While training to become a GP,Gavin Francis became ill with a severe sinus problem. He decided to reduce his hours to three days a week because he was exhausted and in pain. In his new book, Recovery: The Lost Art of Convalescence, he writes that he persuaded himself that there was no point in risking burnout for the sake of sticking to a schedule. Even though I was late, I qualified all the same.
I think this is a proactive attitude for a junior doctor. Francis has an unusual approach to medicine. He chose to study medicine because he wanted to have a job that would give him a kind of trade, as all the men in his family seemed to have a trade of one sort or another. After a year as a junior house officer, he headed off to explore the wildest parts of the world for a decade, visiting the Arctic, motorbiking across Asia to New Zealand, and working for the British Antarctic Survey.
He says that it was peaceful when he was there. There was a lot of time for contemplation. He didn't want to go back to emergency medicine, even though he missed the clinic life. I did not want to go back to that environment. He tells medical students to imagine if they want their lifestyle to look like that in 20 years, if they look at the doctors around them. It would be fair to say that I was good at it early on.
Francis spends half the week in a small practice in Edinburgh and the other half at a homeless clinic. He helps out in remote Hebridean island practices two or three times a year, because he believes the big skies help him stave off burnout. The rest of his time is spent with his primary school-age children, writing essays, reviews and books, on travel and wild places, and on his experiences at the frontline of general practice.
He says he loves practicing medicine. It is quite emotionally exhausting and I can't imagine stopping. I discovered early on that a really wonderful way for me to do medicine that made me more effective as a doctor and also helped me flourish, I suppose, as a human being, was to have a day off to think about it.
Francis devotes time to his own recovery from a job notorious for burnout and never more so than now, as an underfunded, traumatised NHS faces another winter of Covid firefighting. He says that the days of people clapping are over. People are tired after two years of this. It is both for his own and his patients' benefit to avoid getting depleted to a point where he is inffective as a doctor. It was necessary for me to find a way of doing medicine that helped my patients as well.
People try to go back to work too quickly. A sick note is reassuring.
He is the ideal person to explore recovery and convalescence. It has been in his mind for a while. I spent a lot of time talking to people about recovery and convalescence, not just recovery from Covid, but from all the crises of mental health that were provoked by lockdowns and just also talking to people about recovery from surgery. He says he wrote the book because he realized there were a lot of things he didn't take for granted in his consultations.
A collection of reflections, really, is a slim volume that is humane and thoughtful. It explores the architecture of convalescence, rest, treatments and placebos, the healing power of nature, and the impact a sick note can have. I like this section because it provides a counter-narrative to tabloid tales of malingering and fraud. It was influenced by Francis's early working experiences in an area of deprivation.
One of the doctors there told me that sick notes are the most powerful prescription I have ever written. The amount of abuse in the sick note system is small, and most people try and go back to work too quickly. It can be nice to assure someone that they need time and that they need to respect the process. He likes the fact that a sick note can be left vague. I will often call it a life crisis. If a cat dies in a flooded basement, a wife leaves them all in the same week, that is a life crisis.
Recovery is fascinating because of the respect convalescence was accorded in the past. The Princess Margaret Rose hospital in Edinburgh was designed in the 1930s to treat patients with Tuberculosis. The Astley Ainslie convalescent hospital was set up in the 1920s to help patients convalesce after acute illness, but also to fatten them up before surgery. To get a single night in a hospital bed, you have to have a medical diagnosis and a plan in place that is going to prioritize getting you out as quickly as possible.
There are a lot of things we do better now, such as mental health, the range of treatments we have available, and the fact that you don't have to go to destitution every time you get ill. The Victorians and Edwardians were more aware of how slow recovery can be.
The book accepts the limitations of what doctors can do in relation to chronic conditions and that process of recovery. Francis says that people get a slightly inflated sense of the power of western medicine. I wanted to point out that in medicine we can't cure everything.
The range of treatments we have available are fantastic and we are doing mental health a lot better. The Observer has a photograph of Murdo MacLeod.
A survey shows there are 1.3 million long Covid sufferers in the UK, many struggling with the lack of effective treatment strategies. Francis says that people can get frustrated when he says that they don't understand the reasons for post-viral fatigue. We are also frustrated. He reminds me that this is not a new phenomenon. The ancient Greeks talked about post-viral fatigue.
The chapter called Snakes and Ladders reproduces the advice a long Covid-suffering friend received from the health service, which was to: "Don't rush, get fresh air, push, don't pull, slide, don't lift..."
Francis thinks that it is not that negative or judgmental, even though he accepts that it is typical of the National Health Service. Here are some ways that we have seen to be effective to get out of your situation. There isn't a pill for this. He knows how frightening Covid can be for sufferers, having had 25-year-old marathon runners take weeks to recover, have weeks where they were struggling to walk up their first-floor stairs. It is frightening to be reminded of how fragile we can be.
He says that many patients take comfort in knowing that they are not alone and that most sufferers make a good recovery. People recover from Covid. The figures are coming in. There is a long tail, but it continues to drop, the number of people still experiencing symptoms just goes down and down. When I ask, he assures me that the epidemic will end, even though a respiratory specialist colleague predicted it would last five years.
Recovery is not a book that pretends to have the answers, other than the overarching message that healing from anything is completely specific to the individual and is a process that requires patience, from both sufferers and physicians. A patient on a long, unpredictable recovery feels to me like a different job and skill set than the one most people become doctors for. It is part of the job for Francis. If you want to cure all your patients, you will be disappointed very quickly. If my job can ease suffering a little, or give someone a little more dignity or a bit more independence, even if I can't do anything about their condition, it's probably worthwhile.
Francis is planning to take the family on some big overland trips when his children are old enough to enjoy them. He is planning a road trip to northern Italy's Po Valley to visit his wife's family, and respecting the "really lovely rhythm" that works for him. Staffing challenges make it unrealistic to persuade more of my colleagues that is a good model.
Francis doesn't want to do anything different if it is balanced with enough breathing space. It is a wonderful job if you can keep the pressures within bounds. It is immensely satisfying, no two days are the same, and you have the chance to meet a lot of different people, and have sometimes transformational, sometimes mundane conversations with them, and do something small and realistic about making their lives a little bit better.
Recovery: The Lost Art of Convalescence was published by Profile. Go to guardianbookshop.com to order a copy.