The ability to process and compare the benefits and risks of a proposed treatment is considered an important component of being competent to make treatment decisions. Whether psychiatric patients' expressed treatment choice reflects their personal preferences or a deficit in their decision-making process is unclear. The aim of the study was to assess the extent to which patients and staff agree or not on various treatment-related issues. A literature search was conducted to identify published articles comparing the perceptions and attitudes of staff and patients toward various treatment issues. Twenty-eight published articles over the last 40 years were located and their main findings summarized. Analysis of the findings revealed disagreement between patients and staff in 26 of the 28 articles. The consistency of the disagreement over time and across studies suggests that the disagreement might have more to do with the fundamental difference between being a patient and a staff member rather than a patient's cognitive deficits or psychopathology. It is crucial that both patients and staff work toward building bridges when discord appears consistent and pervasive.