This episode features Dr Nicola White (Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK), Dr Christina Gerlach (University Medical Center Hamburg-Eppendorf, Hamburg, Germany), Dr Bert Leysen (Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK) and Prof Yvonne Engels (Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands). The Surprise Question (‘Would I be surprised if this patient died within 12 months?’) is a screening tool which is used to identify patients with palliative care needs. The Surprise Question alone is not a very accurate way to prognosticate. It is not known whether prognostication with the Surprise Question is difficult because clinicians are intrinsically poor prognosticators, because the Surprise Question is interpreted in different ways by different clinicians, of because clinicians themselves are inconsistent in their level of surprise. Our study suggests that the threshold probability, before a death causes surprise, varies across six European countries. Many GPs (including those with specialist palliative care training) are inconsistent about the probability of death that elicits surprise. Further research is needed to understand how the Surprise Question is used in practice, and whether consistency and accuracy could be improved by modifying the Surprise Question, or by training GPs in its use.