Lydgate’s decision to move to London is somewhat painful to witness, as it means that all of his efforts in Middlemarch have come to nothing (and therefore that the standard of medical care in the area will not improve). However, it is perhaps the more honorable thing to choose Rosamond’s happiness (and, to a lesser extent, his own dignity) over remaining in Middlemarch and battling in vain to force reforms in a community that does not want them.