Drawing from an ethnographic study conducted in a Karnataka village, the unfavourable differential treatments against Dalit patients in rural public health services are delineated. An analysis of medical interactions shows that as compared to non-Dalits, Dalit patients experienced more apathy, denial, and avoidance behaviours from service providers. Surprisingly, most Dalits did not attribute this to their caste, but to the flaws of the public health delivery system. Caste and allopathic medical practice are embedded in the rural public health delivery system, and both camouflage and normalise discrimination in paternalistic medical interactions. This sustains the favourable environment for caste-based discrimination in rural public health services even in places where Dalit consciousness is strong.