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In Chekov's "A Doctor's Visit" the theme that I notice is the difference between appearance and reality—how easy it is for pretentious, egotistical and ignorant people to pretend to care for others when they are only interested in self.
When Korolyov, acting as the Professor's assistant, arrives in town, the first thing he notices is the scenery...
...he was charmed with the evening, the farmhouses and villas on the road...
...and the factories...
...whenever he saw a factory...he always thought how quiet and peaceable it was outside, but within there was always sure to be impenetrable ignorance and dull egoism on the side of the owners...
Soon it is clear that Korolyov is describing himself. He is sure that all factory workers live in the midst of rats, fighting and drunkenness. When he arrives at the Lyalikovs' home, he is impatient. He is silently critical of the governess (Christina Dmitryevna)—he notes that she must have some intelligence, but allows the possibility with a sense of elitism.
Korolyov visits the Liza Lyalikov—the patient—and his initial response is how very unattractive she is. His first medical assessment of her illness is a patronizing reflection:
It's high time she was married. . . .
It is not until Liza cries that he expresses any compassion. Eventually, he gives her a pat and tells her she is fine.
When he speaks with Madame Lyalikov, Korolyov is rude, concerned about missing his train—but in light of the mother's tears he agrees to stay overnight. He and the governess dine, and his comment to her shows that his idea of "social health" is tied to the presence of a man in the house:
It looks as though you have no man in the house at all...
After the meal Korolyov walks outside. He greatly resents that the people in the factory work so the governess can enjoy what the others in the house do not—as if she is not worthy of the food. The irony here is that while she is a governess, he is only a physician's assistant himself.
Korolyov goes back into the house and checks on Liza. Self-importantly, he believes that she feels compelled to speak to him—perhaps because he is a man and that in the natural order of things, life must revolve around a man:
...it seemed to him that she trusted him, and that she wanted to speak frankly to him, and that she thought the same as he did.
But she does not speak to him.
As he prepares to leave the next day, Korolyov sees Liza again, no better off than she was before he came, but feels that she is somehow drawn to him:
...she looked at him, as yesterday, sorrowfully and intelligently, smiled and talked, and all with an expression as though she wanted to tell him something special, important -- him alone.
The man is narcissistic—thinking that Liza's secret is meant only for him.
Departing, he thinks not of his patient and her lingering illness, or the tragic lives of the factory workers. He has forgotten what he imagined he saw the night before—factory windows, like "the crimson eyes of the devil..."
The windows in the factory buildings were sparkling gaily, and, driving across the yard and afterwards along the road to the station, Korolyov thought neither of the workpeople nor of lake dwellings, nor of the devil, but thought of the time...when life would be as bright and joyous as that still Sunday morning...
How could a person of substance leave this place and feel "joyous?" The self-centered Korolyov is a man of "impenetrable ignorance and dull egoism."
The theme as I understand it is the dissociation between earned wealth and inherited wealth.
Liza, the only child of a prominent and wealthy iron-working family, is taken ill. The visiting doctor can find nothing wrong with her, but her heart beats fast and her sleep is disturbed. Staying the night, he is kept awake by the beating of hammers on steel, and in the morning he visits Liza again. She explains her worry about the building in vague terms; she cannot put a name to it, just that she is always concerned by everything around her. The doctor sees that the simple status of heir is worrying her; she cannot rest easy because of all that she will inherit and therefore be responsible for. He indirectly advises her to travel and put the factory out of her mind.
The key line here is the doctor's:
"You in the position of a factory owner and a wealthy heiress are dissatisfied; you don't believe in your right to it; and here now you can't sleep. That, of course, is better than if you were satisfied, slept soundly, and thought everything was satisfactory."
The implication is that Liza feels herself to be unworthy of inheriting the factory; more importantly, she worries that she will be unable to run it properly and so bring it to ruin. This worry, based in nothing since she hasn't be in the position of operation yet, is an example of self-fulfilling prophecy: Liza believes herself to be incompetent because she has not earned her position, and so will become incompetent because she cannot believe herself otherwise. Her worry will become the cause of her failure in the future. The doctor correctly assumes that if she were sleeping soundly, without worries, it would indicate a person with no qualms about their entitled position in life, and therefore no reason to worry about how they will manage a business.
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