Abstract
Direct observation of doctors and nurses talking with real, stimulated, or role played patients suffering from a terminal illness has shown that they consistently use distancing tactics. These prevent them getting close to their patients' psychological suffering and are used to try to ensure their own emotional survival. Since these tactics discourage patients from disclosing their psychological concerns they are a serious barrier to effective psychological care. If those concerned in terminal care are to risk relinquishing these distancing tactics they will need better selection, more appropriate training, regular psychological support, and real opportunities for taking time out.