Recent investigations of the care provided for cancer patients in the community have revealed substantial shortcomings, both in the identification of problems and in the help offered to patients and their families. While some explanations have been sought for these omissions, it has generally been assumed that they are due to practitioners' ignorance of problems encountered by families. Focusing on general practitioners, this paper argues that these deficiencies in care arise not only from ignorance, but also from the conceptual and structural framework within which practitioners operate. Working within such a framework, general practitioners experience considerable dilemmas in decisions about the management and care of cancer patients. This paper argues that explicit acknowledgement of these dilemmas is a necessary prerequisite to any recommendations for improvements in care.