BACKGROUND A patient's satisfaction with a consultation may be influenced by many factors relating to both patient and doctor. OBJECTIVE This study set out to examine the effects of emotional disturbance and its detection on general practice patients' satisfaction with the consultation. METHODS A prospective study involving 893 adult patients attending 12 general practitioners in Glasgow was carried out. Questionnaires were completed by general practitioners after consecutive surgery consultations. Patients completed forms assessing mental state and satisfaction with inter-personal aspects of the consultation. RESULTS Patients reporting frank psychological disturbance tended to express more dissatisfaction with the inter-personal aspects of the consultation. This effect was alleviated in the majority by recognition of the disturbance by the general practitioner. General practitioners differed markedly in their assessment of the psychological component of consultations. Fewer dissatisfied patients were found in the surgeries of doctors who tended to rate the psychological component of consultations more highly. In contrast, the general practitioner's overall accuracy of diagnosis of psychological distress was a poor predictor of the proportion of dissatisfied patients. CONCLUSIONS This preliminary study suggests that a tendency among doctors to assign importance to the psychological component of consultations may enhance elements of patient satisfaction. It is not clear whether this [psychological-mindedness' is an attribute which can be learnt. To resolve this uncertainty, studies are needed of the effects on patients of educational interventions designed to increase general practitioners' sensitivity to psychological distress.