The surgeon poised to remove your gallbladder or the internist you've consulted for a routine physical may be harboring dreams of writing a best-selling novel.
To guide them toward that goal, two doctors who made their mark in fiction have drawn a growing number of their colleagues to a three-day seminar held each fall in Massachusetts that offers practical training on how to write medical fiction and get it published.
Tess Gerritsen and Michael Palmer, two of the biggest names in the medical-thriller genre, make it plain to the aspiring authors that their chances of success are small, but there is no shortage of physicians prepared to give it a shot.
"It's amazing how many of them are interested," said Gerritsen, whose bestsellers include "Life Support," "Gravity" and "The Surgeon."
She said part of the reason may be the frustration some doctors feel about a profession that seldom provides room for creativity.
"You're not supposed to be creative in medicine. You do what you're supposed to do and be objective and not make up things," she said, suggesting that those who look to writing "have this need to express another part of their brain."
Palmer, author of 10 books that include "Critical Judgment," "Natural Causes" and "Extreme Measures," said disenchantment about the way medicine is practiced is another catalyst that has doctors exploring other options.
"We've taken quite a pounding from managed care," he said. "Incomes have dropped, job satisfaction has dropped horribly, and there is so much pressure to conform to what bureaucrats think is good medicine."
Palmer, who lives on the North Shore outside Boston, keeps his hand in medicine, working 20 hours a week directing a program that helps physicians deal with illness or substance-abuse problems. Gerritsen, who fell in love with Maine during a vacation to Camden, moved here in 1990 and writes full time; she never applied for a Maine medical license.
Doctors, of course, have pursued non-medical writing long before Palmer and Gerritsen took up the craft. The most celebrated include dramatist Anton Chekhov, storyteller W. Somerset Maugham, Sherlock Holmes creator Arthur Conan Doyle and poet William Carlos Williams. Best-selling author Michael Crichton, a graduate of Harvard Medical School, pioneered the techno-thriller.
Gerritsen, a California native, was a practicing internist in Hawaii when she switched from medicine to writing, a change that allowed her to stay at home with her two young children. She wrote eight romantic suspense paperbacks for Harlequin before coming out in 1996 with "Harvest," her breakthrough medical thriller about the black-market trade in donor organs.
Palmer, a former internist who went on to become an emergency room doctor, was inspired by the success of Robin Cook, the ophthalmologist whose 1977 bestseller "Coma" is credited with creating the medical-thriller genre. Palmer met Cook when they were undergraduates at Wesleyan; they subsequently trained together at Massachusetts General Hospital.
The Medical Fiction Writing for Physicians program got its start when Steven Babitsky, who organizes conferences and seminars for doctors, approached Palmer with the idea.
Feedback from doctors indicated that there was a market for such a program, but Palmer was reluctant to take on the project by himself. After Gerritsen agreed to team up with him, they scheduled the first program in September 2000 at a resort on Cape Cod.
More than 70 doctors attended, and enrollment grew to 120 in 2001 and 200 this year. Babitsky was so pleased that he launched a similar program this year for lawyers, taught by authors Lisa Scottoline and Stephen Horn.
Both courses delve into the mechanics of writing, including plot and character development, back story, points of view and pacing. In the medical program, Gerritsen and Palmer take a tag-team approach as they jointly lead all the writing sessions and take turns offering ideas.
Although the program is not specifically focused on medical thrillers, it is that genre that most students have in mind.
"Evil drug companies, evil HMOs -- they pretty much stick to medical topics," said Gerritsen, who pushes students to refine the premise of their stories and look for ways to enhance their emotional force.
The instructors' approaches to writing differ, showing students that there is more than one path to success. Palmer, for example, prepares a detailed outline to keep from having to rewrite the entire book; Gerritsen uses no outline, preferring to simply plunge in and write.
The course also includes sessions on how to market a book, taught by literary agents and editors who explain the publication process.
Babitsky and the two authors know of no students who have had their work published, but several have completed books and signed on with agents.
Although they provide students with the tools for success, Gerritsen and Palmer do not gloss over the fact that the odds on getting published are stacked against them.
"What's difficult for physicians is that they're all very high-achieving people. They've always been straight-A students, and they've probably never gotten a rejection letter in their lives," Gerritsen said. "It's stunning for them to come up against an industry that says, 'No, I don't want you.' But that's the reality for anyone starting out as a writer."