When a patient becomes upset, the desire of a care giver to make a hasty exit may be intense. It is not perverse but natural for a care giver to discourage discussion of such a topic by the person facing it. Few things infuriate patients more than contrived involvement. For this reason, the patient may excuse even an inability to answer direct questions when the inability stems from genuine discomfort on the physician's part. Real involvement is not only unavoidable but necessary in the therapeutic encounter.
Patients recognize it instantly.
With the terminally ill patient, comfort has a technology all its own. Ensuring the comfort of a terminally ill person requires meticulous devotion to myriad details, great practical knowledge, and continual exercise of creative ingenuity. It must be an aggressive effort and can be technically complicated. Communication Talking with the dying is a paradoxical skill. The wish to find the right thing to say is a well-meaning but misguided hope of persons who work with terminally ill patients.