Lydgate arrives in Middlemarch with big, progressive ambitions. He has an innovative view of medicine and wants to change the way that medicine is practiced in the provincial town. The doctors in the town do not agree with him. They view him as a suspicious outsider with dangerous ideas and they do not welcome him into their community. Instead, Lydgate is left to set up his own hospital. This hospital becomes an important symbol of the difference between Lydgate and everyone around him.

Everything about Lydgate’s hospital is different, from the prescriptions and treatments that Lydgate orders to his refusal to charge for certain procedures that have made his peers very rich. This latter point leads to one of the most significant differences: the clientele. Due to Lydgate's desire to help as many people as cheaply as possible, his patients are largely working-class people. Lydgate and his hospital symbolize the progressive new ideas which are sweeping through the country at the time. Not only is Lydgate in favor of widening the scope of who can afford medical treatments, but political agendas such as the Reform Act of 1832 are widening the scope of who can vote in Great Britain.