Saturday, April 24, 2010


Dear Query Shark,

Dr. Kate Tilton learns about medical fraud the hard way—as a victim. Her recovery from disfiguring cancer surgery at the hands of a trusted colleague, Dr. Stephen Berg, is complicated by a growing suspicion that a mistake was made. The surgical findings contradict the X-ray and biopsy reports that led to her diagnosis.

Your writing is very passive here. "A growing suspicion" is greatly improved by making it "her growing suspicion"; "a mistake was made" to "her doctor made a mistake."

And correct me if I'm wrong here but medical fraud is commonly used to mean billing errors, not surgical errors. Surgical errors are called malpractice. I'm pretty sure they're two very different things.

When Berg dismisses her concerns as groundless, Kate insists on obtaining a second opinion.

Again, tighten this up: Berg dismisses her concerns (dismisses implies groundless) so Kate gets a second opinion. She doesn't insist on it. Insist implies she's making Berg do something.
She herself gets the second opinion, not Berg.

But when her X-rays and pathology slides vanish she is convinced that she has been the victim of a cover-up in a lucrative scheme to justify unnecessary surgery that she now fears took the life of one her own young patients months earlier.

There are 43 words in that sentence. Too many by half.

Also, if you can diagram this I'll eat my x-rays. I cannot over emphasize the need for simple, clear writing in a query: subject, verb, object. Start with that. Embellish as needed. Don't start with hilariously long convoluted sentences and try to edit them down.

Lacking evidence, she is about to abandon her case against Berg when she recalls that a single lock of hair, suitable for DNA matching, may still be contained inside a tiny locket worn by her deceased patient’s grieving mother.

And here is where you lose me completely. What the heck does DNA matching have to do with unnecessary surgery?

"contained inside" is a classic example of over writing. Either word works fine by itself: you don't need both.

Berg is tried in the girl’s death when DNA testing proves intentional manipulation of surgical evidence in her case resulting in surgery for a nonexistent malignancy. By inference, Kate is presumed to have been a target as well.

Implication not inference. I'll spot you that error this once, but this falls in the homonym category: errors I don't tolerate because writers should know better.

Berg’s conviction enables Kate to begin healing both emotionally and physically.

I am a retired family physician and I am seeking representation for The Bandaged Place, a literary novel that explores the sense of betrayal and outrage experienced by victims of medical fraud and traces one woman’s battle for retribution. It is complete at 80,000 words.

Thank you for your attention and consideration.

Yours truly,

Form rejection

Query word count: 591 (in other words, too long by half) The 250 word limit forces you to focus and pare down. If your query is too long it risks sounding like a synopsis, and that's a disaster.

Dear Query Shark,

Human error is commonly invoked as a defense against the litigation of alleged medical fraud when, in fact, the crime is deliberate and it is motivated by greed. Dr. Kate Tilton learns this the hard way.

Start with your main character: Dr. Kate Tilton learns the hard way that yadda yadda yadda.

In The Bandaged Place, Dr. Tilton reluctantly closes her medical practice in order to relocate with her husband, Peter, to a remote northern New England community where he has accepted a position with an expanding regional trauma center. It isn't the move that concerns Kate; it's the marriage. Peter is characteristically reticent and their relationship is distant. Nevertheless, Kate considers it her sacramental duty to stick it out.

Ok, but what the heck does that have to do with the first paragraph? Answer: nothing.

This is all that expensive medical training and practice rearing its head. As a physician, you learned to write things down in chrono-order, starting with "a patient came into a bar" and write down everything the patient mentions. Integrating all the information is the best way to reach a correct diagnosis.

(QueryShark learned about this by reading Dr. Lucy Hornstein's most excellent book Declarations of a Dinosaur)

This is not true for writing novels and, more to the point here, REALLY not true for writing queries.

You already know what's important (the diagnosis) since you wrote the novel. Focus on the key pieces of information that will entice a reader. I don't need to know the patient has hangnails if the problem is a shark bite to the nose.

Before long Kate finds herself clearing away the overflowing ashtrays and empty shot glasses that litter Peter's desk every morning. He refuses to admit that there is a problem but Kate knows better.

Right here is where the story almost starts.

Peter finally concedes that his partners are under investigation for insurance fraud. He worries that his career may be in jeopardy when he is summoned to testify in court. At the same time, Kate discovers a small lump in her breast.

If this is such a small town, how is it she (and everyone else) don't know the partners are under investigation for insurance fraud.

Kate schedules an examination and a mammogram before she shares any of this with Peter; he has enough to contend with. But when her X-ray report is suspicious for cancer, an urgent referral is made for a biopsy. Kate has no choice but to place her care into the hands of Peter's colleagues. This is a small town; no one else can do it.

And she can't drive to Boston?

When Kate's biopsy confirms an aggressive form of cancer, Peter struggles to be supportive even though he is obsessed with the demands of his job and consumed with worry over the conduct of the trial. Instead, despite her objections, two of Kate's new neighbors muscle in with persistence, grace and humor to support and care for her throughout the ordeal.

This isn't important.

However, Kate's recovery from disfiguring cancer surgery is complicated by a nagging intuition that something is wrong. At first, she is elated to learn that her surgery was a success. But elation turns to doubt and doubt, to despair when it dawns on Kate that the surgical findings are inconsistent with her X-ray and biopsy reports. Although she has no proof, she is certain that a mistake was made--a mistake that led to a grave misdiagnosis and to needless surgery.

This is where the important info is, but again, pare it down until you have one sentence: Kate realized the surgical findings are inconsistent with her x-ray and biopsy reports.

With the support of her friends, Kate summons the courage to confront her surgeon, Dr. Berg, about her concerns. When he dismisses her misgivings as groundless she turns, instead, to a former colleague and friend for a second opinion. But before she can see him Kate discovers that her X-rays and pathology reports have vanished. This confirms her growing conviction that she has been the target of a lucrative cover-up that she fears may have taken the life of one of her own young patients months earlier.

Pare down!

Lacking evidence, though, Kate realizes that it is futile to pursue her case against Dr. Berg and his associates and thereby, to clear her husband of complicity. She is about to admit defeat when she learns that a solitary piece of incriminating evidence may be contained inside the tiny locket of a grieving woman hundreds of miles away, if only she can convince the woman to relinquish it.

We don't need to know the entire story. Final clues, solutions, secret info--none are needed. The purpose of a query is to entice me to read the book, and that's IT.

The Bandaged Place, a literary novel, is complete at 75,000 words.

I'll eat my hat and yours too if this is a literary novel. My first choice is women's fiction, but you might actually have a medical thriller on your hands.

I am a retired physician, having practiced family medicine for over thirty years. Readers who wonder about misconduct within the health care system and its devastating impact on patients and providers alike will welcome this book.

I'm sure you hope they will, but honestly, no one reads novels to learn about misconduct in the health care system. That's what the National Enquirer is for. People read novels for entertainment.

And truthfully, a good novel simply can NOT be an accurate presentation on medical misconduct. Life is not a novel.

I hope you will, too.

Thank you for your attention and consideration.

I'm pretty sure the novel is going to need work after reading this. I don't think you've fully recovered from writing like a doctor. I see this with lawyers too.

Really good novels don't have everything on the page. Really good novels are like spiderwebs: the filaments, words, are important but the space they create, the unspoken, is what makes it beautiful.

You must trust your readers to make intuitive jumps with you and to know some of why things happen. They'll be able to do this easily if you write it by SHOWING, not telling.

This is a form rejection.


Anonymous said...

I really appreciate when you take the time to help us writers regarding queries.

This is an informative post and well received.

I fell in love with your second last paragraph, " they create, the unspoken, is what makes it beautiful..."

This line moved me. It's so true. As a reader, that is how I feel when I finish a book. The things left unsaid...

Thank you

Reena Jacobs said...

I'm not an expert on query letters, but I wonder (with a little tweaking) if this might work better as a synopsis. It's not the bare bones I'd expect for a query, but it seems to have all the details needed to show progression of the story. The only thing which seems to be missing is the ending.

Josin L. McQuein said...

Sharkie's dead-on with the "writing like a doctor" comments. This read like someone transcribing medical notes. Your choice of words is also more academic than useful.

The part that astonishes me, however, is your word count. Given how many (BIG!) words you used to write the query, I can't see how you managed a full story in under 80,000 words. That count and your demonstrated style don't mesh.

Merry Monteleone said...

This sounds like it could make a really good novel. Besides what was mentioned about the problems in the query, I have a qualm with the sequence of events.

If I'm understanding the query correctly, we have a doctor who's diagnosed and then treated for breast cancer and the crux is that after a mastectomy, she realizes she was misdiagnosed... but can't prove it because her pathology reports have disappeared.

I don't believe this. I can't wrap my head around a normal non-medical person like myself NOT keeping the pathology reports for a life threatening illness... let alone a doctor who can actually read them. They usually give you print outs of all the labs with your bill - an believe me, they never forget to give you the bill. Maybe you've written around this by having a small hospital that doesn't do things the normal way, but I'm just not seeing a doctor NOT take a copy to study and second guess herself.

Even if you convince me that all of the pathology reports have disappeared - she's had a major surgery that's visibly obvious to any medical person who looks at her - wouldn't the absence of records of that surgery be just as damning?

And the rest of the hunt to prove what's going on hinges on her ability to prove she herself was misdiagnosed, so I'd go back and make sure that your character and the situation are plausible, and plausible for most of us without the medical background, because we'll be the bulk of your readership.

Stephanie Barr said...

I'm afraid I would not have read past "sacramental duty."

Alyson Greene said...

Query Shark,
This line moved me too:

"Really good novels don't have everything on the page. Really good novels are like spiderwebs: the filaments, words, are important but the space they create, the unspoken, is what makes it beautiful."


Who knew the shark could be ruthless and poetic on the same page?

Anonymous said...

Stephanie, yes, that phrase pulled me up short as well.

I thought about it and decided that it meant the main chararcter was Catholic and so considered marriage one of the seven sacraments.

But, to the querier: you don't want anything in your writing that makes the reader have to stop and figure out what you mean. No snags. Keep it smooth.

jjdebenedictis said...

The story's inciting incident (the event that kicks things off) is what convinces a reader to plough through another 400 pages to find out what happens. It's also what will most economically, in terms of word count, entice an agent to ask to read the whole book.

Thus, to pare down the word count of your query, try focusing on just the inciting incident and a few details that serve to increase story tension.

Then leave the agent twisting in the wind, dying to know more. Mwa-ha-ha-ha!

Anne R. Allen said...

Alyson beat me to it. Your spiderwebs paragraph has some brilliant Keatsean truth/beauty stuff going on, Ms. Shark! Who knew our favorite predator was a poet?

Theresa Milstein said...

I agree with Daryl that Query Shark's line is memorable: " they create, the unspoken, is what makes it beautiful..."

From the first paragraph, I thought it was going to bed medical mystery, but the rest sounded more like women's fiction. It reads more like a synopsis that needs some work.

The story, once we get rid of all the unnecessary info, sounds like it could be interesting.

Augustina Peach said...

I agree with Alyson. I'm putting that quote in bold print on my "writing wall."

Greta Marlow

M. G. E. said...

As the reader, I already suspect that her cancer is going to turn to have been true, her fears unfounded, resulting in the group being exonerated and the evil office technician indicted. Or something. If that's your ending it's too predictable.

Also, as the Shark said, this isn't a literary novel, primarily because it's heavily plot driven.

The literary genre is driven by character, plot is often subtle at best. (And yes, "literary" is nothing more than a genre of its own.)

Jenn McKay said...

Dear #156, I think the misdiagnosis aspect of your story would draw readers.

On another note, are you in love with your title? I think The Bandaged Place sounds a little awkward.

Joseph said...

This has touched on a pet peeve of mind. Not knowing the querier, I would wager he/she is from New England and has lived here all his life. I'd doubly guess he's from Maine. Maine is the "big state" as long as you're comparing it to another state in New England. Born in Missouri, lived in Colorado, and now I live in New Hampshire, these states are small. In square mileage, New England is 2000 sq miles less than Missouri by itself. Maine seems bigger because it's long. You can get a good six hours on the highway (you can still get plenty more in a Western state).

What am I driving at (no pun intended). A resident of New England does not have to "settle" for care. The amount of top medical facilities out here is ridiculous. Unless the character is broke or snowed in during a blizzard, there's no reason a trip can't be made to Mass General, Tufts, Dartmouth, etc.

Now, if I'm wrong and the person isn't from New England, then it's an inexcusable mistake. Know the place you're writing about, even if it's just through Google. Look on the map, find a small northern New England town and then drop into Google "hospitals near Littleton, NH" Thirty miles from the Canadian border and--Oh, well look at that, there's one less than an hour away. Go figure.


Ethereal_buddha said...

I felt like there was kinda a plot and kinda not a plot and then there was a plot but then it derailed.
Too much. Too little, not enough to make it clear for me.
For one, why didn't she open a new practice?
Why is husband, whose an alcoholic, still practicing? If he wasn't guilty of insurance fraud then he's sure as hell going to wind up guilty of medical malpractice, right?
And I didn't understand what happened to the biopsy. Was it a mistake?
The only question I need to have is-what happens next. I need to have that question in my mind as I'm reading the first few pages of your novel, or requesting pages. I don't need more questions than I have time to get clarification.
Josin hit the nail on the head-for something covering this subject, it's too short. I would think around 100-115k.
Find an objective person to pick the hell out of it, someone not in the medical profession, and don't get defensive or upset if you don't like what they say.

Leona said...

I live in Washington state and I NEVER get a copy of my labs/medical reports with my bill. In fact, I have to ask them what it's for if I can't remember.

And when I ask for copies, I am usually stonewalled and get the line we have X weeks to find them. I thought it was my clinic, but when I changed doctors, the same held true. I think it's my state, or the county.

Anyway, I think that if #156 takes query sharks comments and what they mean, you can do it. Obviously, you knew something wasn't quite right with your query or you wouldn't have sent it to query shark in the first place.

You've taken step one, now take step two. Fix it :)

Sun Up said...

I'm still slightly offended on the whole "black mammy". WTF?

Kate said...

I'm working on a book for a doctor and I'm always fighting him on this. I have to hold his hand through every transition and even though I've told him to "Give the reader some credit" about a gazillion times, he fights me on it every single time. It's quite exhausting.

JS said...

Yes, the "I'm somewhere in New England where I can't drive to a nationally-acclaimed hospital in less than 5 hours" doesn't work so well for me (and there are only a few reasonably populous places where it would take you more than 3 hours).

And all the docs I know would request copies of their records for their own treatment, which would be given to them as a professional courtesy by other docs.

It seems to me like there are two novels here that are uncomfortably mushed into one: a literary novel about a woman in an emotionally bankrupt marriage who's trying to deal with cancer treatment and recovery, and a thriller a la Robin Cook or Michael Palmer about medical skulduggery. I might read either, but it's hard for me to imagine how the combination would work.

Lucy said...


What, you mean people don't read the National Enquirer for entertainment?


Merry Monteleone said...


They legally can't bill you without giving you an itemized list of what you're being billed for along with the claim numbers needed for insurance.

I'm sure some facilities will try, but you're not responsible for the bill without that information - maybe this differs from state to state, though, I'm not a lawyer. But I ran into this problem in Illinois and the upshot was, I wasn't responsible for the charges unless they gave me an itemized list and claim numbers...

I'm sure you could write around being able to get the pathology reports (but I'd think a doctor wouldn't consent to surgery without looking them over herself)... I'm still having trouble figuring out how to write around the fact that she had a major surgery, so obviously she could prove THAT.

Ethereal_buddha said...

JS-Damn! You said it better than I could have. Two separate plots and no way to twist them together and make them believable.

Stephanie Barr said...

It's almost like an entirely different plot than the first revision, but just as bewildering. If someone were going to commit deliberate malpractice (unnecessary surgery), why would you do so to a doctor who could be expected to know better? And I echo the Shark's query about DNA.

Unfortunately, the second version of the plot rundown leaves me as baffled as the first and just as unconvinced it makes no sense.

Perhaps there are small details that put all this together, but I don't think I'd have the patience to search them out.

EM said...

This is a great example!

Thank you to the writer and Query Shark.

The spiderweb comment was great.