Navigating the Publishing Journey
Christine J. Ko, MD, has written a book for physicians, How to Improve Doctor-Patient Connection: Using Psychology to Optimize Healthcare Interactions, published by Routledge. In this interview she shares her vision in writing a book for physicians, her book writing and book proposal process, how she would go about it differently now, the challenges she faced and the ways she overcame them.
Colleen: Given the burnout during this pandemic, it seems a book for physicians on improving doctor-patient connection and optimizing healthcare interactions is especially necessary and timely. Can you share how How to Improve Doctor-Patient Connection came about, your inspiration and vision for writing a book for physicians?
Dr. Ko: I’ve always loved books, and it was a long held dream to be a writer, in terms of a day job. At the same time, I always wanted to be a doctor (much more acceptable as a steady source of income in the view of my immigrant parents!) and had a naïve view of my helping patients for the better.
‘Hacks’ Based on Cognitive Psychology
In reality, I know increasingly that I can fail at serving my patients optimally. There is the COVID pandemic that doesn’t seem to have a true end in sight, bureaucracy, ins and outs of different insurance policies, personal stress, and the inescapable time crunch. Yes, doctors are very short on time! – but I do not want to be too busy for my patients.
I never took psychology as an undergraduate, and I became exposed to cognitive psychology and positive psychology in the last decade or so through reading books. There are some simple ‘hacks’ based on cognitive psychology that will improve the doctor-patient relationship. Yes, doctors can use them, but so can patients, parents of patients; virtually anyone who cares about their healthcare interactions. This is what How to Improve Doctor-Patient Connection is about.
Colleen: How did you start writing a book for physicians? Where did you begin?
Dr. Ko: My book started as personal thoughts and notes to myself – things that I wanted to remember. My sister is a clinical psychologist, and all the things I was learning about cognitive psychology were very familiar to her, but not to me. One day when we were on vacation I told her that I thought that all doctors, and patients, could benefit from knowing some important principles of cognitive psychology. And then I started writing specifically with that in mind.
Feedback from Beta Readers
Colleen: What challenges came up and what did you do to meet them?
Dr. Ko: There were many rejections along the way; many times I got feedback that what I was trying to do was not publishable – not relevant to people’s experience. It is hard to keep going, and it helped to have pockets of encouragement along the way. I found a few beta readers and editors – I will say they were not easy to find, either, as I wanted to go beyond friends and family. One was found through searching the internet, and one found through a course for physician writers. There was another whom I found through a friend’s recommendation.
The tough thing I found is that everyone has an opinion, and that opinion (whether right or wrong, in terms of “selling books”) may not be compatible with the book you are envisioning. My beta readers and editors sometimes had directly opposing opinions, as well. There are no easy answers for writers!
The Importance of Clarity from the Start when Writing a Book for Physicians
Colleen: Were you picturing your audience, physician readers, as you wrote?
Dr. Ko: Had I had the experience and knowledge to do that, I think the editing process would have been easier. As many writers will say, my first draft was way too long, and an editor commented early on that it was probably 3-5 books worth of material (not in length, but content). Another editor suggested that I start from scratch. In retrospect, I did a lot of things the “wrong” way – I didn’t start with a strong book proposal, as many suggest doing (I didn’t have the knowledge). Once I had my particular audience in mind – doctors and patients who care about connecting with each other – I did try to always keep them in mind.
Colleen: You write, “I didn’t know (and couldn’t imagine) what I may have hoped to receive from the doctor until my mentor gave me exactly what I needed – someone to bear witness to my humanity.” What does it mean to bear witness to your humanity?
Dr. Ko: To me, that means to see someone else as a human being first. Without fully realizing I was doing it, patients were often a given diagnosis – 50-year-old man with psoriasis, for example. The psoriasis – the diagnosis – becomes the important thing, and you barely know anything about the patient. Doctors need to focus on the correct diagnosis and create appropriate treatment plans for patients. But those diagnoses and treatment plans are better, and better serve patients, when they are put into the context of that unique individual – their culture, their attitudes, their reactions and emotions.
Think about your thinking
Colleen: The title of the book says that physicians can use psychology to optimize healthcare interactions. Can you break that down a bit?
Dr. Ko: In some ways, it is too simple. Metacognition means to think about your thinking. The book addresses visual, auditory, and emotional perception, what I term metaperception – thinking about your perception. Improving doctor-patient connection just takes thinking about what you see, what you hear, and what you feel in that interaction.
Notice the Color of their Eyes
Colleen: Can you give some specific examples?
Dr. Ko: In terms of thinking about what you see – do you truly see the patient or doctor in front of you?
One trick is to make eye contact. This is not big news – eye contact helps us focus on who you are talking to, in any conversation. But when you are actually in the exam room with someone – how do you make this habit, when there are all these competing signals, especially the big electronic medical record and the need for the doctor to click, type, and navigate, and the patient may have a fair amount of anxiety? A trick is to take note of the eye color of the patient (and the patient can do this with the doctor, too!).
When I take a couple seconds (really, that’s all it takes) to really take note – are they blue? How blue? – it changes the interaction for me. It is human nature to mirror someone else’s actions, so whoever starts the eye contact, whether patient or doctor, it will be naturally mimicked by the other.
Tips for Doctors who want to Write a Book for Physicians
Colleen: Do you have any tips for other doctors who may want to get published?
Dr. Ko: Just write, and keep on writing. Write what speaks to you, and don’t worry too much about what others might think of it. I recently heard on a podcast, something like, “write what you don’t even want to tell yourself.” I think that kind of honesty is hard to turn away from, as a reader. It is hard to get it down onto paper, but a reader will want to read that.
Start with a Strong Book Proposal if you want a Traditional Publisher
Colleen: At what point did you search for a publisher? Did you have an agent?
Dr. Ko: I began searching for a publisher once I thought the book was finished, and I realized at that point that I should not have done it that way. The “easier” way to do it (although it is never an easy road to get a book published) is to start with a strong book proposal and if you can find an agent, even better. I did not have an agent, and I sent in my proposal to publishers that are willing to work with non-agented authors.
What to do When you Want to Give Up
Colleen: Were there any times you thought about giving up?
Dr. Ko: Yes. I received many rejections from publishers, and rejection is never easy to handle. Another concrete example of encouragement: After those initial rejections, I discovered Lisa Tener and engaged her for a consultation. In that consultation, Lisa encouraged me and gave me actionable steps that I could concentrate on [to increase the chance of securing a publishing offer], rather than focusing on the rejections. This included specific advice on creating an author website (and what is needed), suggestions for developing my platform, including writing articles for Kevin MD and other venues, and responding to reporter queries. With Lisa’s advice, instead of giving up, I pressed on, continued to strengthen my platform, and I received an offer from Routledge, which has now published the book!
Colleen: Any final comments?
Dr. Ko: Burnout is at an all-time high for doctors, and the COVID pandemic has created a huge amount of stress on the healthcare system, as well as other systems (just take a look at the grocery store shelves!). I believe most doctors became doctors because they care, and patients certainly need doctors to care. I hope that reading my book can help doctors and patients return to that safe space of optimal doctor-patient connection.
About Christine J. Ko, MD
Christine J. Ko, MD is a professor of dermatology and pathology at Yale University. Dr. Ko is the author of How to Improve Doctor-Patient Connection: Using Psychology to Optimize Healthcare Interactions, published by Routledge, Dr. Ko is the mother of two children, aged 14 and 11, and the integration of being a mother as well as a doctor has changed the way she sees patients. You can find her on Twitter @ChristineJKoMD and @ChristineJKo.