The doctor's significance in the play in Act IV is to show the reader/audience the extent of Lady Macbeth's guilt and the result of her conscience.
The doctor witnesses her sleepwalking and talking about what she knows of the murders of Duncan and the others. She washes her hands in this scene and never seems to be able to get the smell of blood and the spots of blood off of her.
We also learn in this scene that Lady Macbeth always carries a light with her...as if she is afraid of the dark and the evils it carries with it. Funny how in the beginning of the play she calls on the "ministers of evil" and darkness to help her be brave and resolute in her murder plan.
The doctor also helps us to understand where the people of Scotland stand where Macbeth is concerned. He mentions that if he could get away, no amount of money in the world would bring him back. This thought is echoed when we hear that warriors from Macbeth's army are switching sides and running over the fight with Malcolm's armies.
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