It’s in the subconscious mind that people’s true natures are revealed.

Since the entire story is presented as a kind of dream, the people and events likely represent the doctor’s repressed feelings. The groom is a proxy for the doctor’s latent sexual desires. Kafka notes that the pigsty has not been used for a long time, indicating that the doctor has not indulged his more primal desires in years. By all indications, the doctor himself is a moral, responsible, professional man. However, when he kicks the pigsty in frustration and releases the groom, he is setting free his own unconscious thoughts. The groom emerges like an animal on all fours and refers to the horses as his siblings, representing the doctor’s bestial nature. The doctor’s ability to magically see Rosa trying to escape and then hearing the groom breaking down the barriers suggests the doctor accepts the assault because he is not physically committing it. Although he expresses concern at times throughout the rest of the story about Rosa, the doctor never makes any attempt to aid or rescue her, demonstrating that the attack on Rosa is something he subconsciously accepts and even desires.  

The doctor’s unconscious feelings of impotence are demonstrated in his interactions with the patient and the townspeople. In his dreamlike state, the doctor’s feelings of powerlessness are highlighted while he’s with his patient. The doctor first assumes there’s nothing wrong with his patient and then, when confronted by the horrific wound, he concludes there’s nothing he can do about it. Not even trying to help the man shows the doctor’s feelings of being completely ineffectual. This is compounded with the arrival of townspeople and children who sing that the doctor is not valued and that if he cannot cure the patient then he should be killed since he’s “only a doctor.” Being stripped naked and fleeing without getting dressed also serve to emphasize the doctor’s feelings of powerlessness, feelings that only confront him through the lens of his subconscious.  

It’s easy to be manipulated.

The doctor allows himself to be manipulated by others throughout the story. When the groom appears, the doctor accepts his presence without more than an initial curiosity about the man’s origin. He even directs Rosa to help the groom, putting her immediately in the man’s power. When the groom savagely bites Rosa in the face, the doctor’s first impulse is to defend his servant, but the fact that the groom is supplying exactly what the doctor needs in that moment is enough to manipulate the doctor into feeling obliged to stay quiet and accept the groom’s actions. When the groom asserts that he is staying behind with Rosa, the doctor does not fight. Instead, he is pulled in the carriage by the groom’s horses, indicating that he is in the thrall and power of the groom. The magical speed of his trip, traveling ten miles in mere moments, shows how quickly the doctor is transported and controlled psychologically as well as physically.

The doctor is also manipulated by the patient’s family, the townspeople, and even the patient himself. When he first arrives, the doctor is irritated by the belief that the patient is fine and that he’s been called from his home for nothing. Instead of leaving, however, the doctor is manipulated by the family who take his coat and give him rum. He describes how the mother entices him to go to her son, and the doctor appears helpless to resist. When townspeople inexplicably show up and sing threats, the doctor reflects on how he has always felt compelled to do what’s expected of him despite the sacrifices he’s had to make. When he’s forced to lie next to the patient and his wound, the doctor attempts to get control by lying to the man and telling him he’ll be fine so he can escape. Ultimately, however, even that one act of agency fails since the doctor is left naked and freezing on a journey home. The doctor’s susceptibility to influence by others illuminates the futility of trying to obtain control in a world that is ultimately uncontrollable.

People tend to look for scapegoats.

The groom is a scapegoat for the doctor, who feels an overall sense of helplessness and blames the groom for it. Rosa is first sacrificed when she is the one who goes door to door in the freezing cold, and she is sacrificed again when the doctor rationalizes the groom’s attack on her. When the groom sends him on his way, the doctor never attempts to return to Rosa even though he magically heard the groom breaking down the door to get to her. Despite repeated moments of concern through the rest of the story, the doctor allows Rosa to be sacrificed to the animalistic groom so he can fulfill what he considers his responsibility of tending to a patient.

The chorus of townspeople treat the doctor as a scapegoat because they see the doctor as merely a tool to serve the purpose of saving people. The doctor acknowledges that he’s being scapegoated, lamenting how the people in his community expect too much from him and consider him disposable if he doesn’t deliver on their expectations. He observes that more is expected of him than even members of the clergy and goes so far as to imply that doctors are like gods whose purpose is only to serve others. When they can no longer do their job, they are discarded. When the children sing that he should be killed if he doesn’t cure the patient, they make clear that he is “only a doctor” and not entitled to his own identity and life. In the end, the doctor is out in the cold, naked and far from home, and he knows he’s going to die. His main concern, however, is that someone else will take his place to be scapegoated in turn by the community at large.