Two papers in this week's journal amply demonstrate the failure of many general practitioners to follow the recommendations of the British Heart Foundation's working group on managing patients with myocardial infarction. Why do doctors and other health workers repeatedly fail to carry out what is widely understood to be best practice even when the scientific evidence is solid and guidelines have been established?1 Is it that doctors value their clinical freedom too much or that you cannot teach old dogs new tricks? Impassioned defences of clinical freedom, however, often mask dangerous and inefficient practice. Management based on findings from epidemiological studies and clinical trials is surely …