Summary Psychiatric morbidity in patients with cancer is high and without appropriate treatment unremitting. We assessed the ability of 143 doctors to establish the psychological status of 2297 patients during outpatient consultations in 34 cancer centres and hospitals in the UK. Prior to seeing the doctor, consenting patients completed a short self-report questionnaire (GHQ12), designed for the psychological screening of large populations. At the end of the consultation, doctors completed visual analogue scales rating patients' distress. 837/2297 (36.4%) patients had GHQ scores suggestive of psychiatric morbidity. The doctors' sensitivity (true positive rate) was 28.87% (SD 25.29), specificity (true negative rate) 84.79% (SD 17.44). The misclassification rate was 34.7% (SD 13.79) meaning that for 797 patients the wrong assessment was probably made. These data show that much of the probable psychiatric morbidity experienced by patients with cancer goes unrecognized and therefore untreated. Doctors need communication skills training to elicit problems during consultations. Appropriate referrals to psychological services are necessary when patients requiring help are identified and ought to be an integral part of cancer care. http://www.bjcancer.com oncologists as in the patients whom they treat (Whippen and Canellos, 1991;Ramirez et al, 1995). Approximately 29% of British oncologists had above threshold scores (Ramirez et al, 1996) on a psychiatric screening inventory (GHQ12) (Goldberg and Williams, 1988). The under-trained, over-stretched and underresourced doctor is unlikely to actively elicit information about the psychosocial impact that cancer and its treatment exerts on patients.We report data from a study establishing the prevalence of probable psychiatric morbidity in a heterogeneous sample of 2297 patients with cancer seen in cancer clinics throughout the UK. We also report the ability of their doctors to detect this morbidity and the characteristics of both patient and doctor that were associated with detection. METHODS143 doctors from 34 different cancer centres and hospitals in the UK took part in the study. All were participating in a randomized trial of a communication skills training programme for cancer specialists or specialists in training. Data about psychological morbidity and its recognition were collected as an outcome measure in part of the main trial. The specialty, seniority and sex of doctors are shown in Table 1. Participants included clinical, medical or surgical oncologists, 2 chest physicians who dealt primarily with lung cancer, a dermatologist with a specialist interest in melanoma and a palliative care physician.2681 consecutive patients, waiting in out-patient clinics, were invited to join the main communication skills trial; of these 2331 (85%) gave their written consent to participate. The demographic characteristics of the 2297 patients with completed questionnaires for the detection of psychological morbidity study are shown in Table 2. ProcedurePrior to seeing the doctor con...

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