“Have you seen The Pitt?”

This question has become commonplace; patients want to know if it is realistic, colleagues want to compare reactions, and many of us find ourselves dissecting the commentary on an imperfect health care system captured in weekly, one-hour installments that mirror physicians’ everyday reality.

The show does many things well: It is medically accurate, faithfully depicts interdisciplinary teamwork, and reveals the humanity and vulnerability of health care workers. But its greatest achievement is how vividly it captures the sociopolitical failures of our health care system and the moral injury those failures create for the people working inside it.

A new national study from Physicians for a National Health Program, conducted in partnership with the Robert Wood Johnson Foundation, surveyed more than 1,200 physicians and found this moral distress is not rare or episodic, it is routine; 62 percent of physicians reported experiencing moderate-to-high levels. Repeated exposure can lead to moral injury, the psychological damage that occurs when clinicians are forced to practice in ways that violate their ethical commitments.

For years, we’ve been told that the problem is burnout. When physicians leave clinical medicine, we say they got tired or sold out. When fictional doctors break down on screen, we assume they are overworked. Moral injury offers a more precise explanation and helps explain why The Pitt resonates so deeply: We are not just tired, we are wounded by the system we work within.

Consider resident physician Dr. Samira Mohan. During a grueling 12-hour shift, she becomes demoralized while treating Orlando Diaz, an uninsured working father admitted with diabetic ketoacidosis, a dangerous but treatable condition. Orlando explains that he has been rationing insulin because he makes too much to qualify for Medicaid but not enough to be able to afford private insurance. She attempts to address these financial barriers threatening his care: the cost of insulin, his pre-existing medical debt in excess of $100,000, and concerns about the cost of an ICU admission. But despite her efforts, he leaves against medical advice, only to return hours later with catastrophic neurologic injuries after an alleged suicide attempt.

The grief and helplessness Dr. Mohan experiences is painfully familiar to physicians who care for uninsured patients. The PNHP study found 57 percent of physicians report moderate or severe distress from working in systems that fail to treat vulnerable patients with dignity and respect. The physicians most committed to serving vulnerable communities are often the ones most deeply harmed. Dr. Mohan is portrayed as compassionate and devoted, the kind of physician every community deserves, yet she, like many physicians, questions whether she is cut out for medicine.

Nearly half of surveyed physicians report having been unable to deliver medically necessary treatments. Many describe the distress of providing substandard care, searching for workarounds, and losing autonomy to insurance bureaucrats and administrative mandates. Dr. Garcia, the incisive trauma surgeon, bluntly observes, “You’ve got to love it when insurance companies make medical decisions.”

Another storyline follows siblings Chantal and Jude after their parents are deported to Haiti. College-aged Chantal becomes her preteen brother’s primary caregiver while juggling work and school. When Jude is injured while unsupervised and intoxicated, clinicians feel deep moral conflict about involving Child Protective Services. They recognize that the true cause of his injury is structural violence committed by immigration policy, economic precarity, and the absence of social support. When clinicians are unable to address root causes, patients suffer, and the harm falls disproportionately on marginalized communities. Notably, 41 percent of physicians in our study reported feeling complicit in structural racism perpetuated by the health care system, a feeling closely tied to moral distress.

The characters in The Pitt may be fictional, but their experiences are not. At the end of the hour, viewers turn off their TV and await the next episode. Physicians, meanwhile, wake up the next morning bracing for the same moral distress portrayed on screen. Recognition alone is not enough; it must lead to conversation, and conversation must lead to change.

We can build a health care system where patient care never comes at the expense of corporate profit, where clinicians are empowered to practice ethically, and where compassion is supported rather than punished. The first step is acknowledging that moral injury is not an individual failing but a systemic one, and deciding, together, to fix the system that causes it. So the next time someone asks, “Have you seen The Pitt?” perhaps the more important question will be: What are we going to do about the reality it reflects?

Toby Terwilliger is an internal medicine-pediatric resident. Cassandra Craig is a medical student.