By Manu Kant

Last year, when my elder niece formally became a doctor, a small celebration was held at home. Two family friends, both doctors, were present. Everybody was happy. The two doctors did a loud “Hip hip hooray!” three times. Their voices rang with joy and pride. Watching them, I realized this pride was more than personal achievement. It reflected a deeper social and class phenomenon rooted in India’s economic and social structures.

Most doctors in India come from a middle-class, petty-bourgeois background. As Lenin observed:

“The petty bourgeoisie constantly vacillates between the bourgeoisie and the proletariat.”

They are not owners of capital. Yet they are not part of the exploited masses either. Their economic and social positions remain uncertain. In such circumstances, professions like medicine offer a rare combination: financial security, social respect, and recognition.

This is precisely what the petty bourgeoisie desperately yearns for. In a capitalist society, the vast majority of the middle classes can never realistically become owners of large capital. Factories, banks, and major enterprises remain concentrated in the hands of the big bourgeoisie. At the same time, they live with the constant fear of falling downward into the ranks of the proletariat. This double pressure—blocked from rising into the bourgeoisie and terrified of sinking into the working class—creates a deep psychological and social insecurity.

Professions like medicine therefore become especially attractive. They offer relatively secure income, authority over others, and high social recognition—advantages that mimic, in symbolic form, the status enjoyed by the capitalist class. For a petty-bourgeois family anxious about its future, medicine appears not merely as a profession but as a shield against proletarianization.

Yet being a doctor does not automatically mean possessing superior morality or ethics. Doctors are members of society, and society itself is structured by class relations. Their outlook and conduct are shaped by the class environment from which they emerge and by the capitalist institutions in which they work.

That is why incidents of malpractice, negligence, and mistreatment are not rare aberrations. They occur with disturbing regularity. Patients are sometimes refused treatment in private hospitals because they cannot pay. Unnecessary tests may be prescribed. Medical care may be rationed according to profit rather than need. In many large corporate hospitals, doctors are also placed under pressure to meet institutional targets—whether in terms of diagnostic tests, procedures, or admissions. Such pressures can lead to over-diagnosis, misdiagnosis, and unnecessary interventions, since hospitals often link performance with financial incentives, bonuses, or career advancement.

The result is a deeply unequal system of care. Wealthy patients are attended to quickly and respectfully. Poor patients often face indifference, long delays, and sometimes open humiliation. Class differences shape the quality of attention, the time spent by doctors, and even the tone in which patients are addressed. What should be a humane relationship between healer and patient frequently becomes a relationship structured by economic power.

Government hospitals are not free from difficulty either. They suffer from overcrowding, inadequate infrastructure, and overworked staff. Doctors operate under severe pressure, while patients endure long queues and hurried consultations. In such conditions, poorer patients often receive brief and impersonal attention, while those with influence or connections are able to bypass queues and obtain quicker treatment.

Out of this situation arises a peculiar social psychology. Patients and their families often display excessive respect toward doctors. This reverence is not always pure admiration; it is also a strategy. People hope that by showing deference they will receive humane treatment and proper attention.

Most people address medical practitioners as “Doctor” or “Doctor Sahab” out of respect. Implicit in this form of address is the assumption that the person so titled will discharge their duties conscientiously, guided by professional ethics, knowledge, and care. It reflects not just recognition of formal qualifications, but also a societal expectation that the doctor will act responsibly in matters of health and life—an expectation that carries weight because medicine involves life-and-death decisions.

The middle class, in particular, tries to cultivate personal relations with doctors. The well-off middle class dislikes standing in long queues in government hospitals. Instead, they rely on contacts, acquaintances, and social networks. Doctors are treated with unusual reverence partly in the hope that such relations will ensure prompt treatment, but also an objective and careful diagnosis and safe medical care—something that patients often fear is not guaranteed otherwise in an overcrowded and strained healthcare system.

Scarcity reinforces this tendency. India’s doctor-patient ratio remains highly uneven. When skilled professionals are few, scarcity increases their prestige; under capitalism, this prestige converts into social deference and fear, reinforcing class hierarchies.

Yet doctors are not outside society or above class relations. Under capitalism, prestige is unevenly distributed among professions. Occupations involving manual labour are often regarded as inferior, while professions associated with specialized knowledge are elevated. Doctors, engineers, and managers are placed at the top of this hierarchy.

This hierarchy shapes attitudes. Many doctors unconsciously absorb the values of the petty bourgeoisie and begin to regard manual professions—construction workers, sanitation workers, factory labourers, and agricultural workers—as socially inferior. Yet the irony is obvious. Without the labour of these workers, society itself could not function, and the hospitals where doctors work could not even exist.

Capitalist ideology separates mental labour from manual labour and places them in opposition. The result is a distorted hierarchy of prestige. Professions linked with knowledge command respect, while professions linked with physical labour receive little recognition, even though both are essential to social life.

Professional education does not automatically guarantee moral integrity. Even highly educated specialists remain part of society’s political and social struggles. The accusations made during the Doctors’ Plot (1952–1953) in the final years of Joseph Stalin’s leadership reflected precisely this reality: doctors, like other professionals, could become involved in political conflicts and conspiratorial activity. Technical expertise alone does not place individuals above class interests or ideological battles.

Knowledge itself adds to the mystique. Medical science is technical and difficult for most people to understand. Like priests in earlier societies who controlled sacred knowledge, doctors command specialized knowledge that others cannot easily question. Technical authority easily becomes social authority. Precisely because this knowledge is so specialized, it can also shield professional errors from public scrutiny. When diagnosis and treatment are opaque to ordinary patients, cases of misdiagnosis, malpractice, or negligence can sometimes be explained away or justified through technical language that patients are unable to challenge. This opacity of knowledge further deepens the reverence people show toward doctors, because patients often feel they have little choice but to trust and submit to the authority of the expert.

There is another dimension often overlooked: fear. Doctors are not only caregivers but also literal arbiters of life and death. On the operating table, they wield power that surpasses that of politicians. For Marxists, this authority is real, but entirely material: it arises from specialized knowledge, institutional power, and the scarcity of medical professionals—not divine status. Yet even from this materialist perspective, their authority is immense, because human life can depend entirely on their skill, judgment, and intervention.

From a Marxist viewpoint, this dynamic reflects broader social structures: the doctor embodies a specialized, institutionalized knowledge that places them in a position of material power over ordinary people, who often have little access to the means to protect or restore their own health. The respect, deference, and even fear shown to doctors are socially produced, reinforcing hierarchies of knowledge, authority, and access. In this sense, the honorific “Doctor Sahab” is a small window into how class and material power operate in everyday life. It is also a remnant of feudal deference: historically, “Sahab” was used to signify submission to social superiors, and its continued use today subtly reinforces hierarchical relations between patient and doctor.

The socialist experience of the Soviet Union offers an instructive contrast. In the USSR, doctors were respected for their knowledge and skill, but their social standing was never above miners, machinists, or farmers. Authority was professional, not hierarchical, reflecting Marxist principles of equality of labour. Medical education was largely funded by the state, and healthcare functioned as a public service rather than a profit-driven industry. Doctors were trained to see themselves not as privileged professionals but as participants in the collective construction of socialist society.

This social outlook reduced the exaggerated aura that often surrounds professions under capitalism. Respect for expertise existed, but the cult-like veneration of professionals was far less pronounced. Pride in work was encouraged, but it was linked to collective achievement rather than individual prestige.

The contrast is instructive. In capitalist societies, reverence for doctors often grows out of scarcity, hierarchy, fear, and class aspiration. In socialist societies, respect for doctors existed alongside a broader respect for all forms of labour.

Family prestige amplifies this effect. When one member becomes a doctor, the entire household gains status. Relatives boast. Marriage prospects improve. A doctor becomes a symbol of aspiration fulfilled: economic security, social recognition, and elevated standing. Yet beneath this symbolism lies a simpler reality. Doctors perform a necessary social function, just as teachers, engineers, farmers, and workers do. Their importance comes from their role in society, not from personal virtue or moral superiority.

In corporate hospitals, doctors themselves increasingly function as highly skilled employees required to generate revenue for the institution, which further embeds medical practice within the logic of profit. The aura that surrounds them is therefore not natural. It is socially produced.

In India, doctors may sometimes appear godlike. But this perception does not arise from individual greatness. It emerges from the intersection of class aspiration, professional scarcity, capitalist hierarchy, social deference, and the fear that life itself depends on their decisions. Change the social structure, and the aura changes as well.