The Iron Cage and the Gaze: Interpreting Medical Control in the English Health System

Abstract

This paper seeks to determine the value of theoretical ideal-types of medical control. Whilst ideal types (such as the iron cage and gaze) need revision in their application to medical settings, they remain useful in describing and explaining patterns of control and autonomy in the medical profession. The apparent transition from the cage to the gaze has often been over-stated since both types are found in many contemporary health reforms. Indeed, forms of neo-bureaucracy have emerged alongside surveillance of the gaze. These types are contextualised and elaborated in terms of two empirical examples: the management of medical performance and financial incentives for senior hospital doctors in England. Findings point towards the reformulation of medical control, an on-going re-stratification of the medical profession, and the internalisation of managerial discourses. The cumulative effect involves the medical profession’s ability to re-cast and enhance its position (vis-à-vis managerial interests). Keywords: medical profession, medical control, iron cage, gaze