Recovery. A brief interview with Dr. Gavin Francis

General Practice hasn't changed much in the last century - the possibilities of treatment have been transformed, and medicine has modernised out of all recognition of course, but the basic structure has remained the same: a waiting room, a clinic room, a stream of people with all sorts of problems, coming to see the doctor because they are suffering in some way, and they would like help with easing that suffering. But the pandemic changed all that - suddenly it because dangerous to bring people together in the waiting room, and decades of medical orthodoxy was turned upside down. Medical students have the mantra 'always see the patient' drilled into them, because direct physical examination is so illuminating, but suddenly we were being asked to gauge and triage over the telephone, and only see people face to face who we were particularly concerned about. I write for the Guardian reasonably regularly, and was asked by them to write about this transformation in primary healthcare. A series of essays worked for me as a kind of diary, particularly in the early months of the pandemic when everything was changing so quickly. I gathered them into a book, and carried on the diary. Intensive Care: A GP, a Community, & a Pandemic describes the first 18 months of the pandemic from the perspective of a GP.

So much of my time has been spent talking to my patients about recovery not just from Covid, but also from the mental health effects of repeated lockdowns, that I realised certain themes were coming up in conversation after conversation - aspects of recovery I take for granted, but which my patients did not. So I decided to put all those thoughts in one short, easily accessible book in the hope that it would benefit others. That book, Recovery: The Lost Art of Convalescence asks people to respect the process of recovery, take the time to heal that they need, listen to their bodies and mind, value the role of nature and the natural world in recovery, and remember that even in the most difficult, incurable conditions, it's still possible to 'recover' in the sense of building towards a life of greater dignity and autonomy.

'Recovery' comes from a root word meaning ' to regain consciousness', and I think to recover is to become conscious of a new way of being, with a new attention to the body and its needs. 'Convalescence' comes from a root meaning 'to grow in strength', and that's often the kind of recoveries that I'm involved with as a GP, coaxing people back to health after protracted illness, or surgeries. But there are many kinds of strength - including mental and physical - and I wanted this book to be as general as possible, as helpful for someone recovering from a broken leg as from a crisis of depression or anxiety. My own view is that something happened in the 1950s and 1960s when there was an explosion of new drugs - antidepressants, antipsychotics, antibiotics, inhalers, steroids. Previous to that most recoveries were about rest and nutrition and time. Then suddenly, all these powerful drugs appeared, and people began to suspect that all that was needed was the right prescription. We began to close convalescent homes, because all we needed was a pill. And so an 'art' began to be lost - an art in the sense of an intimate appreciation of a bodily process that can often be slow, and is different for everybody. Convalescence isn't inevitable - some people get worse and worse from an illness, and we know that even just physically, inactivity causes our muscle bulk to wither - so no, convalescence isn't something that happens automatically. We have to give it attention and respect, and as doctors and nurses, we have to learn ways of encouraging it ('encourage' means, 'to put heart in'). My own experience as a GP is that there are as many kinds of convalescence as there are illnesses, and people, and that no two recoveries are ever the same, but there are some principles that can be drawn out which would be helpful for most people. I'd certainly welcome a greater academic focus on modes of recovery and convalescence, both within the medical profession and outside it.

Health is a balance, not an extreme, different for everybody. There are all sorts of activities that can help us rebalance our strength and our mental equilibrium. Exercise is definitely one of them, as is working with our hands. 'Craft' comes from a word that denotes dexterity and skill, and the oldest medical writings, from the Greek world 2,000 years ago talk about ball games of various kinds as the best way to improve strength and balance after injury. Learning how to work with your hands can be both a balm and a kind of physiotherapy, useful in many kinds of recoveries, and I have certainly recommended different kinds of crafting activities over the years. We have a whole discipline dedicated to 'Occupational Therapy' after all, and I regularly refer on to OT colleagues for advice and support in healing activities.