Books: Shapeshifters: On Medicine and Human Change

‘The very essence of being human is change’ says Gavin Francis. In this wonderfully readable book he sets about illustrating this point using a broad variety of historical and literary references interwoven with tales from his own life as a GP.

The chapters are a series of short essays on life’s changes and transitions from conception to death, via puberty, body-building, gender, pregnancy, tattoos, menopause, and many others.

Our state of ‘perpetual metamorphosis’ is a fascinating theme for any reader. For those of us who work in general practice there are many moments that may prompt pause for thought. He delves into the historical and metaphysical contexts of familiar consultations in a way that we seldom have the opportunity to do in our time-pressured working days.

Describing an elderly gentleman with dementia and delirium Francis discusses how memory and identity are profound concepts, grappled with by figures from Homer to Schrödinger.

A chapter about sleep reflects upon the Babylonian Epic of Gilgamesh through to Freud. These meditations often lead to nuggets of clinical relevance. As Francis puts it:

‘Work as a physician takes advantage of those changes that aid us and tries to slow down those that would constrain us.’

There is a sense of enthusiasm and wonder in his writing that is infectious. He is a celebrant of holism. Iona Heath wrote in The Mystery of General Practice that:

‘All aspects of human existence are legitimate concerns of the general practitioner’.¹

This book epitomises that sentiment.

At a time of uncertainty and angst for the NHS the positive tone is welcome. There has been no shortage of medical memoirs in recent months (Adam Kay’s This is Going to Hurt, Caroline Elton’s Also Human) and Shapeshifters certainly falls at the more uplifting end of the spectrum.

If there could be any criticism levelled at this book then it is that at times the scope is so ambitious that complex topics such as gender reassignment are covered with a brevity that could seem reductive, even glib. However, there is such compassion and humility in his writing that this is easily forgiven.

The core strength of this book is its humanity. The author’s rare skill is that of bringing a broad range of influences and disciplines seamlessly together, which could perhaps serve as an apt analogy for the art, and the mystery, of general practice itself.