The medical profession are 'a bunch of lions led by donkeys', a leading health academic has claimed.
Speaking at a BMJ/King's Fund debate, Professor Alan Maynard said that nearly half of NHS treatment has no evidence base, and doctors who attempt to collect it are often treated with suspicion by colleagues.
'Why was it economists who created NICE and PROMS (patient-reported outcome measures)?' he asked. 'Why wasn't it doctors?'
Professor Maynard was proposing the motion that 'doctors have neglected their duty to lead health service change'.
It was seconded by Nuffield Trust fellow Dr James Mountford, who noted that heart attack patients in Hampshire had less than a 50 per cent chance of receiving angioplasty, compared with a near 100 per cent chance in London.
He asked: 'Where is the cacophony coming from clinicians about this?'
Clinically led organisations do up to 50 per cent better on 'a whole range of measures', he added.
But Dr James Cave, a GP in West Berkshire, retorted that doctors' influence has been steadily undermined since the 1980s.
He cited his experiences after reporting a problem with Choose and Book to trust bosses.
'The problem was fixed, but I was "managed",' he said.
'The NHS doesn't want clinical leaders. What it wants is clinical NCOs (non-commissioned officers).'
Dr Jonathan Fielden, chairman of the BMA consultants' committee, said that the profession could do better. But he warned: 'We need to throw out this motion. The message it sends out would be so negative.'
He added that, 'in the current climate, being called a donkey by an economist is probably a positive thing'.
The debate heard from a huge range of doctors, outlining their attempts to change health services, and the blocks that had been put in their way.
Before the debate, 63 per cent of the audience backed the motion. Afterwards 51 per cent opposed it.
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