The authors describe a pilot workshop designed to help doctors achieve a greater understanding of and ability to cope with their 'heartsink' patients. Participants were asked to list their personal objectives in attending and a number of cases were discussed in the group. A 'heartsink survival kit' was provided which consisted of skills and strategies which are useful in difficult consultations and an approach to reassessing the goals of the relationship which might promote a more realistic understanding. The workshop was videotaped and two scenarios are presented. The implications for further training are discussed.