SQL-Server follows the principle of "Least Privilege" -- you must (explicitly) grant permissions.
'does it mean that they wont be able to update 4 and 5 ?'
If your users in the doctor role are only in the doctor role, then yes.
However, if those users are also in other roles (namely, other roles that do have access to 4 & 5), then no.
More Information: http://msdn.microsoft.com/en-us/library/bb669084%28v=vs.110%29.aspx