Normal rubbish: deviant patients in casualty departments

Abstract

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

Social regulation, medicalisation and the nurse's role: Insights from an analysis of nursing documentation

“…Other studies have also noted that nurses make moral judgments about patients (Stockwell, 1972;Jeffery, 1979;Johnson & Webb, 1995). Yet our data also demonstrates that this invigilating capacity of nurses to evaluate and categorise can have a positive impact for patients, as exemplified especially by the category genuine incapacity.…”

Self-Harm and Medicine’s Moral Code: A Historical Perspective, 1950–2000

“…First, Jeffery (1979) endorsed the signifi cance of the self-harm-suicide link for the code, noting the comparison that A&E staff drew "between those who really tried to commit suicide (for whom there is some respect) and the rest (viewed as immature calls for attention)" (p. 100, emphasis added), the latter being associated with what we have referred to as the gap group. However, Jeffery also modifi ed our understanding of the self-harm-suicide link by incorporating it into a wider comparison that is both a moral and a medical one.…”

“…3. Sociological research, particularly that of Roger Jeffery (1979), which foreshadowed arguments against the code that psychiatric survivors later advance. These arguments extend the comparative analysis surrounding self-harming behaviors to include not suicide only but also (a) being an accident victim and (b) the perceptions of health care professionals about what it means to be "genuinely" ill. …”

“…This is the conclusion to be drawn from the work of Roger Jeffery, a sociologist who studied the treatment of self-harmers in A&E departments in the 1970s. Jeffery's (1979) study, "Normal Rubbish: Deviant Patients in Casualty Departments," enhances the analysis offered so far by providing insights into the treatment of self-harmers in A&E. Jeffery's method was direct: he physically observed medical practice in a number of A&E departments and conducted interviews with the doctors and nurses working there. The results were startling.…”

Sõnad haigetoas. Keel, tervis ja koht

“…Üks uurimus, milles vaadeldi juhuslikult valitud kirurgili-si patsiente, sedastas, et neid kirjeldati kas tavaliste, suhteliselt tavaliste või kõrvalekalduvatena (Lorber 1975). Robin Jeffrey (1979) täheldas, et kolme haigla traumapunktides liigitas personal haigeid "headeks" meditsiiniliste tunnuste (s.t arstid võisid nende peal oma oskusi harjutada) ja "halbadeks" sotsiaalsete tunnuste (s.t patsient oli purjus või narkouimas) alusel. "Halbu" patsiente nimetati näiteks dross 'jätis', dregs 'saast' ja rot 'mõttetu (mees)'.…”