By a two-to-one majority, the ruling council of the British Medical Association inflicted a humiliating defeat on Dr Jeremy Lee-Potter, a hospital consultant, who had put himself forward for re-election after three years as chairman.
On the day after NHS waiting lists grew to a record high of 1 million, the council elected a public health academic, Dr Sandy Macara, a persistent and outspoken critic of government policies on the health service.
The decision, by a 36-17 vote, is expected to usher in an era of more vigorous and combative leadership of the BMA, said by many doctors to have lacked direction and impact under Dr Lee-Potter's leadership.
Last night, no one in the BMA hierarchy could recall the last time a public health doctor had taken the chairmanship. By tradition, the top job (no woman has ever been elected) alternates between a general practitioner and a hospital consultant. The landslide for Dr Macara came as a suprise even to his most active supporters, who had been saying that the result would be too close to call.
The vote brought to a dramatic climax the BMA's week-long annual conference in Torquay. Much of the debate was characterised by expressions of frustration and weariness by doctors battling, at times in vain, to protect patients from budget cuts and ward closures since last year's general election.
As he emerged from the council meeting, Dr Macara, 61, a senior lecturer in public health at Bristol University, promised a change in BMA style but not policy.
'We have to make a consistent, vigorous and fearless attempt to persuade Virginia Bottomley to examine our evidence.' Lengthening waiting lists and the growing threat to doctors' freedom of speech would be the first issues on which he planned to tackle the Secretary of State for Health, he said.
'My profession is one of teaching, and I believe in the power of persuasion on the basis of evidence and information about what is happening to the health service and the care of our patients.'
Dr Macara, who is married to the deputy headmistress of an independent girls' school, is a veteran of medical politics. He was chairman of the association's ethics committee from 1982-89, and has been a member of the General Medical Council since 1979.
Dr Lee-Potter, a consultant haematologist at Poole Hospital, Dorset, and the husband of the Daily Mail columnist Lynda Lee-Potter, has always defended his non-confrontational style and his belief in the art of quiet diplomacy.
But a growing number of critics say privately his performance has been lacklustre.
Dr Lee-Potter declined to comment on the result last night. Edwin Borman, chairman of the BMA's junior doctors' committee, said doctors were looking for a change of style: 'The profession needs to take a higher profile in pointing out the problems in the health service and saying why they arise.'
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