By Daniel Sokol
Earlier this year, I was invited by the Dr Prem Nath Berry Educational Trust, a medical charity, to deliver a new lecture in India on medical ethics. At that time, I was also thinking of a suitable topic for my presidential lecture at the Osler Club of London, a medical society founded in 1928 to keep alive the spirit and ideals of Sir William Osler (1849-1919). I chose to create a lecture that I could deliver, with minor tweaks, in both settings. The result was From Error to Ethics: Five Essential Lessons from Teaching Clinicians in Trouble. It drew on my experience of teaching ethics, one-to-one, to hundreds of clinicians facing disciplinary proceedings.
I wanted to adapt the lecture into a short book, containing a biographical introduction to Osler and a collection of 100 Oslerian aphorisms for doctors and medical students.
As the India trip was just months away, there was no time to publish the book through a traditional press. I also had doubts about whether traditional publishers would be interested in a short volume on clinical ethics and Oslerian wisdom.
I was delighted, therefore, when the Berry Trust agreed to fund the publication. It would be my first foray into the world of self-publishing.
In this article, I share my experience of this process in the hope that it may assist, or even inspire, other ethicists considering writing a book.
Once the manuscript was finished, I bought ISBNs and barcodes from Nielsen Bookdata UK. These appear on the back cover of most books.
Together, the ISBN and barcode make the book easier to catalogue, sell and track. I needed separate ones for the print and ebook versions. Each pair of ISBN + barcode cost £108.
I then found a book designer on Fiverr to create the front and back cover design. This cost £46.54.
The next step was hiring a proofreader. I used London Proofreaders as they offer a service where two independent proofreaders check the text. That cost £180.44.
Next came the typesetting and interior book design. Even as a newcomer to self-publishing, I knew this was going to be critical. You can often spot a self-published book from the awkward design and layout. After much online research, I turned to freelance designer Vanessa Mendozi on the site Reedsy. I think she did a wonderful job. Below is an example of a typeset page from the book.
The cost of the design, which took less than a week, was £1,417.90.
By this stage, I had an electronic file which I could submit for publication, but where should I publish it?
As I had no idea how many copies would sell, I wanted a print-on-demand option, meaning the book would only be printed once ordered by a buyer. Unlike some of my other titles, the book would never go out of print (unless the publishing company itself went out of business).
I considered various options, such as Amazon KDP, IngramSpark, and Lulu. I chose Amazon for several reasons. It was easy to set up, offered fast delivery, had good search visibility on Amazon, and provided immediate sales tracking. The print quality also seemed excellent.
I uploaded the file to Amazon KDP. There are various options in terms of paper format (I chose paperback and ebook), size of book (I selected a pocket-sized 6 x 9 inches), type of paper (cream, as it is warmer than the white used in textbooks), matt or glossy cover (glossy), and bleed (something to do with margins – the designer recommended ‘no bleed’).
I then set a listing price for the print and ebooks: £9.99 for the print copy and £6.99 for the Kindle. An academic publisher would doubtless have charged several times that, limiting sales.
Prior to ‘launching’ the book publicly, I ordered an author copy to check the quality. It looked good, so I ordered 250 copies to give away to clinicians on my remedial ethics courses and others. The cost, with shipping, was £537.99, so just £2.15 a copy for a 106-page book.
How long did the publication process take? From initial steps to the e-book’s appearance on Kindle, it took exactly 1 month. The paperbacks arrived just 8 days after that.
The total cost of publishing the book, including 250 paperback copies, was £2,398. Without the copies, it would have cost £1,860.
Historically, self-publishing has had a bad press, linked with rejected authors and second-rate books. This has changed. Many respected authors have chosen the self-publishing route, attracted by the greater control over the process and the higher royalties (60-70% of the sale price compared with 10-15% for traditional publishers). The quality of Amazon’s printing is, to my eyes, indistinguishable from a conventional press.
My experience has been overwhelmingly positive, and I was encouraged by Dr Papanikitas’ book review in the British Journal of General Practice, which started:
‘I am not usually a fan of self-published books. […] This elegant little volume bucks that trend.’
Publishing with Amazon is, of course, less prestigious than publishing with the likes of Penguin Random House or OUP, but the top-tier publishers have low acceptance rates. I doubt my booklet would have been accepted given its niche subject matter, short length, and modest commercial prospects.
Traditional publishers usually promise some marketing but, in my experience, authors still have to do the heavy lifting. Even with well-regarded publishers like Sweet & Maxwell, I found that much of the promotion fell to me as the author.
For this book, I relied on social media and writing articles in medical outlets such as the BMJ and Medscape. At just £2.15 a copy (+ £3 for postage), I can afford to send complimentary copies to bioethicists and clinicians who might find the book useful and, with luck, review it or recommend it to their students or colleagues.
Self-publishing is now simple, affordable, and capable of producing high-quality books. For medical ethicists who contemplate a book, especially one in a niche, interdisciplinary, or fast-moving area, it is an alternative worth considering.
Daniel Sokol is a medical ethicist and barrister at 12 King’s Bench Walk. He has published 5 books on law and ethics.
Author: Daniel Sokol
Affiliation: 12 King’s Bench Walk
Conflicts of Interest: None to declare