This paper describes typificutions of good and bad patients made by staff working in three linglisli hospi il Accident and Kniergency departments, commonly known as Casualty departments. The staff explain or defend their behaviour and tlieir hostile evaluations by accounts which in many respects parallel the classic description by Parsons of the sick role.' The data presented are most easily interpreted as eases where certain sorts of patients are unable to achieve entry into what is essentially the legitimate career of sickness, and this will lead into a disussion of the relationship between sicknesses and deviance. English casualty departmentsCasualty departments have been recognised as one of the most problematic areas of the NHS since about 1958, atid several official and semiofficial reports were published in the following years, the most recent being a House of Commons Expenditure Committee Report.'^ The greatest public concern is voiced when departments are closed permanently, or over holiday weekends, because of shortages of staff.-' Tlie major criticistris have been that Casualty departtiients have to operate in old,crowded.and ill-equipped surroundings,and that their unpopularity with doctors has trieant that the doctors employed as Casualty Officers are either overworked or of poor quality. 'Poor quality' in this context seems to mean either doctors in their pre-registration year, or doctors frotn abroad. The normal appointment to the post of Casualty Officer (CO) is for six months, and many doctors work this period only because it is required for those who wish to sit the final examinations for FRCS. Although consultants have in general played very little part in the running of casualty departtnents (which is one reason for their poor facilities) there has been dispute over whether they should be the responsibility of orthopaedic or general surgeons: sotiic hospitals have appointed physicians as consultants-in-charge.'* These problems with the doctors have apparently not affected the nursing staff and in general Casualty seetns to be able to attract and keep enough nurses. The reasons for the unpopularity of Casualty work amongst doctors

SummaryOne hundred and nine inpatients were compared with 84 day cases by means of specially designed questionnaires presented at set times by staff other than the oper ating surgeon. The aim was to highlight patient attitudes, expectations and satisfac tion with a standard method of endocapsular cataract extraction and posterior chamber lens implant under local anaesthetic as either a day case (DC) or an inpatient (IP). The results showed a high patient acceptance of whichever method of management was chosen. Both groups appeared satisfied with their treatment and the final result. The cost of DC and IP treatment was assessed.

Areas of concern about day case surgery are highlighted. A group of 442 patients underwent cataract surgery with lens implant. They were randomly allocated to day case or inpatient groups. Questionnaires were used to assess opinions about day case cataract surgery and how patients felt they would manage. None of the areas of concern were actually a problem. Difficulties encountered by patients and clinicians in the postoperative period are discussed. Most patients appear suitable for day case surgery provided they are well informed.