Understanding disruption in the social contract between the medical profession and society in India: a tale of mismatched expectations?

A harmonious relationship between the medical profession and the society it serves is essential for any country’s health system to fulfill its mandate. Society offers trust, respect, authority, and professional autonomy to doctors, and in return, expects doctors to provide good care and prioritize people’s welfare. However, in many parts of the world, we observe growing dissatisfaction, increasingly expressed violently, with the medical profession. Understanding what explains this growing dissatisfaction is necessary to initiate measures to maintain and improve this important social relationship and social contract. Using India as a case, and drawing on insights from qualitative, in-depth interviews with purposively selected doctors, journalists, legal experts, police, patients and patients’ rights activists, and social commentators, we demonstrate how a range of mismatched expectations—regarding the organisation of the medical profession, the structure of healthcare provision, the status and identity of doctors in society, and fair compensation for care provides—are contributing to the disruption of this critical social relationship. We argue that these dynamics can be meaningfully examined through the lens of the "social contract" between the medical profession and the society it serves. Our analysis also shows how these mismatched expectations are highly contentious and how they are rooted in the increasingly market-logic-based organization of healthcare. For researchers across the world, our study offers a novel approach to researching the relationship between the medical profession and society, and, for policy makers and health system leaders in India, our findings offer practical entry points to develop policy interventions to help restore, recalibrate, and secure this important social contract.