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Background Effective communication between parents and physicians is critical for physician diagnosis and management of psychosocial problems in children. This study tested the hypothesis that physicians and parents perceive their communication differently, by evaluating the topics that both physicians and parents reported and their agreement about whether psychosocial issues were discussed during a paediatric primary care visit. These reports were compared to independently rated videotapes. Methods Participants were parents of 54 children between the ages of 3 and 10 years, and their child's primary care physician. The exam was videotaped. Videotapes were rated by trained observers. Parents and physicians completed questionnaires about their discussion of psychosocial information. Results Parents and physicians included different issues in their definition of psychosocial topics. Kappa statistics indicated that both parent–physician agreement and their agreement with independent ratings of videotapes was poor, with kappa of 0.09 and 0.20 for parent and physician agreement with independent ratings, respectively and 0.35 for parent–physician agreement about discussion of psychosocial issues. Conclusions Definitions of psychosocial issues appeared to differ between parents and physicians. These findings suggest that asking specific questions about psychosocial functioning may improve communication and help physicians assess information of interest.