This study examined the ability of surgeons and significant others to evaluate psychological distress in patients attending a breast clinic. Ratings of anxiety and depression were obtained from 164 patients, 51 accompanying significant others and 9 surgeons. Interviews were conducted with participating surgeons to assess how they recognized psychological distress in their patients. Forty-four (26.8%) patients were anxious, and only 5 (3%) depressed. Analysis demonstrated a significant tendency of surgeons to underestimate. Anxiety ratings from the significant others were significantly associated with patient's self-ratings. Significant others appeared a better source of proxy data than surgeons. Content analysis of the surgeon's interviews suggested that time constraints forced a reliance on behavioural cues to identify psychological distress. It was concluded that surgeons may facilitate patient care by lowering their threshold for attributing such cues to psychological distress.