Explanations of patient use of hospital emergency departments have tended to emphasize either patient preferences for hospital treatment or the barriers that restrict patient use of their family practitioner. The weakness in these approaches has been the oversight of situations in which many accidents and some sudden illnesses occur. The object of this study is to examine what part social circumstances play in influencing patients' decisions to go to a hospital emergency department. An analysis of data collected from interviews with the sample of patients at a hospital emergency department suggests that social circumstances may be an important influence on patient demand for hospital service. The policy implications of these findings are discussed.