Dr. Angela Marshall had just finished medical school when her son Nathan was born with serious health issues. When he was four months old, he had a health emergency. At the hospital, Marshall told the care team it was urgent. “All the nurses realized it was, but the doctor dismissed my concerns, dismissed the nurses’ concerns, and I ended up losing my infant son,” said Marshall.

It took Marshall more than 20 years to be able to write in detail about the experience. Her new book, Dismissed: Tackling the Biases That Undermine Our Health Care, is the only advice on the subject written by a primary care doctor who is a woman of color. It examines many forms of discrimination, from race and gender identity to age, obesity and the bias against science — instructing patients, doctors and administrators how to do better.

After meeting through a women's networking organization, Marshall hired Kathy Palokoff as a ghostwriter to articulate her vision and voice, taking her ideas and turning them into an engaging story that landed a publisher. Palokoff’s company, goFirestarter,[1] helps changemakers create manuscripts that can be self-published or submitted to a publisher.

They offer this advice to anyone thinking of writing a book:

1. Define Your Goals

Don’t expect book sales to make you rich, Palokoff said, but a book can open up other opportunities, such as speaking engagements and consulting projects. Marshall is poised to do both, positioning herself as a thought leader on bias in healthcare, Palokoff said. Marshall emphasized a primary reward. “This book allowed me to share my story — that's one of the most powerful things about writing a book for any person,” she said.

2. Develop a Winning Book Proposal

A book proposal is almost like a business plan, said Palokoff. Detail your target audience, the competing titles and marketing strategy. Timing is also important. When Marshall’s first proposal about women’s health received only rejections, she revised her proposal to focus on bias in healthcare. In the wake of Covid and the rise of the Black Lives Matter movement, she received five publishing offers.

For nonfiction proposals, Palokoff recommends writing a sample chapter as well as an outline of each chapter with descriptions. Publishers may often suggest a different focus, said Palokoff. “If you've already written a whole book, you may have wasted time.”

3. Build Your Platform and Media Readiness

Develop your social media following to attract publishers. Marshall hired someone to boost her online presence. She also had done speaking engagements at The White House and the state level and did some television appearances, which showed publishers her ability to promote the book.

4. Get Expert Help

Marshall strongly encouraged hiring a ghostwriter. “It's one thing for me to write clinically or technically, but I learned from Kathy that there's a whole other dimension of writing a book that involves making it engaging for the reader.” Look for a successful ghostwriter or published author and invest time in ensuring the right fit. “The relationship is very intimate,” said Palokoff. “You’re almost sort of married to someone for a while. We argued, we laughed, all those things, but we had a real shared goal and a huge amount of shared respect.”

Ghostwriting rates vary widely depending on the quality, author, book, topic and ghostwriter, said Palokoff. According to Scribe Media, “You can find good ghostwriters from $25,000 to $40,000, but expect them to either be desperate for a gig or relatively inexperienced. The sweet spot for good ones with credentials is usually within $40,000 to $75,000.”

5. Decide Between Traditional or Self-publishing

A traditional publisher offers editorial guidance, credibility, increased distribution and more marketing avenues; however, going from acceptance to release date can take about two years. On the other hand, while self-publishing is much faster, it requires you to do more yourself. See Palokoff’s column, “Five Tips about Self-Publishing, in the sidebar to consider your options. Expect that writing a high-quality manuscript for traditional or self-publishing can take several months to a year.

Marshall and Palokoff won a publishing contract from Kensington Publishing Corp, which invited the pair to participate on an author panel for librarians across the country before the book’s launch. Exposure such as this does not come with a self-published book, Palokoff said. For Marshall and Dismissed, which came out in March 2023, visibility is a crucial step in her mission — to change the practice of medicine so no one will ever go through what she did.