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Summary This paper describes typifications of good and bad patients made by staff working in three English hospital Accident and Emergency departments, commonly known as Casualty departments. The staff explain or defend their behaviour and their hostile evaluations by accounts which in many respects parallel the classic description by Parsons of the sick role.1 The data presented are most easily interpreted as cases 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.