Saturday’s Search: What is the racial breakdown of medical errors? Day 20

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One of the most common reasons for medical errors is poor communication between doctors and patients. When patients are not believed or heard, it sets the stage for medical errors. The two most common medical errors–misdiagnosis and medication errors–follow.

White supremacy is the gold standard for healthcare in America. The care is biased, leading to disparities in outcomes as well as increased morbidity and mortality. We see it in maternal mortality rates where Black women die over twice that of any other racial group, including white women.

Are hospitals a threat to the health of Black patients? YES, without a doubt, hospitals are killing us, some with intent. Let’s dig deeper to see how well concealed the information can be.

My search to find out more about what groups are at the highest risk for medical errors led to a review the 2018 National Hospital Ambulatory Medical Care Survey (N.H.A.M.C.S.). It collects data on the utilization and provision of hospital-based ambulatory care services. (

The National Hospital Ambulatory Medical Care Survey (N.H.A.M.C.S.) is the Nation’s foremost study of ambulatory medical care in hospital emergency departments and has been conducted annually since 1992. Each year, approximately 450 nationally-representative hospitals provide data on a sample of patient visits to their emergency service areas. Sampled data are collected over a designated 4-week reporting period. These data are weighted to produce national estimates that are widely used by health care researchers, policy analysts, congressional staff, the news media, and many others, and have helped to improve our knowledge of ambulatory care patterns in the Nation’s hospitals. N.H.A.M.C.S. is sponsored by the Centers for Disease Control and Prevention’s (C.D.C.s) National Center for Health Statistics (N.C.H.S.), and is administered by the U.S.U.S. Census Bureau.(2)

It’s a cross-sectional study that collects data from emergency department (E.D.E.D.)visits over four weeks. Of the 490 hospitals selected for the 2018 N.H.A.M.C.S., 323 responded, yielding an 85% response rate.

A total of 20,291 Patient Record forms (PRFs ) were submitted electronically. During the 4-week study period, the total number of emergency department visits was 129,974. I interpreted that information to mean 20,291 patients had 129,974 visits to the E.D. Each patient had an average of 6.4 emergency department visits during four weeks. That’s a lot of visits. I am not sure my interpretation is correct. Suppose so many could have returned for imaging or consultation. However, they could have returned because of misdiagnosis or medication errors. When I worked in the E.D., it was a revolving door with some patients seen almost daily for the same problem.

In Table 3. Emergency department visits, by patient race, age, and ethnicity: United States, 2018, we see Blacks or African Americans utilized the E.D. more than any other group. At 84 visits per 100 persons, African Americans were way above the national average of 40 visits per 100 persons. I red flag that because the data does not give a reason. How many of those visits were return visits because of misdiagnosis or lack of a complete evaluation on the initial visit necessitating repeat visits?

To be continued next week.

1. National Center For Health Statistics: Ambulatory Health Care Data

2. National Hospital Ambulatory Medical Care Survey (N.H.A.M.C.S.)

3. National Hospital Ambulatory Medical Care Survey: 2018 Emergency Department Summary Tables


Author: Angela Grant

Angela Grant is a medical doctor. For 22 years, she practiced emergency medicine and internal medicine. She studied for one year at Harvard T. H Chan School Of Public Health. She writes about culture, race, and health.

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