Communication between general practitioners and patients dying at home.

Semi-structured interviews were carried out with four general practitioners and some of their terminally ill patients in order to investigate how doctors solve the problem of communication with these patients about the outcome of the illness. Three of the doctors preferred not to give explicit information, or to talk about the outcome, even when they knew that the patient realised that he or she was dying. Within this constraint they developed different ways of coping with the problem of how to talk to the patient. We interpret this behaviour as an attempt to remain within the framework of rules and expectations provided by the traditional roles of doctor and patient, a framework that would be threatened by the doctor's acknowledgement of helplessness. The fourth doctor did tell his patients, and treated the problem as one of counselling patients to help them cope with their predicament. His role of healer was thus extended to include terminally ill patients.