Writing for the Lay Public: Rosanne Leipzig and Louise Aronson

Eric: Welcome to the GeriPal podcast. This is Eric Widera.

Alex: This is Alex Smith.

Eric: And Alex, who do we have with us today?

Alex: Today we are honored to welcome two esteemed guests, Rosanne Leipzig, who’s a geriatrician professor of Medicine at the Mount Sinai School of Medicine, an author of Honest Aging: An Insiders Guide to the Second Half of Life, as well as a newsletter, Focus on Healthy Aging that comes out monthly. Welcome to the GeriPal podcast, Rosanne.

Rosanne: Thank you, Alex. It’s a pleasure to be here.

Alex: And we are delighted to welcome back. Louise Aronson, who’s a geriatrician professor of medicine at UCSF and author of Elderhood: Redefining Aging, Transforming Medicine, and Reimagining Life. Welcome back to the GeriPal podcast, Louise.

Louise: It’s great to be here. Usually I have your voices in my car.

Eric: And for our audience, if they can’t tell, there’s a theme here. We have two authors, books, op-eds, prolific authors, and today’s podcast is a two-part special. So this week we’re going to be talking about writing for the lay public, and next week we’ll be publishing a podcast on writing for healthcare providers. So two different things, really excited about this, but before we dive into that topic, Rosanne, I think you got a song request for Alex.

Rosanne: I certainly do. It’s the Activity Room.

Eric: And tell me about why did you pick this song?

Rosanne: Well, I first heard it probably before I decided I was going to be a geriatrician, which is a long time ago. And I loved it. Ronnie Gilbert sang it. She was one of the original weavers, and it’s about how I hope we all look at getting older.

Alex: That’s great. Thank you for this. I really enjoy the song. Here we go is a little bit. (Singing).

Eric: That was great, Alex.

Louise: That was awesome, Alex.

Rosanne: I always thought the title of that was, If You Ask. So when I went to find it, I had a little bit of trouble.

Eric: Alex is just happy you didn’t ask for a Taylor Swift song. [laughter]

Rosanne: You don’t have to worry about that.

Alex: A lot of those recently.

Louise: Yeah, we may not be the guests for that request. [laughter]

Alex: This is fun. This a little bit of musical theater interlude. Enjoyed that. Thank you.

Eric: So let’s dive into the topic. I’d love to talk about some of the details about writing op-eds and books, but maybe we can start off with what motivates you to do this because I can imagine it’s an incredible amount of time to write books or even to do op-eds. Rosanne, I’ll start with you. What motivated you to write this book?

Rosanne: I think I was motivated by the number of times patients asked me to get rid of their pot-bellies, quite honestly. It has to do with how little is known about normal aging and the people who are doing it have no idea what’s coming, what’s normal and what’s not and what they can do about it. And unfortunately their doctors may not know a whole lot more than they do about some of these things. So I felt like over all these years I have learned so much from my patients and from the science, that it should be out there in one place where people can easily access it and help themselves.

Eric: Did you know what you were getting into when you started this process?

Rosanne: Hell no. [laughter]

Eric: Would you have done it if you did?

Rosanne: I don’t know. I mean there are several answers to that piece. Okay. So one is the incredible amount of work, learning a whole new way of writing, et cetera, which I’m sure we’ll get into. The other, and I’m sure Louise can speak to this as well, is how much publishers don’t want to deal with aging. Okay.

Eric: Why is that?

Rosanne: Because –

Louise: They’re human. The whole species doesn’t want to deal with it.

Rosanne: Right. They don’t think it’ll sell, they think it’ll turn people off. It’s just extraordinary. So I had the idea and then I tried to put it out there and publisher after publisher had no interest because it was about aging and it wasn’t about backwards aging or reverse aging or it was about honest aging.

Eric: Yeah. If it was anti-aging, you would get tons of probably interest in it.

Rosanne: I think so. I think so.

Eric: Yeah. Louise, you wrote a book-

Rosanne: It’s about those non-evidence based things, right? Because have you seen anybody who isn’t aging? Have you seen anybody not die? It’s really strange.

Eric: What motivates you, Louise, to write for the general public?

Louise: Well, I think I like writing. I mean, even though there are moments where you just want to jump off a building or shoot yourself, but that’s true for many things in life. When it’s going well, it makes me incredibly happy. I like crafting sentences, I like thinking through things in the way I can. When I write, I learn a ton from that. And then I feel like when I’m in clinic I’m helping individuals, and you only have so much time to help so many people. And I tend to think of writing as my version of public health. Even if I write a scholarly article. In clinic, I’m helping what, hundreds or thousands. You write a scholarly article in geriatrics, it’s not dissimilar. Hundreds or thousands, maybe it’s New England Journal, you’re getting to tens of thousands or more. Who knows?

You write for the New York Times and it’s a top 10 email thing and you’re talking millions. And we’ve also seen in medicine how many times when the public says, what’s going on? Medicine changes. People write scientific articles within medicine time and time again. One of my favorite examples of this is the quality and safety movement, which is everywhere. Bob Walker and others had a million articles, nothing happened. He wrote a New York Times bestseller and now we have quality and safety in every aspect of healthcare. So you take it to the people.

Eric: And as we think about doing this, I’m going to turn to you Rosanne. So you have this idea of what you want to write about, what do you do with that?

Rosanne: What I did with that was to mull it around in my brain for quite a while, write a lot of outlines, trying to figure out what it was I was trying to do and talk to a lot of people about what they wanted to know, in this case for this book. And what I kept hearing from people was this, and we’ve all heard it, this real negative sense that this stuff happens to you as your age and there’s nothing you can do about it. And I remember reading Elizabeth Eckstrom, was mentioned in a Times article about somebody with swollen legs and she talked about putting your legs up for half an hour before you go to bed. And my patients started coming in talking about why didn’t you ever recommend that to me? And it really, it’s those sorts of things which are not high-tech that can make such a difference in someone’s life if somebody mentions it. If you ask.

Eric: Yeah. And how about you Louise? Like Elderhood. I was actually just in a bookstore in the marina in San Francisco. I was walking down one of the main aisles. I saw Elderhood there. Oh, I know that lady. Did you just have the I idea, I’m going to write this book about elderhood, I know what it’s going to look like. I already have the whole thing in my head. Or what does that process look like to you?

Louise: No, so I definitely don’t outline, because if I know what’s going to happen, I’m already bored. Part of why I write is so I can delve into new things and part of why I always am changing up what I’m doing at UCSF is apparently my boredom threshold is not what it could be. So I always want to be learning and trying new things. And the word essay actually comes from learning, trying. And so I have a topic, I have ideas and interests and often for a great deal of time before that I have the beginnings of, I’m actually scared to count but 40, 50 articles, different ideas just because if I don’t have time I’ll speak into my iPhone or I’ll type a quick… As much as I can get down into a Word document and save it. And then I’m reading and thinking and saving things to my reading list and putting things in and it all eventually comes together.

So I’m starting a book, I’m at the beginning stages of a book now. And I have various ideas of what it’s about, but I couldn’t articulate it until I get farther in. And that’s because I’m exploring and learning. And I feel like that’s a good way to bring the reader along too. Come learn with me is a very friendly way of saying things instead of, me expert. And I think friendliness is also something Rosanne and I have in common because if you look at her book, which is terrific, one of the things I love best about it is the tone, which is this is an expert, but she’s speaking to you as a human being. And that’s another advantage I think, of public writing.

Eric: And that also reminds me of Atul Gawande’s books. It’s never, I am the expert in this and this is what I say you should do. It’s learned this throughout my process of researching this and talking to people. And I’m going to share what kind of, how I learned. It feels like every book that I read of his goes in a similar pattern like that.

Louise: I think that’s his MO. I love his just because this is a palliative care audience in the article that then turned into being mortal, New Yorker, I don’t know, circa 2011 or something. He says something like, “I thought palliative care was you hooked them up to morphine and walked away.” Or something. And then he kind of walks with the reader into what is it really? And how great is this? And it’s a fabulous approach. It’s very friendly.

Eric: Yeah. It’s sharing that vulnerability, the lack of knowledge and we’re going to learn this together.

Louise: Exactly.

Eric: I wonder as we think about, because that’s a great example. He started off with an essay, right, and then it turned into a book. Rosanne, why didn’t you just do a couple essays about this instead of doing a book? Or-

Alex: How do you decide?

Eric: How do you decide what to do? I’m going to do an oped to talk about this or I’m going to write a book or I’m going to write. I’m going to see if the New Yorker’s interested where I got a little bit more room.

Rosanne: So for this book, I actually… You know the book, What to Expect When You’re Expecting? Okay, that was the book I wanted to write for aging. And so it was very clear to me. And actually I’m writing a talk right now and I’ve been thinking a lot, this is a bit of off-topic, but we’ll get back. I’ve been thinking a lot about why the word old is a four letter word. People hate the word old, except if they’ve got something they want to take to Antique Roadshow. But other than that old is bad. And I was trying to think of something like that where people actually flipped the meaning of the word and the way it’s used. And I realized as I was looking at What to Expect When You’re Expecting, that pregnancy was like that. That when I was growing up, pregnant women were invisible.

They wore these tents, they weren’t allowed to work anymore. My mother used the word fragrant instead of pregnant. Now that’s a whole story about my mother, but that’s another thing. But it really, it was not talked about. And now you get pictures of Demi Moore on the cover of Vanity Fair. I mean there’s a whole new way that being pregnant has come out of the closet and it’s a wonderful thing. Can we do that to being old? So that’s what I was thinking about, that by normalizing aging and getting people to know what to expect, it would be something that people would become more comfortable with and actually become a desirable state. I mean we have 20 to 40 years that or after the kids are out or after I’m talking to the converted, I know that. But after retirement and how can you not think of that as a gift? So that’s what really got me going on writing a book about all this.

Eric: Yeah. Louise, I know you have some thoughts about the names and the titles and the labels we put into things, like older adults, elderhood, elderly. Thoughts on that?

Louise: Yeah. But from different angles. So elderhood is this is a long diverse phase of life. So I needed a word that was the analog for childhood and adulthood that acknowledged the 20 to 40 years that Rosanne just talked about. And that also acknowledges that 60 is about as similar to a hundred as 20 as to 60 or two is to 20. Like, hello, we all know this. But you don’t have systems and structures if you don’t have language. Language is how we create our conceptual framework. So I think elderhood is one thing, the old elderly thing I also feel strongly about for the same reason. We need to have language and 60 is different from 80 is different from 100. And we have ways of describing, actually all of adulthood suffers from this. We do really well with children. You’ve got your neo, your infant, your toddler, et cetera, et cetera. And we keep getting new category’s like tweens. Only when did that come like 20, 30 years ago. Anyway, in my lifetime, tweens weren’t invented.

So we need to do the same thing for this new 20 or 40 years or we don’t know what we’re talking about. I do think one of the challenges is that it’s not so linear. Unless there’s something very wrong with the child, they go predictably through the steps. Whereas we all know from our expertise that you can be frail after your chemo and be incredibly healthy again a year later. And so there’s a back and forth and you can be frail in 68 or you can be healthy in 92. So that makes it much more difficult. And I actually think, although this sounds like a linguistic and conceptual problem, I think because we have a linguistic, conceptual problem, the health system is unable to address aging issues with the same lenses and tools that it uses for kids and adults. And that is happening to our detriment.

And if we don’t lead on naming and defining these things, older people will continue to get very bad care. So I think it’s important. And I think when groups like JAMA or JAG or the leaders of the American Geriatric Society say we have to call everyone older adult, they’re doing a disservice to all of us. I am now what I would consider an older adult. I have gray hair, I have actually some of that belly thing Rosanne was just talking about, which I am so upset about. That really needs to go. Tell me what I need to do. But I have a mother who’s 30 years older, she’s old, she’ll be 90 this year. Who’s going to not call her old? That is insane. And she’s bordering on elderly because she’s getting a little more frail. We need words.

Eric: Yeah. So what are the words? What would you recommend? Because AGS recommends, I think JAGS recommends older adults.

Alex: Did you just point at me? [laughter]

Eric: I did just point at you, Alex, for those YouTube listeners. [laughter] Is Alex doing a disservice?

Louise: I believe so, yes. Although I don’t think it was Alex’s article and you should publish opinions. Maybe I’m not right, but I’d like a pushback. I feel like I can make a case why older adult is insufficient. So if they think it’s sufficient, they’re only argument in the couple of articles that have been published on this now. And I think only one is in your tenure, Alex, but is that people don’t like the words. Well they don’t like the words because of ageism and internalized ageism. Those words are not inherently prejudicial.

Rosanne: That’s right.

Louise: And people have taken back other words, queer, black. There are so many words that groups have owned and have increased not that we have no prejudice at this point, but if you can’t even talk about something, how are you going to raise the lives of those people and have them count as much?

Eric: Rosanne, what do you think?

Alex: Hoping that I’m going to respond to that and rise-

Eric: Yeah, I was giving you a pause, Alex, then I decide I’m going to punt it to Rosanne.

Alex: You’re going to be waiting a while. Let’s punt it to Rosanne.

Louise: Is it a politically precarious situation there?

Rosanne: I think the word old is a great word. I have no trouble with the word old. I think it is a word that we can take back to Louise’s point about the fact that there are stages and they don’t go in a linear fashion. I think that’s a different issue. We have a word children or child, or young that we use at that end. And at this end I see no problem with using the word old. But I do think it’s incredibly important that we recognize the heterogeneity and the resiliency. One of the things that, when I talk about the book I talk a lot about is frailty and what you can do to avoid it.

Not that everybody can, but there’s a lot of stuff out there that people don’t even recognize that that’s really what they’re trying to do. And that one of their biggest fears is of aging, is frailty, losing their independence and their function. And then while we’re talking on that level, another word that I think we need to redefine is independence. Independence means that you can do everything you want on your own. And as you get older, we need to think of independence as doing everything that you want, using whatever you need to use to be able to do what you want and have the life that you want. So I couldn’t exist without my hearing aids. I love my hearing aids. I am so glad we have that.

Eric: But it’s true for everything stage in life. So when we think about independence, being able to get to the place that we want to be, we’re reliant on things like transportation, whether it be cars or trucks or trains, and how society is built around that. So I mean, I think this is the hard part is how do we pick a different word than independence? Or do we realize that your ability to do things is wholly reliant on everything else that’s built around you. Whether again, be transportation, food delivery, things like that.

Louise: Well again, if you take that approach, you also get rid of ableism and ageism against children and prejudice against people who are ill. It’s much more inclusive and we can align ourselves with others. And it aligns with the world health definition of health, which isn’t the absence of disease.

Eric: So I got a question now all of this talk about picking the right words is making me even more fearful of writing, because it seems like it’s just a landmine. I am going to blow myself up if I put myself out there. So I’m just going to shrink back into my little old world.

Rosanne: So it’s very funny. I felt that way my whole life. I am not like Louise. I am not a writer naturally. And I was even the kid who didn’t write her parents from camp. Okay. I came from a family where you didn’t write things down, somebody could find them and hold you to them or all of that kind of stuff. There’s a little paranoia in the family for good reason. And so I just didn’t like to write. And then word processors came in, and I started learning how to write because I could get rid of anything I wanted. Nobody could have to see it, and I could just throw up on the piece of paper. And I think when it comes to things like, is this the right word? Is this not the right word? I think there are two things.

One is somebody will always object to what you’ve done. That’s all. If you’re going to get into this business of putting your thoughts and your beliefs out there, people will challenge them and will come back. And that’s something that you do have to learn how to live with and can be a hard thing to learn how to live. But one thing that I’ve been doing is I show my stuff to a lot of people as well before I put it out there, so that I at least hear what people are having a problem with. I may not change it, but at least I’ve got some idea of how it’s coming across.

Eric: Yeah. Is that what you do too, Louise? Do you do a lot of other people reading your stuff before you send it out?

Louise: Yeah. I mean, to some degree and also me putting it aside and rereading it. I mean, I do think one of the advantages of writing, there’s delete, but there’s also that, you draft. Rewriting is a huge part of writing and you can learn as you go. You can make yourself better or wiser, kinder or more generous in each draft. And I feel like that helps the draft and it helps the person. It’s kind of a great thing that you can do that with input from others and not, I think that no risk, no reward. If people are getting upset, it’s because you’re challenging something and ideally you’re not randomly challenging it, you’re challenging it because of some inequity or not good outcome. So it’s a risk that’s worth taking because if the potential benefit is to many, then you take that risk. And particularly if you’ve thought it through embedded it, then maybe they just have a very different stance on life or different values as can happen. And sometimes people write you letters and you learn something really important.

Alex: Can I ask about the role of editors in your writing?

Rosanne: Is there a personal reason you’re asking that?

Alex: No, no, no, I’m just kidding. No, not from that perspective, but when you’re writing a book, it’s a big mystery to me. To what extent are the editors involved in your writing, giving you feedback? At what stages? Do they like wholesale red pen it? Like I red pen my mentees and we go through 17 versions. What is that process like? I’m sure it’s different with different editors, et cetera, but what was it like for you, maybe Rosanne first?

Rosanne: Well, Alex, the first thing I have to say is that for any of my former fellows who are listening, Alex also uses a red pen. They laugh at me about that. My book went through a couple of iterations in terms of publishers and editors because of the pandemic. And the first editor I had, I basically sent him chapters and he would write things in the margins and they would come back. I think the biggest role he had for me was clarification. One thing, especially our kind of writing, there’s some jargon and helping me iron out the jargon, but he also challenged me to get the science in there in a way that people who were not scientists could read and understand what was happening to them.

And there were times that I was tempted to skip the science and then I decided, no, it made a lot of sense because people are more likely to do something if they understand the reasoning behind it. So that was that editor, the editor for the publisher I ended up with, quite honestly, I didn’t find as helpful as my friends that I sent the manuscript to and how they helped me with editing it. But as Louise does, I iterate and reiterate and iteration after iteration after iteration, put it away for a while, come back. So that by the time it’s going out there, I’m feeling fairly good about it. Not that I couldn’t make another change.

Alex: Right. And Louise, how about you? What has been your experience with editors?

Louise: Well, I think it does vary a lot from journals to books. And many of us have had the experience of you get all kinds of feedback that’s helpful or you get things that are sort of out there. My book editor, I had a multi-book deal. So I’ve had the same editor who is a lovely and helpful person. And generally I’ll know where the weak points are and she’ll just say like, “Well, I really thought…” I’m like, “Yeah, I know.” I buried that for a reason. But so she’ll work at different angles if you’re submitting 600 pages or they get a line by line and not necessarily, but you’ll also have a copy editor and you have all these people, and then you have friends. And it’s actually fascinating who’s helpful and who isn’t, because it isn’t necessarily who you would think would be helpful, which every time that happens surprises me.

But it’s kind of fun. Some people will send you comments that are absolutely transformational and just nail it. And maybe that’s a mix between how you see it and how they see it. But I do think getting lots of opinions just to make sure that it is logical, it makes sense. You’re hearing the problems early on and you have to be willing to hear them and to think about them. That’s another thing. But that’s where putting things aside and coming back to them are critical because you may have a beautiful sentence, but if it’s not serving the peace it needs to go. Flannery O’Connor called that killing your darlings. And it’s not your darling… It’s your darling if you wrote it last week, if you wrote it sometime last year, you’re like, delete. It’s much easier.

Eric: Can I ask some more specifics about the process of writing books? If you don’t have a multi-book deal, like Rosanne, you don’t make the book and then shop it around. Do you shop around the idea?

Rosanne: So I had a proposal and I shopped the idea around and I kept getting, no, no, no, no, no.

Eric: So you were just emailing publishers?

Rosanne: I had some friends who had had, I can’t remember what it’s called, they put books together and would shop them out and get publishers for them. And they had retired. And so initially I started working with them and they helped me put my proposal together. And then we kept getting the same thing back over and over again. You need to change the title to make yourself 10 years younger, whatever. And I said, “No, that’s not the book I’m writing.” So I had a patient who was a publisher, who was an agent, and I asked her, but she didn’t do this kind of book, and she kind of asked around too. And then very strangely, I got this little publisher from a woman who is a physician whose father had this little publishing company that did mainly textbooks. And she asked Mary Tonetti and Kate Callahan if they knew anybody who wanted to write a book about aging, both of whom knew all my worries, troubles. And they said, “Yeah, talk to this guy.” So I did. And that’s how I ended up actually writing the book. Okay. Yeah.

Eric: Another question, details. Both of you have a lot of other things going on in your lives. How do you find the time? Do you set aside time throughout the day, you block it out to write? So the other aspects of your life, don’t fill it in? Do you just do it during empty hours? How do you think about that? Louise, I’m going to start with you.

Louise: Well, writers always talk about you have to write every day and you have to read every day. And they’re not doctors. So that’s my response to that. Sometimes you can’t. Like in pandemic, I wrote a few articles early on and then when I started working for the city and state, I just stopped and partly was the horrible, horrible, horrible things we were seeing and that the government was doing to older people. And part of it was just not having time because I was doing my UCSF job and that job. So sometimes I don’t write. And I actually stopped reading then too, which also happened to me in residency when I did the cancer ward, the first… Just sometimes things are so horrific it shuts me down and I can’t bear any more pain fictional or otherwise. But when things are not in international crisis situations, then I’ll often go in spurts. I mean, if it’s ideal, I will do it first thing in the morning, but if I’m really busy at work, it tugs at me and then I have this anxiety and I have to do my job.

But we have weeks that are better and weeks that are harder. And if I’m disciplined or you get a lucky clinic where you can write your notes, it’s not going to take you the rest of the week to get through them and make all the phone calls and all the arrangements and stuff like that. That helps. And then I’ll usually have a run of things. I also tend to acquire information because my process is so different from Rosanne’s, I can write little pieces of things that then when I get time, and generally, I will have blocks where I’ll take a vacation or I’ll go to there are these artists or writers colonies, or you could do fellowships to do this where you actually get time. And in two or three weeks at one of these places, I can do what I do six or eight months in my real life with the stopping and starting.

But I think if you’re going to be a good doctor, you have to be clear that when I’m doctoring, I’m doctoring and that’s what I’m doing. That’s my job. That’s the first and foremost. So for me, if I write, it’s usually first thing. And then when I switch hats, I completely switch. And people are like, are you in the room thinking? Actually I had a 95-year-old yesterday make this great comment. And I’m only hoping the student who was with me can remember what the hell it was. But I was focused on his very ill wife. So I don’t remember it. But I really think for integrity reasons, you have to be one or the other.

Eric: Yeah. I was like, I’m fascinated when I read medical books and they’re quoting patients these long paragraphs. How in the world did you do that? I can’t even remember what I had for lunch yesterday, let alone what somebody told me. Are they just writing down all the conversations that they’ve had and then picking through that?

Louise: Yeah. I mean you can paraphrase to some extent. You have a disclaimer saying, this is to the best of my memory-

Eric: Rosanne, how do you find the time?

Rosanne: I definitely am a morning writer.

Eric: Do you block time off in the morning?

Rosanne: I just get up early and I have a routine in the morning. And when I started writing, my routine moved the crossword puzzle down a little bit, and I didn’t look at my emails until a little later. Now we’re talking seven o’clock, we’re not talking real late. But I just had these hours that this is what I was going to do. And the older I get, the more I have to decide what am I able to do at what point during the day? So writing is definitely a morning job. The leading emails, four o’clock. Great.

Louise: Right. And even if you have all day, you’re going to do your best work between five and seven anyway or something usually. So you lose lecture later in the day.

Rosanne: The only thing I just wanted to mention while you were talking about this, is when you’re writing about medicine, it has the nerve to change while you’re writing.

Eric: Oh, yeah.

Rosanne: So you get something done, you think, beautiful. And something else comes out. And what I found myself doing to begin with was every time that happened, I went back to that chapter and made the changes then. And then I said, this is ridiculous. And I made a bunch of file folders, one for each chapter and whatever I saw in the journal in the paper, just put it in there. And when I finished the book, I went back through and added all that in.

Alex: Can I ask for, if we have listeners who are interested in this sort of avenue of writing for the lay public, should they start with a book or would you advise that they instead start with something else, like a short story, an essay for a local paper or national paper or a magazine? Something like that. What’s like the first step?

Rosanne: I think there are different… Louise and I are different types of writers. So I am someone who writes much more integrating the science with what I’m doing and in reaction to a lot. So a book is a huge commitment and you have no idea till you’re done with it if it’s got any legs or not. So I definitely would not start with a book. A chapter in a book, all right, but not a book. An article for a newsletter, great. Get mentored by somebody who does that and work your way through.

I find that things like a letter to the editor, they come out because my gut gets hit by whatever I read and I just have to respond. Okay. And it’s quick, it’s three lines or three sentences and very quickly whether it’s going anywhere or not, but at least it feels good because you’re getting your thoughts out there. So if you’re interested in that kind of stuff, I think, and this is for journals as well. I mean letters to the editor can be anywhere. All right. And don’t aim for the New Yorker to begin with.

Louise: Oh yeah, yeah. They get a lot of that. You’re almost certainly not there. You could be, but probably not. You have to be the one in 100 billion, which most of us are not. I think it depends a little bit on the size of the idea and how comfortable you are with expressing it. It doesn’t have to be great literature to make a big difference. There’s sort of more literary writing, but it just has to be clear and understandable. It kind of depends on your goal. And do you have a whole cohesive, big idea? Even if you do, it’s a good idea to write an article or a chapter or something and send it out because you’re more likely to get an agent and a publisher if they’ve seen something and they want more of it. If you really don’t know how to write, actually, sometimes quote Eric in my talks on this, because you years ago said something about in doing the initial GeriPal, sort of just blogging, you would do it.

I don’t remember what you said after Kai was asleep and you would work on it. And that was how you learned to write by doing it. So it is called a practice, much like medicine. And so you can get good, but you can always get better. And practicing in different forms and styles is fun and interesting. And if you’re nervous, like Alex, your thing where you were writing those case pieces for the New England Journal and you worked with tons of other people. There’s so many good ideas for how to get yourself out there. If something makes you angry, if something is so wonderful. And when you tell everybody this story, they’re like, oh wow, write it. Other people will have the same reaction. It’ll be fun.

Eric: And Louise, if I remember correctly too, when we’re thinking about writing op-eds you, if I remember correctly, you actually think about where you’re going to send it, but you don’t just have one place. You think about the place I’d love to get into, my second, my third, my fourth. Is that how you think about op-eds when you’re also kind of shopping it around?

Louise: That’s how you really should, because your odds at the New England Journal are better than at most newspapers by exponential factors just given the numbers of submissions. So that gives you a sense of perspective. On the other hand, if you’re a healthcare professional, you have a personal experience, that is a version of expertise in the public sector that doesn’t necessarily count. I could write an article now about tuberculosis and if the New England Journal had any sense, they would not publish it because what do I know about tuberculosis? Very little. But if I were to get it, I could write about it as an expert for the Times that they might love that or if I had a patient with it or something.

So you have to kind of think, who do you want to be talking to? Also, are you trying to reach policymakers? Are you trying to reach the public? Are you trying to reach people in your local community? Well then if you publish somewhere else, that’s not going to be helpful. Is this issue really local or is it bigger than that? On the other hand, we sometimes see that you publish something locally and it gets picked up nationally because it resonates. So don’t assume that even if it’s in that great journal, this San Francisco Chronicle as opposed to the New York Times, that it’s not going to make a difference because it really can. And one of the mistakes I see, which Rosanne sort of alluded to with don’t send it to the New Yorker, is that people aim high and then they quit.

And that means it never gets published. And it means writing research articles too. You’re going to have a lot of drafts and there’s going to be a lot of red ink if you’re working with Rosanne or Alex, or comments in the margin on Word if you’re working with me. And I feel like a huge part of it is having the resilience to just keep writing and rewriting until it gets to a place that it’s ready. Yeah. Talent is something, but it’s really about putting in the work and then keeping also to place it somewhere or waiting for an event. Biden trips, which I’m actually getting annoyed about people. In his eighties, he’s going to trip. It doesn’t mean he can’t be president, but whatever, that’s a different conversation. So then maybe it’s your fall article.

Eric: Yeah, Jimmy Carter goes into hospice. It’s a timely time right now to write a op-ed about hospice care.

Rosanne: Yes.

Louise: Totally. Yes.

Eric: Any other tips? Because I feel like op-eds are a nice kind of entryway into writing. Any other tips for op-eds? Either of you?

Rosanne: Don’t try to say too much it. When you start an op-ed, oftentimes every thought you’ve ever had about that topic comes out and it’s a limited number and they only really want a couple of ideas with really catchy ways for people to think about why this is important or something like they just never thought about before. So the line from my times up many years ago that I hear over and over again from people, is every medical student gets four weeks of pediatrics and four weeks of OB/GYN, but most will never deliver another baby or take care of another baby other than their own. But they’re going to take care of a lot of older people. Right? So it’s there-

Louise: I do quote you on that quite frequently.

Alex: Yeah. Great line.

Rosanne: It is. Yeah.

Louise: No, I would say something similar. And also it’s hard to reduce this. I give hour long talks on this and do three hour long workshops. But first you’ve got to get the people’s attention, because they’ll only keep reading if they start reading. And in the world where we swipe so easily, what’s going to be your hook? Is it something counterintuitive? Is it something funny? Is it a great story? Is it a fact? Because I think we can really use science to advantage and people hue to different sorts of information. So hook them in. Don’t give them too much. Don’t tell them about your whole career and know what you want from them. That’s another thing. Do you just want to raise awareness? Do you want them to contact their legislator? Do you want them to vote differently? Do you want them to take better care of their health? What is it you want? Because the more clear it is, the more likely you are to produce the outcome you are hoping for.

Eric: All right. Lightning question because we don’t have another two hours to talk about all these tips. Any great resources for aspiring writers? Books that you think are really important or any other pieces of information websites they can go to?

Louise: I think for op-eds, the opedproject.org is great. And you can actually take workshops with them as well, but they have all kinds of resources there.

Rosanne: It’s good.

Eric: Great. We’ll have a link to that on our website. Any other books or resources?

Louise: Oh, there’s so many writing books.

Eric: I know you got to pick one.

Louise: This is not my forte.

Rosanne: Me neither.

Eric: What was it Bob Arnold said, Alex again? Do you remember?

Alex: Anne Lamott’s, Bird by Bird?

Louise: Oh, Bird by Bird. That was in my head.

It’s like when you sit down to write and you realize you haven’t dusted the blinds yet, that it helps with the emotional part of it.

Eric: Well, I want to thank both of you for joining us. We can go on for another couple hours, but it is the end of the hour and that means we get a little bit more of… The title of the song again?

Alex: The Activity Room.

Eric: Activity Room. Alex, let’s hear it.

Alex: (Singing).

Eric: Thank you, Alex. Thank you Rosanne, Louise, for joining us on this podcast.

Rosanne: Thank you.

Louise: It was a pleasure.

Eric: And with that, we look forward to all of our listeners’ books and op-eds and other writing samples. Send them our way with that. With that, goodnight everybody.