The Trust Diagnosis

Introduction to Trust

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Meeting Dan

0:57I have a friend named Dan. I've known him for years. He's in his 70s, lives outside Washington, D.C. He's in the crisis communications business. Companies call him in when they have a big problem. In fact, that's how I met him. I was working on a story about one of his cases, and he called me up. Dan and I talk all the time. And last fall, he said something to me in passing about having to go for a bunch of tests. He didn't say why. It didn't seem like a big deal.

1:29Last May, my internist told me that he was pretty sure I had prostate cancer. And for me, it was a, I can't say it was a nothing reaction, but it was certainly a very modest reaction. I said to him, isn't this a minor league of cancers?

1:49And isn't it a rite of passage if you're a man my age? And that's how I thought about it. And it was reinforced when I went connected with a urologist who said to me, any time in the next few months, have an MRI.

2:09So I thought of it as a minor thing. And my first contact with my expert reinforced that. So I didn't even bother to do anything until August, from May to August. And I go from a, so a blood test to an MRI to a biopsy to a PET scan. And then it was, yeah, you got it. And then the next deal was, you should just go and get some radiation and some hormone therapy.

2:46And it was, and I had to draw it out of the physician. And it was a casual matter of fact. And that was sort of dumped in my lap at that point. But at a certain point, something nagged at him. He wasn't sure why, since everything thus far had been straightforward. So he started calling around. But as I was going through it, because of my work and friends, I've had lots of health clients and education clients, as you know, I asked somebody just to look at it to make sure there wasn't something.

3:17And I was even embarrassed and hesitant to ask because I thought it's such a minor problem. And it felt like an imposition. And my friend wanted to do it. And I was even hesitant and reluctant. And a doctor, which I will name, Dr. Master at Emory, looked at it and said, you have a big problem. You have an urgent problem. And it was like that. And he said, if you were my patient, I would have had you in my surgical suite last week.

3:48But you have an urgent matter.

Dan's Work

3:52My name is Malcolm Gladwell. You're listening to Revisionist History, my podcast about things overlooked and misunderstood. This episode, where we explore how and when trust decisions are made, is sponsored by PayPal Open, trusted by consumers built for all business. For over 25 years, they've been at the forefront of commerce, helping merchants of all sizes grow. So wherever commerce moves next, you can rest assured PayPal Open has your back. Head to paypalopen.com to learn more.

4:24Over several episodes, we'll dive into the topic of trust, where it comes from, the moment it's earned, and how we decide who to trust or not. And I wanted to start with the story of my friend Dan, who out of the blue one day was told that a problem he thought was routine was actually threatening his life. And who had to decide, under the most emotionally overwhelming circumstances imaginable, who to trust.

4:56He looked at my files, looked at my data and said, you have a big problem. And he said, others will tell you that you don't, but I'm telling you, you do. One of the many interesting things about Dan is that if I told you his full name and you Googled him, almost nothing would come up. He doesn't advertise. He doesn't give interviews. He doesn't go to fancy gallas. There are no pictures of him anywhere. He's almost invisible. But in the very rarefied world of Fortune 500 companies

5:29and CEOs and political bigwigs, everyone knows Dan. Because he's the guy you call when you have a problem you don't know how to deal with. For the past nearly 40 years, I have lived at what I refer to as the intersection of bad luck and bad judgment. I help people who have managed to get themselves into really serious trouble. The kind of trouble that is career-defining,

6:03can be threatening to the existence of a business, brings a level of scrutiny from the Justice Department or Congress or media that is inescapable. Usually, to borrow the words of Hank Williams, these are folks who see their name at the top of the page. And you are, you're not going to blow your own horn, but literally, like, if some big-shot person gets in trouble, you're like, it's like Ghostbusters. It's like,

6:33Dan gets the call. You get the first call, as far as I can tell. For the last 25, 30 years, I get the call. Yeah. And there have been many times where I will see a story break and I'm automatically processing it, reacting, what do I think? What do I think is going on? And in the back of my mind, I'm thinking, I might get a call. In many cases, I do get a call. And whether it's the General Motors bankruptcy

7:03or the Paterno-Penn State case or the BP oil spill, the Equifax data breach, you know, either limits of what I can say about what I did, but I get the call. Now, why do, let's talk about this in the context of trust.

Trust in Crisis

7:19So you have spent your life walking into boardrooms, executive suites, what have you, to talk to people who, in most cases, you have never met before. Right. So people just know you by reputation. Correct. Why do they trust you?

7:38It's an interesting thing. I've thought about it sometimes because I've wondered about misplaced trust. The genuine trust comes through the process. It isn't, in the beginning, it's hope. It's in its panic and its fear. And they've been told by somebody that they do trust, this is the guy you need. They, you know, they're in such a difficult spot. They don't know where to turn. And they are desperate to find somebody

8:09who can help them. You know, an irony for me in my medical situation is I used to say to clients, sort of jokingly, that I'm a urologist and that I'm the person you don't really want to see. But when you need to see, there isn't anything more important. You want to see that urologist and you want that problem solved. There is a sense of urgency that is focusing in a way that nothing else matters. And then I end up

8:40in this situation needing my urologist. But it is,

8:47what I know is,

8:51they know quickly if they can trust me. They can tell your tone. The first things you say are so critically important. The manner, your style, your sense of confidence, all those things communicate absolutely instantly. People are processing, is this a person in the most critical situation of my career? Should I give them time? Should I give them space?

9:22Should I pay attention to what they're saying? And what is it in that moment are you, if you had to summarize as simply as possible what you're bringing to them in that moment, what is it? It's a good question. It's a hard question because as I've explained, I will be the least knowledgeable person in any room I'm in.

9:47And partly it's because I'm in the rooms on calls, in meetings, in boardrooms with people who are phenomenally experienced, capable, educated, credentialed, leading scientists, engineers, MBAs, lawyers, CEOs, board chairs, tremendously accomplished people. And they have a world of advisors around them. They don't like for counsel, in-house counsel and the communications front, marketing, legal,

10:17outside advisors, business consultants. So what do I bring? I don't have any of those credentials.

10:23I bring a depth of experience of being in truly, truly difficult situations hundreds of times where the stakes are so big and the pressure is so great. I think if I have a particular skill that is synthesizing, clarifying, I hope and believe that I bring a common sense perspective to it which relates to the clarity and I want to help them prioritize what they're doing

10:53and how they're processing it and then inevitably I'm involved in what do you say about it? What do you say? Who says it? When do you say it? How do you communicate that? And that, it can sound easy but then you've got all the technical aspects, the factual side of that. You've got the legal considerations, the regulatory considerations and all those pressures are there. How can you help them fight through that and get them to say something that real people can understand there's an honesty

11:24and an integrity and a value to it? In a meeting with a client, have you ever raised your voice? No. You do have, speaking of why it is people trust you, you do radiate a kind of calm and there's something dispassionate about the way you see the world and I'm imagining you're doing with people who are often highly emotional. Oh, I mean, I'm in a room where there's always,

11:54there's lots of screaming, there's jockeying, people are desperate to sort of seek an advisory role, others are trying to get out of it, there are people who are trying to take credit and there are people trying to lay blame and there's just tremendous emotion. You know, when I, what I know, I'll just tell you a few things I really have never talked about. I need to get

12:25to a point where the CEO will tell me anything and I mean tell me the personal side because the personal emotional toll of these things is never really factored in and it plays a huge part in what they're going through. So I, it's not as much what I say as what I hear. I want them to feel, if they reach the point where they want to truly confide in me, then I know I'm going to play a role.

12:55The other thing that I know is it is absolutely essential for me to be candid in my very first conversations. Really candid. So you mentioned earlier about do you tell them how bad it is? In a sense, I do. I'm not telling them something they don't know. But I want them to know two things. That I have a sense of the situation without all the factual command that they have. I have a sense of it and that I am going to be

13:26absolutely direct with them. I'm not trying to shock. I'm not trying to make them feel worse. But I'm unafraid to tell them what I think. And that's absolutely, and those first, literally those first conversations, it's critical to your role. So you go and see Dr. Master. Yeah. And the tables are turned.

13:51Dan had become the client. The person in a state of emotional distress and confusion. Talking to a stranger and trying to decide whether to trust him. We'll be right back.

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15:11See paypal.com slash risk dash management for details. This is fascinating though, Dan, because you are in a moment, there's a moment here when you start to treat this problem you're having in the same way that you actually said this to me. There was a moment when I started to treat this problem, I understood this was no different from the problems I deal with in my work. Yeah, that's when this whole thing turned. When do you have that sense of, oh, this is something I've been doing my whole life?

15:42Well, so Dr. Master is telling me I have a serious problem that it needs to be addressed and that I need surgery, but he's not the one to do it. Then I followed up and I talked to two surgeons who said to me, surgery is out of the question, can't be done.

16:05And that my problem was a lot more complicated, a lot more advanced. And now the script is flipped have changed dramatically. We've gone from doctors shrugging to doctors saying, it's so bad we don't even think we can do surgery. Right. And when they say that, so what are they telling you your options are at that moment?

16:28That you're going to need other, all the treatments that are available. And they kept saying, Malcolm, it's a very interesting thing because, you know, I pay, again, it was my instincts. I listen to exactly what they're saying and the way they say it and the order in which they're saying it. The first thing they would say to me is we can keep you alive.

16:55And that was meant as a reassuring message and it wasn't. Not because I feared death, but because I thought they thought that I feared death and what I was worried about was quality of life more than length of life. And consistently it was about we're going to keep you alive. We can keep you alive. And then it was but surgery is not an option. You're too far gone.

17:20And then it was radiation, extensive hormones the rest of my life and chemotherapy and an ordeal that would be I'm grateful for anything but exceedingly unpleasant a life that was tremendously compromised.

17:44So I talked to these surgeons and their language was one surgeon said oh no no no no no no immediately after he told me you know you can stay alive you don't want the surgery he said I would be I would not want to do it but he said I'll do it if you want me to. And I don't you know but he literally said I'll do it if you if you really want me to. And you know no one of course is thinking of that.

18:14A second surgeon that I talked to kept saying and I'm not exaggerating I think he said it I made notes seven times in my I had a video chat with him he said it's at least 90% that I will not be successful and he said it's probably below it's probably single digits to have any chance of success here and he was so worried that I wasn't hearing that he kept

18:44repeating it over and over and over again so after I talked to them I talked to another doctor who said to me finally the magical message for me which is you're the only one who can figure out what to do here Dan the doctors can't figure this out for you and I immediately understood what that meant and I was immediately comfortable I thought the stress interestingly the challenge was great but the stress receded I thought I know this I know exactly what he said what

19:15did he mean not that I had been talking to incompetent doctors not that I was getting bad advice you can argue about elements of it but that it is a problem that doesn't have necessarily obvious clear advice attached to it that what no one had said but which I figured out the tests are not clear they're not definitive they're not

19:45perfect and that the science is incredibly complicated and that I could get extremely accomplished people from different fields oncologists pathologists surgeons looking at this and they could legitimately come to a wide range of different views I thought I've lived my life in that room I know what that means so what

Taking Control of Diagnosis

20:10was your next step wait at the moment he says that so that's the moment where you say okay I've been here before no I know I know the deal he was in a crisis and what had he spent his entire life doing solving crises what was a change in your perspective at that moment did you you said had you tremendous comfort yeah it was it was I am a hundred percent confident

20:40and comfortable making this decision myself not because I thought I would be perfect or that I knew more than the doctors I knew that I didn't but that I knew the right process to go through to arrive at the best conclusion I could arrive at and I it was it was a tremendous calming experience for me but I was blessed because of this experience nothing I had ever planned on nothing I would have ever thought about when I started this but

21:12I have been through it dozens and dozens of times on incredibly complicated high stakes issues careers billions of dollars and that I had a network of people that I could call on for perspective so I knew I would get good advice so I just from that moment I just said this is my newest case assignment first trust was misplaced trust second trust stage was you can trust yourself I can trust myself on this

21:42I can trust myself in this process so so he started over doing exactly the thing he always does when he takes on a new case he read everything there was to read he went through his medical records with a fine tooth comb flagging the things that he didn't understand or that needed clarification he was guided by one of the foundational principles of his work first facts are always wrong always wrong always wrong always great describe

22:12explain that

22:16facts are wrong wrong why are first facts wrong well it's it's the kind of thing you know I had to learn through experience again you're in a room you have brilliant doctors brilliant engineers MBAs fabulous lawyers outside counsel you would so when they're telling you something you believe it you you're based on

22:46their credibility their integrity their experience the problem is where do they get what they know in a crisis it's coming too fast how's it being processed how thorough is it how much can you know and how's it being interpreted who's interpreting it and sometimes there could be some obvious bias sometimes there's unintentional bias but what I what what I always know

23:16is you don't have it all what you think you have part of it's wrong and you need to be extremely careful the decisions you're making based on those facts and what you're saying because you're going to be reversing some of those decisions you're going to be eating some of those words and Malcolm I never even thought about that in my case I did what all my clients do well I've got serious lab tests I've got an important experienced doctor I've got other experts who've looked at it

23:47surely these things are right you can rely on them and I did and I was absolutely wrong what he learned was that the tests that everyone was using to make sense of his case where was his cancer how bad was it how much had it spread were flawed not because of anyone's incompetence but just because trying to get an accurate picture of cancer when you first find it is really really hard and that what happens is when doctors speak to their patients they sometimes

24:18forget to communicate this

24:24don't which meant that you couldn't put your trust in the results of biopsies and scans you were of necessity in the world of subjectivity and judgment and Dan knew all about the world of subjectivity and judgment it was where he had spent his entire career then when he felt that he was at least informed enough to ask the right questions he put together a list of doctors he wanted

24:54with one specialist after another so you you go out how many doctors do you interview um i had conversations with 18 doctors 18 18 and of those 18 how many told you can you kind of quantify what they told you like how many told you surgery or 15 told you what don't do surgery don't do surgery

25:24one was split and two said yes tell me about the two who said yes um it was uh and i never shared the information between the two of them i wanted just objective views and they both said almost exactly the same thing almost exactly the same way and they said they both acknowledged that i'm certain

25:55this will be a distinct minority of views that you're going to hear if you talk to other people almost anybody else will tell you not to do surgery and that you can't do surgery and but they're wrong and a factor in it was they also both said your chance of beating this isn't great but it's non existent if you don't have surgery and

26:25mattered a lot to me and you know the other calls again good doctors experienced doctors but saying likelihood of being successful almost nothing we know from the start we're not going to be able to get it all out it's going to give you a lot of difficult side effects then you're