The putative benefits of patients participating in decision making in health care are frequently asserted by the proponents of a strong consumerist approach but are supported by few data. The proponents argue, for example, that an opportunity to choose surgery prevents the psychological morbidity associated with breast cancer. Results from studies are equivocal, although the studies are often based on small samples with short follow up and minimal assessment of morbidity.*RF 1-3* We report psychological data from a prospective study covering three years which compared women treated by surgeons who offered choice whenever possible with women treated by surgeons who favoured either mastectomy or breast conserving surgery.