tech-sympathetic management.
Season Two also sees the uneasy introduction of generative AI in ‘charting’ (the process by which doctors record patient information and clinical observations). The tech is fast but fallible, hallucinating details and missing critical patient data. While Al-Hashimi frames these tools as ‘efficiencies’, the staff are divided in their reception, with some suggesting that ‘efficiency’ is simply a ruse to give doctors and nurses an increased workload. Together, they point towards a system in which care is increasingly mediated by managerial and technical priorities.
The pressures depicted in The Pitt , namely the increasing mediation of medical care through technology, resonate in the U.K. In its 2025 productivity targets, the government set a 2 percent year-on-year productivity increase for the NHS, followed by the launch of the largest artificial intelligence trial of its kind, involving Microsoft 365 Copilot and more than 30,000 NHS workers. While the institutional frameworks remain fundamentally different, the underlying logic of efficiency looks increasingly familiar.
The Pitt has faced criticism for its ‘ham-fisted’ approach to both the AI debate and political narratives more generally, cramming everything from systemic racism and mass shootings to the dead-naming of a Trans patient into just two seasons. Yet, this lack of subtlety is perhaps one of the show’s most honest features.
Crises in healthcare are rarely subtle. The United States remains the most medicalised country in the world, spending roughly twice as much per capita on healthcare compared to its peers. And yet, as of 2023, an estimated twenty-eight million Americans – nearly ten percent of the entire US population – are uninsured.
At the same time that Season Two of The Pitt aired in America, insurance premiums soared for millions of Americans as the Trump administration cut subsidies for Affordable Care Act health insurance. The political issues depicted in the show are reflective of a system in which access to healthcare is directly affected by policy decisions. Politics can no longer be a subplot; it’s the putrid air that hangs in this ER. It’s unavoidable. The Pitt is at times clunky in its political representations because the reality of modern medicine is clunky.
For those within the medical profession, this emphasis on political realism is part of the show’s appeal. Gulliver Herrod-Taylor, a third-year medical student and avid viewer of medical dramas, points to the way The Pitt captures more than just clinical procedures. By foregrounding the social and ethical complexity of care, he argues, the series is ‘not just about the medicine’, but about navigating patients’ lives, families, and difficult decisions. Such attention to the human realities of the job, particularly the visible psychological toll that COVID-19 has taken on Dr Robbie, is a rare insight into the profession. As Gulliver puts it, ‘you don’t often see doctors who aren’t fortresses’ on television, despite the emotional weight that practicing medicine brings.
It is precisely the show’s grounding in the realities of care that resonates with a British audience. The language of patient satisfaction, suggestions of private management, and the tumultuous negotiation between care and constraint point find a clear echo in the pressures facing the NHS. What the series dramatises in a Pittsburgh ER is, in a different form, already visible within British healthcare.
This appetite for and appraisal of the so-called ‘realism’ of The Pitt is reflective of a broader shift. As another medical student, Elamin Ibrahim, told me: there is a growing desire, among both medics and the public, for a clearer understanding of what medical work actually entails. ‘There’s a lack of clarity around what a medical professional’s job looks like’, he notes, particularly in the context of recent resident doctor strikes. While no television drama can capture that reality in full, more grounded and realistic portrayals of medical work such as The Pitt play a significant role in shaping public perception of the profession.
Why The Pitt resonates in Britain
While support for the NHS remains culturally bedrock in the U.K., the terms of its survival are changing. The rise of Reform UK, with proposals for expanding private sector involvement in healthcare through tax reforms, treatment vouchers, and the use of private capacity signals a shift in the discourse. These developments remain contested but they do indicate a change in the Overton window for discussions about the future of the NHS. According to the King’s Fund annual survey in 2025, fifty-one percent of Brits reported they were ‘dissatisfied’ with the NHS.
The British fascination with The Pitt may lie, in part, in a narrowing of relational distance. Not because the NHS is becoming americanised, but because it is increasingly exposed to some of the same pressures: efficiency metrics, technological mediation, and renewed debates over the role of private provision. For decades, the Atlantic has served as a buffer between two diametrically opposed approaches to healthcare: one being a right, the other a commodity. Many of us Brits watched earlier American medical dramas to marvel at the wizardry of miraculous intervention and the glossy and soapy heroics of the people operating in a world that wasn’t our own. The Pitt marks a shift in that dynamic, collapsing the distance between two different styles of medical television.
The success of The Pitt is reflective of an appetite for high-intensity, formally ambitious drama that treats systems, not just individuals, as its central subject. But as political language around the NHS shifts, it offers a moment to reconsider how medical dramas now reflect the convergent pressures shaping healthcare on both sides of the Atlantic.
At the press conference for the launch of The Pitt, Noah Wyle (Dr Robbie) acknowledged that both the U.K. and U.S. healthcare systems are ‘frustrating for totally different reasons’. While those reasons may indeed be different, the shared frustration unites viewers. Though the funding models remain poles apart, the operational friction for the people treating and being treated in these shows and systems is becoming increasingly similar. What once appeared as two opposing models of healthcare is beginning, in practice and in dramatisation, to feel like two variations of the same strain.
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