TY - JOUR T1 - Prevention in practice: why is it neglected and what can we do? JF - British Journal of General Practice JO - Br J Gen Pract SP - 237 LP - 238 DO - 10.3399/bjgp22X719429 VL - 72 IS - 718 AU - Paul Aveyard AU - Susan Jebb Y1 - 2022/05/01 UR - http://bjgp.org/content/72/718/237.abstract N2 - ‘If the moon, in the act of completing its eternal way around the earth, were gifted with self-consciousness, it would feel thoroughly convinced that it was traveling its way of its own accord on the strength of a resolution taken once and for all. So would a Being, endowed with higher insight and more perfect intelligence, watching man and his doings, smile about man’s illusion that he was acting according to his own free will.’(Albert Einstein)In the UK, one in seven adults smoke and more than one in four have obesity. Clinicians universally recognise these conditions as important preventable causes of early morbidity and mortality. Clinical consultations allow clinicians to intervene opportunistically on these risk factors but intervention is uncommon, even when patients consult with disease caused by the risk factor.1 This is irrational, judged by explicit medical standards embodied by guidelines: opportunistic behavioural interventions are effective and cost-saving,2 something rarely true for other medical treatment.When a preventive interaction occurs, clinicians typically advise people to change behaviour rather than offer support to achieve this. Despite expanding a pay-for-performance system to incentivise opportunistic support for smoking cessation, intervention frequency did not increase, and advice was given 30 times more frequently than support.3 Similarly, advice on obesity rather than referral to support is clinicians’ most common intervention.1 Qualitative evidence shows that patients report receiving banal and insulting advice from doctors, but welcome support when offered.4Researchers have asked clinicians to account for their failure to follow preventive guidelines. Common explanations are that it takes too long, it … ER -