The Coalition Government has approved the advice of the NHS Future Forum that all clinicians (including 'opticians' - sic) offer advice to patients at every consultation about smoking, alcohol, exercise and diet. Laudable as this may be it did start me thinking as to what exactly this is beyopnd what is already happening. Most if not all practitioners ask about smoking habits and many about other factors. Any previous reluctance to do so has been overcome by an acceptance of the evidence that these factors have a significant impact on many eye diseases, especially AMD and diabetes. If our role is not just to refract and assess eye health, but also to 'impart information' to the patient about each of these, then a mention of risk factors is part and parcel of the role of the enrty level competent optometrist and dispensing optician. It is already in our competencies somewhere. My concern is always at how advice is given and how little training the eyecare practitioners have regarding advice-giving. I always remember the consultant diabetic specialist shouting at patients who had lost eyesight because he felt it was the best way to realise a behaviour change. His drop out rate and no-show rate was through the roof. I don't think (and I know many disagree with me on this) that optometrists should tell people nit to smoke, to eat healthily, and to exercise more. I think we should tell patients how smoking, poor diet and lack of exercise can increase disease risk, and how avoidance of these can reduce risk. The patient can then make an informed choice. Communication skills is the least popular CET competency subject and the new post 2012 GOC rules will hopefully make readily available more quality information about how best to advise patients. Didactic is better than dictatorial!!! Happy New Year!