5 Reasons Your Book Isn’t Written Yet (And The Cure For Each)

Are you still hoping to write your book “some day”?

Here are 5 reasons your book isn’t complete (or maybe even started) and how you can turn it around:

1. You Have No Time: No one has time to write a book. Yet, I’d venture that the people who get published are often the busiest people of all. No matter how busy you are, you can find time by temporarily limiting or even cutting out certain activities (cut back on e-mail, web surfing, TV, cooking or reading). Or employ help for certain tasks to get an extra few hours a week to write. Maybe you can even negotiate time off. Or wake up an hour earlier each day. I’ve seen many of my book writing students find time when they didn’t think they had any.

2. You’re Afraid You’re Not Saying Anything New: Maybe  there’s nothing new under the sun, but trust that you have a unique voice and unique way of saying things that will resonate for a certain group of readers—your niche. I’ve seen many people in my book writing classes who started out sounding trite. As they mined their personal experiences and asked themselves what their patients/clients/friends/colleagues liked most about them, they found their “voice” as a writer and that made all the difference. Certainly research the other books in your area and see how you can add something new to the picture—experiential exercises, a fresh perspective or engaging anecdotes.

3. You’re Just Plain Stuck: Most times that people get stuck they just don’t have a detailed enough outline. Go deeper in your outline and you may just pull yourself out of a hole.

4. You’re Confused by How to Structure the Book: Many people come to a standstill when they wrestle with the book’s structure, or even the market or concept of the book. If you can’t tackle this one on your own, a session with a writing coach can provide the clarity you need to move forward. I take my clients through exercises that help you clarify your audience, gain clarity on your book’s outline and structure and create the tone and features that will wow your readers.

5. You’re Discouraged: Maybe the book doesn’t seem to be going where you wanted or the writing just doesn’t compel. Maybe the whole process overwhelms you. The cure for this is getting support—to write better, gain clarity or move forward. Show your book to a trusted friend or colleague to get feedback. Or, if you know it needs work, work with a professional. Or sign up for a book writing class to get the support, motivation, community and structure to see the project to completion.

Writing A Book Proposal Is Like Writing An Rx

One of the most important things to learn about publishing is how to properly submit materials to editors.

Sure, some editors are pretty informal and will look at whatever is sent. But, the vast majority of editors are incredibly busy, and they won't bother looking at anything that isn't at least close to being properly submitted.

For a non-fiction book proposal, editors expect to see a book proposal.  For a work of fiction, they want to see the entire manuscript. Why? It's pretty simple.  A non-fiction book proposal explains the book concept, the author's credentials and lots of other important information in a "snapshot". Usually in non-fiction the author's credentials as an expert are important. 

In a novel, the ability to tell the story from start to finish is crucial. Thus, editors just want to read the story—all the way through. 

Non-fiction book proposals are very formulaic—a lot like prescriptions. Imagine if you wrote out an Rx for the pharmacist that said, "Hey, give this nice lady something strong for her high blood pressure." What do you think would happen? Well, trying to get a non-fiction book published without writing a proposal is a lot like that. It's just not going to work very well. 

I write this (and all of my future blogs) with the caveat that no matter what I say, there are writers out there who will prove me wrong. That's because there are ways to do things that aren't very conventional. But, usually it's eaiser to go the conventional way and just get the nice lady the Rx you want her to have and get book editors to take your proposal seriously! 

Is Medicine Destroying Our Young Physicians?

I came across a blog post not long ago that's a great read. The title of the blog is the Traveling Medicine Show and the specific post is entitled, What Could Possibly Go Wrong?—Leaving Medicine the First Time.

This post is a very interesting and humorous story about how the author—a first-year Neurology resident at the time—decides to leave his residency on an impulse after a spontaneous marriage to his girlfriend.  The story is well-written and quite funny, and it's easy to identify with the author who is so frustrated with medicine but can't seem to quite find a life outside of medicine either.  Here's how it begins:

After the third month of my neurology residency in Chicago, I took a trip out to New Mexico and never came back.

No one leaves medicine. It’s just not done. Or rarely. There was the guy in my medical school who was so twisted, that even after repeated reprimands for being inappropriate with female patients and colleagues, he couldn’t get it together. Though not by choice, he left. Or the anesthesiology resident found dead of an overdose in his call room, a surreptitious IV catheter still taped to his ankle. He left. These were the role models.

I had fantasized about leaving medicine for years. By my second year of med school, I had the feeling that I had boarded the wrong train, but I kept on clunking down the wrong track, hoping things would improve as I passed into each new stage of training. Things would be better when I was in the clinical years. Clunk. Clunk. When I get to my internship. Clunk Clunk. I couldn’t find the strength to leave something that seemed so successful, even noble. Anyway, the ticket had been so exorbitant, and soon so many miles had flown by that getting off was simply not an option.

I won't ruin the story and tell you how it all ends, but suffice it to say that it is worth reading.  I know many physicians who have felt, and still feel, like this author but only discuss these feelings behind closed doors to their closest confidants, if at all.

What's particularly poignant about this post, however, are the comments at the end.  The post was written in 2007, but the comments have been building since then and emote a sense of desperation amongst the writers. "Glad to know I'm not the only one who feels this way," reads one comment.  "I wish I had never done [medical school]—just look what they make you give," reads another. 

The comments continue: "I just left residency after two years of medicine...," and "I'm in my first semester of med school and I hate it," and "I’m a family doc, have been practicing for eight years. Recently hit with two meritless, frivolous, ridiculous lawsuits… both still pending, one I’ve fought for two years now... I'm getting out."

There are more comments, but you get the point.

What most disturbs me about these comments is that they are all from individuals at the beginning of their careers in medicine. It's one thing to have a cohort of physicians towards the end of their careers, complaining about changes in medicine and longing for "the good old days." But these writers are all young, early in their careers—and desperate to get out.

Our colleague Dr. Ryan Flesher produced an entire documentary film on this subject entitled The Vanishing Oath.  Ryan's film sheds light on the problem of early burnout in young physicians, and after watching his film, it caused me to be seriously concerned whether there would be anyone left in medicine to care for my family and me when we're older.

When I read comments like the ones mentioned earlier, or see a film like The Vanishing Oath, or speak to colleagues who are overwhelmed by their careers and stressed to the hilt, it makes me even more committed to what we're doing here at Freelance MD.  

You see, I come from a family of medical people. Between the stories I've personally heard and the stories told to me by other family members, I have had a growing concern that the practice of medicine is becoming increasingly toxic to those who practice it. Medicine is devouring its young.

This unfortunate truth is why Freelance MD and the Medical Fusion Conference were developed—to help physicians navigate the now treacherous waters of modern medicine.  

We'll be discussing physician burnout and other indicators of the problems in medicine in more depth, but our hope is that the discussion won't simply digress into a complaint session. We've created this site as a place not to simply document the obvious problems in medicine, but to offer direction for those who are struggling and connect them to leaders who can help them progress into a career that is fulfilling.

So take advantage of the resources here at Freelance MD and begin building towards a better career.  

We need you in medicine.

Epiphany

Have you had yours yet?

When did you think you might be capable of trying something different from your training as a physician?  Did it happen suddenly, or was it a gradual pull to a new area of interest?  Have you made the transition yet, or just thinking about it? 

Whatever your answer, it's good. One experience for me got me started in directions that I never dreamed possible. If I hadn't followed my instincts, my world would be very different today.

1985. Working way too hard in my medical practice, organizing an IPA, getting burned out. I wanted a complete break from practice for awhile to get my priorities straight. I wanted to see the highest mountain on the planet.  Not climb it—just see it. Imagine asking your partners in practice—and your wife—to take a month off to do that! I was blessed to have the support of both.

I agreed to be an expedition doctor for a well known trekking company. That way their clients could feel more secure, and I could just tag along with a well organized group. Eat "American style" food, and have my own private tent each night. Nothing too difficult or challenging.

To make a long story short, the group was small. Because the clients and their physician weren't honest on their medical forms (heart issues), they got scared at 13,000 feet in the village of Namche Bazaar. They wanted to go home to the US.

The group leader was frustrated. He wanted to visit his friend the rimpoche at the monastery a half days walk up the trail. He asked me what I wanted to do. He could see I was impressed with the Himalayan experience. We bargained with our clients to give us one more day to make a decision. They agreed, and asked us to take lots of pictures for them.

I decided to stay the remaining three weeks—but without a group to take care of me. Just me and a nineteen year old Sherpa who spoke as much English as I spoke Sherpa. It was a turning point in my life. Every day was a new adventure. Stay in the Sherpa lodges and homes. Eat the native cuisine.  Explore at my own pace. Learn to deal with altitude sickness, and maybe a bit of HACE. 

I asked my young Sherpa guide to take me to HIS favorite place—not the usual tourist destinations. His choice? The chorten memorial to Sir Edmund Hillary's wife and daughter, who were killed in a plane crash at Lukla several years earlier. The Sherpas built the chorten out of respect and love. It was in a beautiful spot. Sir Edmund never did visit the site because of his emotions, but I was privileged to see it with my Sherpa friend.

As a result of having everything fall apart, and having to face a new challenge every day, I realized I could handle new career challenges that I never imagined. I returned home with a new appreciation for my wife and kids—and a promise to bring them to Nepal someday. (They've been there twice now, and my boys have spent far more time there than my wife or me.) One of my partners told me I was "different now". How, I asked. "You aren't as serious". My attitude about serious issues had changed. I saw the struggles differently. 

Six years later, when a new career challenge popped up unexpectedly, I was prepared for it. The inner confidence and desire to take on something new and different helped me move in that direction. Follow your instincts, even if you aren't quite sure why. You might find, as several other physicians who have journeyed to China and Tibet, or Rwanda, with my wife and I, that these adventures help develop your leadership, flexibility, and creativity. You don't have to travel half-way across the world to find your inspiration. Just be aware that what's drawing you to a new interest is happening for a reason—even though you may not understand that reason just yet. 

Or, as the rimpoche tells climbers wanting to know the secret to getting to the top of Everest—no secret. He says there are many ways to get to the top—fast, slow, different routes, etc.  Or you can decide the top isn't your goal anymore.  He laughs and says, "it's all OK".

Non-Clinical Careers For Physicians In Medical Devices

Physicians are playing key roles in the medical device industry.

Physicians looking for non-clinical careers may be seeking better work-life balance. Some may have years of experience in clinical practice but are looking for something new.  They still want to make a difference in people’s lives—but may be disenchanted with the business of medicine.     

The medical device industry could be a viable option for physicians who are ready to jump the clinical track.  The device industry is one of growth and innovation—and physicians are playing key roles in design, development, and marketing. 

Historically, practicing physicians have worked closely with medical device companies to develop and market new products. Device firms—and the physicians that work with them—have learned that these relationships are essential to device innovation.  Some have raised concerns about potential conflicts of interest in these collaborations. Critics worry that payments to physicians could influence their decisions about which devices to use and when. So now, more than ever, companies are recruiting physicians to help them navigate these issues, creating a variety of career opportunities.

Physicians often provide important knowledge about technology and medical practice that becomes incorporated into new devices.  Involvement in activities such as clinical trials and testing is one of the ways physicians can both learn about new technology and pass information about technology to commercializing companies.

The medical device arena is highly dependent on clinical development and is capital-intensive. Medical device companies spend about 10-12 percent of sales revenue on research and development (R&D), somewhat less than some of their pharmaceutical counterparts—but on average, much more than companies in the manufacturing sector. Leading medical device companies generate the majority of their revenues from products that are only a few years old, due to competition from fast followers. The life cycle for new products in this industry is relatively short, making new product innovations crucial for firms. The key challenge is to manage all the moving parts of the commercialization process: come up with new product ideas, anticipate market demand, manage product development, gain regulatory approval, and encourage adoption of new technologies and new generations of existing technologies. 

Device firms that identify and acquire information that resides outside the firms have the most success in maintaining their innovative edge. In the medical device industry, practicing physicians are an important source of knowledge regarding unmet needs, customer preferences, and potential market opportunities.  Their knowledge can be used for either refining existing products or creating new products that would be well-received by healthcare professionals. Physicians in corporate roles are in the best position to help companies gather this information, prepare business cases, and design protocols for clinical studies.     

Physicians may contribute directly to the commercialization process by inventing medical devices themselves or participating as a member of the product design team. Doctors often have the best knowledge about unmet medical needs and the clearest sense of the most feasible solution to a particular problem. They can provide unique insights about market needs, product modifications, and new products. Their knowledge comes from using devices—so they know what is problematic, which improvements are most critical, and which solutions are preferable from the perspective of the end user.  The depth of their knowledge is based on their clinical experience and may be difficult to convey to industry executives without strong communication skills and relationships of trust and respect. 

Corporate physicians could also play a role in other aspects of commercialization. For instance, they could help manage strategic partnerships with external physicians and suppliers. Clinicians who invent new devices or modify existing devices typically have little or no experience in manufacturing and marketing the devices themselves. Corporate physicians who have experience in these areas could help facilitate the tech transfer throughout the commercialization process. 

Depending on their background and experience, corporate physicians could also participate in regulatory submissions, sales training, and corporate compliance as well as licensing deals and mergers and acquisitions. 

For more information about career opportunities, check out the websites for these leading medical device companies: Johnson & Johnson, GE Healthcare, Medtronic, Baxter International, 3M Medical, and Zimmer Holdings.  This could give you a framework to explore specific opportunities or extend your network to other firms in the industry.

We Need Effective Physician Leadership

Where's the rank and file physician leadership? The Story Behind the Story

The New York Times recently ran a front page story about the Senate Finance Committee's ongoing investigation of an interventional cardiologist in the Baltimore area. This cardiologist, among other allegations, is being questioned about the appropriateness of inserting 30 intracardiac stents in a single day. THIRTY STENTS IN A DAY!!!!

In their investigation the Finance Committee has discovered evidence that many of this physician's procedures were not medically necessary...DUH!

But wait, this soap opera is not over. It turns out that this interventionalist was recruited by the hospital in which he worked, from the group he himself founded by a seven figure salary. His premium salary apparently was not based on superior medical judgement. But this lurid card was trumped by the president-elect of the Society of Cardiovascular Angiography and Intervention. When asked for a comment from the Times, he responded that "inappropriate stenting was a problem, but a rare one". The 3.6 billion bucks a year Medicare spends on stenting does not stop on his desk.

This story is really a story about the total ineffectiveness of today's medical leadership. Where was the CMO, VPMA, Director of Cardiology, and Cath Lab Director during this eveloving scandal. Who was safegaurding the quality of care delivered? Why was the behavior of this "cowboy" not addressed by them insead of the Federal Government, The New York times and some soon to be wealthier ambulance chasers?

Why didn't the president-elect of SCAI make the following statement to the times? "The allegations, if true, are an outrage and are unacceptable. I will take personal responsibility to learn from this unfortunate episode and make sure we develop protocols that will assue this will not happen again".

We need to invest in the training of physician leaders who embrace accountability and transparency, who are committed to consistent and demonstrable excellence in healthcare delivery, and most importantly master the skill set to be effective.

The consequences of our failure to train such leaders will be further loss of public confidence, more external regulation and review, wealthier personal injury lawyers supported by increases in our malpractice premiums and, most tragically, inconsistent suboptimal outcomes for our patients.

10 Quick Tips to Get Started Writing Your Book

Writing a book can open all kinds of doors—reaching more people with your message, securing high profile speaking engagements, meeting like-minded inspiring colleagues and fulfilling a lifelong dream.

Yet, if you’re like most people, you’ve put it off—or started and stopped—for years.
People put off writing their books for a number of reasons:

• No time
• Not sure what to write
• Afraid of success or failure
• Unsure where to start
• Don’t have the support to see it through to the end
• Not a good enough writer

Here are 10 Quick Tips to Get Started that address each of the challenges above.

1. Write Down Your Vision and Goals for the Book: When you’re clear on why you’re writing the book, it will be easier to make the time, commit the resources and write the book that will fulfill your goals. If you have several book ideas, this step can help you choose the one that best fits your goals. Your clarity will propel you forward.

2. Envision Your Readers: When you get a clear picture of who your core audience is—and why they’ll be motivated to buy your book—it will be much easier to write the book—and your book is more likely to succeed in this competitive marketplace.

3.  Decide What You’ll Give Up: To find time in your busy life for this book—whether it’s 3 hours a week or 8 or 12, you need time to write. Is there something you can do less of—decrease you patient load for a time, hire a colleague to fill in the slack, put aside a volunteer project temporarily?

4. Prioritize: Put book writing time before e-mails. Make e-mail time your reward after the writing is done. Unplug your phone and turn off e-mail alerts while writing.

5. Schedule: Write down exact times for book writing. If you say you’ll write Saturday mornings, that’s not clear enough. You need a start time and ending time. Of course, if you’re on a roll, you can extend that ending time.

6. Get Professional Support: Most people don’t have the experience to write a book. Join a book writing class, find a skilled editor or book writing coach, but get the professional support you need to help you clarify the book’s concept, tone, features and how you organize it, as well as help you make the writing compelling and polished.

7. Tell Yourself a New Story: If you think you can’t write a book, remind yourself you’re learning and you don’t have to do it alone. A supportive colleague, friend or writing coach can often help you break through this potential block. Just because you’ve never done something doesn’t mean you can’t do it. Tens of thousands of new authors break through that block every year and you can, too.

8. Get Organized: One of the biggest challenges to writing a book is figuring where to start and how to organize the book. I have my book writing students use color coded index cards with content, exercises and questions on them. They move the index cards around to play with how they organize the material. 

9. Enjoy the Process: The more fun you have, the more fun your readers will have—and the more often they’ll recommend your book to their friends and colleagues.

10. Start with the End in Mind: Picture a day in your life as a published author. How does your day begin and end? Use your senses to make it real. The more you envision your success, the more you pave the way for it.