My limited understanding is that hybrid publication is somewhere in the space between traditional publication and self-publication and is usually offered by independent publishers, as opposed to the big five. In the hybrid model the author pays the publisher towards the cost of publication and probably also marketing and distribution, the idea being that if the book sells, the company and the author make money. I get the impression that there are some companies offering hybrid deals that behave reasonably and that the fee is a consequence of the publishers’ limited resources in an uncertain market. However there seems to be quite a lot of crossover with the rackets of ‘vanity publishers’ who charge authors as well but have a different business model that ensures the company makes a profit regardless of whether there are any sales. Pundits on social media have warned me against them. On first glance it’s really difficult to tell the difference. In general my approach is that I wouldn't ever pay a publisher a penny but I wonder whether some of the small presses that offer hybrid deals might be worth a shot.

Indie publishing clearly is the less moneyed end of the spectrum. And if one isn’t paying a penny that’s one thing, one is subject to all the anticipated uncertainty that comes with being an author. But if the offer is of a hybrid contract, is it ever worth paying the fee?

There’s been more than one thing. I’ve been doing research by reading a Lonely Planet guide to a potential setting just in case it becomes relevant. Over the last few months there’ve been multiple distractions from the rest of my life. Before that I’d written 41K words, many of them I’m pleased with. I heard an author say how she uses a four-act structure and divides each act into two sequences. That seemed to help. I’ve got the scene summaries set out horizontally in that structure on an Excel spreadsheet. The challenge is how to fill the remainder. I have some plot stepping stones for the rest of the story, but they are limited. Perhaps there are too many options re where to take the plot, although they’re escaping me at the moment. I know I can only try one thing at a time but am not sure what to try next. I have a vague idea how it ends. There’s a kind of fear for me about getting started again. I’m worried I might have to backtrack at some point and lose some of my scenes, which would be OK, I just don’t which scenes they might be, it’s as if I only have a partial sense of direction. I haven’t given up yet. I know that there are myriad possibilities (perhaps that’s the problem) and there’s no such thing as an insurmountable brick wall. My plan is to sit down next week and write even though I don’t know what’s coming.

I agree with Lorna, Beth. From James' point all that you've written seems highly appropriate, and it's the first paragraph so we get to know things about the setting and his thoughts nice and early. I suspect that would fit very well with book club fiction. In that sense the negatives: no stethoscope, no white coat, are doing a good job. Alternatively if you cut “movements deliberate. No white coat, no stethoscope, ” we'd have the same story with more action and less thought, perhaps that might suit straight commercial fiction rather than book club, I don't know. Either way it's an enticing set-up. I want to read on. Of course if James isn't familiar with hospitals he wouldn't know that doctors don't wear white coats very much any more. When I was a junior doctor in the mid 1990s we did and stuffed the pockets with all sorts of things but now they tend just to wear either their clothes or, very commonly, scrubs, regardless of whether they ever have to go to theatre or not, which is what scrubs were originally meant for. That would apply for doctors looking after someone after an accident like most other hospital doctors. The only sort likely to be doing clinical work on wards who wouldn't wear scrubs (that I can think of) would be psychiatrists.

@Beth Wellington It’s difficult to say Beth but I think either just “no stethoscope” or scrap it perhaps. For some reason “ no scrubs” seems out of place. But “no stethoscope” would make sense and do the job of noting that she’s not just another doctor.