Embarking On Something A Little Different

DrRich | February 28th, 2012 - 8:26 am

As I was sending in the (finally!) completed manuscript of the 5th edition of my textbook of electrophysiology last week, I was interrupted by two thoughts.

The first was that, while I enjoyed writing this book, I did not have as much fun as I had with the first four editions. Oh sure, I still entertained myself by trying to embed as many jokes, innuendos, double entendres and other amusements as I could into the text (95% of which, as always, will be caught and removed prior to publication by the editors – who are up to my tricks). But still, writing about cardiac electrophysiology is necessarily a desiccating endeavor. I guess I’ve gotten used to the free-reign style of writing I employ here at the CRB, and perhaps it’s ruined me for writing textbooks, at least as far as my own enjoyment is concerned. Sure would be fun to write a book in the style of this blog.

The second thought came to me as I pressed the “send” button, thus instantaneously zapping all the text, tables, and illustrations that comprise a medical textbook to the publisher. Even as recently as seven years ago, when I did the 4th edition, the process involved bundling up three copies of a thick manuscript, and three glossy prints each of all the illustrations, tables, etc., into a bulky package, and hauling it to the US Postal Service for (eventual) delivery.  How the world has changed in so short a time! (I sez to myself.) No need to do things the old way anymore.

Ruminating on these two thoughts for a matter of mere hours, I called an audible on my plans (such as they were) for my immediate future.

I’ve been thinking for more than a year that I need to write another book on American healthcare. It would be a book about what Obamacare expects (and will demand) from all of us citizens. I believe that if we Americans understood what really is to be expected of us from now on (instead of believing the soothing prevarications and wishful thinking commonly thrown our way), then we would do something about it. But Life got in the way, and I have not done much more than think about such a book.

My failure to act creates a seemingly insurmountable problem. The message I hope to convey, if it has any legitimacy at all, is most pertinent right now, before the November election. Given that I have not begun my book, the time frame appears difficult.

Indeed, as anyone who has published a book knows, unless you are writing about last week’s celebrity kidnapping or, perhaps, a Whitney Houston bio (in other words, unless you are writing about recent events so momentous that the usual chains of publishing protocol must be rent asunder to accommodate you), the time that elapses between the conception and the publication of a book is usually measured in years.

But, as I have noted, things have changed. So I have decided to try taking advantage of some of these changes, to try something a little different.

I am going to attempt to write my book right here, on this blog.

This is what I propose to do. Working as quickly as I can (while still fulfilling all my commitments to the various enterprises which are actually paying me to do things), I will compose my new book in real time, on line, here on the CRB. Quite simply, as I finish each chapter I will post it here.

The chapters I put up here will be a work in progress, essentially a draft. I reserve the right to change what I have written at any time, as much as I think I need to. I make no representations regarding how often I will post chapters, or even whether I will be able to carry this project to completion in a reasonable time, or at all. (I’ve never written a book like this before – I doubt many have – and I don’t really know that it’s feasible.)   I risk making a great fool of myself, but acquaintances would tell you that such a result should not create too great an additional burden for me.

I am sure regular readers will recognize large parts of this book as I post it, because I intend to incorporate themes – and even text – from some of my blog postings from the last five years. But I hope that presenting those words and themes in the more coherent and more logical form of a book will give them new life, and possibly extend their meaning.

Because this will be a work in progress, I invite (beg) comments and criticisms from all (or, as the case may be, both) of you.  I promise to consider every comment seriously (as indeed I always do), and I will undoubtedly incorporate many of them into the revisions I’ll be making all the time.

Once I decide that the book is finished, I will plan to publish it in electronic book form (Kindle for sure, maybe Nook) under my own label. Unless this occurs by Labor Day at the latest I will consider the entire effort an abject failure. If by some miracle the book does well in electronic format, I will plan to seek a real publisher in the future.

I realize how backward this all is. But (sez I) see how the world has changed in such a short time!

I will end this strange post with a personal note.

I will embark on writing this book despite my better judgment. On two occasions in my career – once as a practicing physician and once as a consultant to a biomedical company – I had very scary and very personal run-ins with officials of the federal government who had the authority (and the desire) to extract large fines and/or lengthy incarcerations from lots of people.  While I myself was not a direct target in either of these matters, and indeed suffered no real damage from either, these episodes were extremely distressing to me, and even life-changing.

I have written about one of these encounters in my temporarily obsolete book, “Fixing American Healthcare” (I’m hoping it will eventually come back in style, thus rendering its current obsolescence obsolete), and here on the CRB. I have not written about the second encounter, which was much more recent. In that second encounter, while I was being interrogated under oath by a prosecutor from the Department of Justice, the opening line of questioning, which lasted far longer than I ever could have imagined, concerned my writings here on the CRB, writings which were not remotely related in any way to the matter at hand. While the line of questioning itself was not particularly intimidating, and even occasionally bordered on expressing amusement (it might have been irony, though I do not expect irony from the DOJ), the message seemed clear: We in the DOJ know who you are, and we know in some detail what you’ve been saying about the government’s role in the healthcare system. And we find it very interesting.

I must have looked as calm and collected as Richard Nixon during the Kennedy debates.

In short, I doubt that such episodes with the Feds are things I could ever get used to, and I would prefer to avoid them in the future if possible.

And so I am ambivalent about the ultimate success of this book. I would be delighted, of course, if the book is successful, as that would indicate that a lot of people will have found it helpful to them, and perhaps some of them will be motivated to affect certain changes that might help all of us. The remote prospect of such an outcome is what compels me to write it.

But I must admit that if this book simply drops into oblivion – which is certainly the more likely outcome – that would be just fine with me. I will be able to tell myself (when what I think I see coming actually arrives), that I did what I could to sound the alarm. I will have done what I thought I must do. And having tried my best, I hope to enjoy my failure (and thus my success in staying under the radar as much as possible) with equanimity. And with an abiding sense of peace I will take my Obamacare medicine along with everyone else.

Here is the up-to-date archive for all the chapters that have been posted so far.

15 Responses to “Embarking On Something A Little Different”

  1. Ak says:

    Thank you and I look forward to reading your book. Your blog has been very interesting and thought provoking.

  2. Sarah says:

    An excellent plan, DrRich. I look forward to reading your book in progress.

  3. Pavlov says:

    Blogs are scary stuff, indeed.

    Your post reminded me of a med school friend, immensely intelligent, and even more immensely scornful of the countryside, who was almost kicked out of the med school because of his purportedly libelous internet writings: he dared saying med school was boring.

    In the turmoil, the guy — who always expected, not unreasonably, to get a spot in radiology –, ended up in family medicine, and practices emerg med in Gaspé (http://en.wikipedia.org/wiki/Gasp%C3%A9,_Quebec), pretty much one of the most remote spots in the province.

    So, beware, Rich, beware !

  4. James Gaulte says:

    You made my day.I look forward to seeing your book as it plays out on the blog.I envy your energy and courage to go ahead with projects like that.Your insights and points of view deserve wide audience particularly those that conform with mine. Seriously,Godspeed.

  5. Rob Sypher says:

    Go Rich, Go!
    I have referenced your blog to many of my citizen, non medical friends and neighbors.
    They are genuinely clueless as to the currents that are sweeping us along toward 2013 and beyond.
    This effort will be a great educational tool to interpret the herd care mentality of our leaders closing the gate behind us.
    They are stunned when they become clued.

  6. Joyce says:

    I’ve enjoyed your blog for a long time, and I want you to know that I appreciate the clarity of your arguments and I am glad that you are going to post your book here.

  7. SilentRunner says:

    Dr. Rich:
    RE: your run in with the DOJ

    May I suggest a couple of weeks with old colleagues of mine:


    After the stimulating training, The FBI, CIA, not even the NSA will be able to crack you.

    Good luck with your book, “Thomas Paine!”

  8. Jupe says:

    Before you begin political pontifications in the book, I’d like you to consider the idea that we live under a clever fake 2 party system. On all major issues, it is a Uniparty. Social issues like gay marriage and even contraception very well might be issues used to distract thinking people from realities like Romneycare/Obamacare.

    The same people fund both the dems and repubs, for the most part. And a lot of people are waking up to that fact. And the Funders care about neither individual liberty nor social justice. They care about keeping and increasing their power.

    Don’t piss off the activist bases, who are already naturally inclined to agree with your enlightened perspective and insights, and there’s no reason why your book shouldn’t be pretty successful.

    Also, consider distributing it under the creative commons license. That tends to wildly increase readership.

  9. seamd73 says:

    Congratulations on the new edition of your EP text! I remember, with some fondness, the first time I had an “aha” moment as a cardiology resident paging through your first edition. You are able to explain complicated concepts with ease, and in a way that is easily digested. It sparked an interest in EP that has sustained my career since.

    I await with eagerness the installments of your book on the “healthcare” system. Having become educated and experienced and jaded, I have drawn tremendous comfort from your blog that I am not the only one out here who smells a rat. Now, if only we had a support group or something!

  10. An MD says:

    Best wishes from a long time fan

  11. nsmurali says:

    Great beginning..You have already captured my interest. can’t wait to see what is coming!
    Dr. Rich’s books should be on the “must read” list for anyone studying healthcare policy.

  12. Karthik says:

    Dr. Rich,
    Thank you for your tireless work. Your book made me a better EP fellow, and ‘Fixing American Healthcare’ made me a better doctor and citizen. I never fully understood the doctor-patient relationship until your blog. You are making the world a better place, and your positive influence reaches to every patient I touch. Thanks for sharing your ideas. The world needs them!!!

  13. Clear concise, accurate and scary as all hell! There are those of us who have not given in and still uphold our oath but we are scattered across the country and are the unheard minority.

    You have given us a voice. Unfortunately, your analysis is accurate and I won’t sleep tonight worried that the Feds will come for you. Nonetheless, someone has to speak out!

    I will continue to share your work with those who follow my blog and my patients.

  14. SonjaS. says:

    I am very glad to have discovered your blog. As one of those people who managed to self-diagnose and self-treat because I couldn’t get system help, I also wanted to understand what’s wrong with practice of medicine today. What I found out was very depressing. I live in Europe, but it seems that the current health model is practiced in most industrial societies (and not just the Western societies). I applaud your courage and cross fingers you won’t have trouble.

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