The Trust Diagnosis

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0:58I 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. Last 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.

1:45I said to him, isn't this a minor league of cancers? And 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 connected with a urologist who said to me, any time in the next few months, have an MRI. So 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 and then the next deal was you should just go and get some radiation and some hormone therapy 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.

2:55But 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. And I was even embarrassed and hesitant to ask because I thought it's such a minor problem. 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.

3:37You 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. But you have an urgent matter. My 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.

4:19Head to paypalopen.com to learn more. Over 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.

4:57He 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 and 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.

5:39For 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, can 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. Mm-hmm. 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.

6:32It's like Dan gets the call. You get the first call, as far as I can tell. For the last 25, 30 years, I get the call. 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 or 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.

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. So people just know you by reputation. Why do they trust you? It'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. And it's panic and it's 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. They are desperate to find somebody who can help them.

8:10You 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 in this situation needing my urologist. But what I know is they know quickly if they can trust me. Mm-hmm. 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.

9:13People are processing, is this a person in the most critical situation of my career? Should I give them time? Should I give them space? Should 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. and 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.

10:11They don't like for counsel, in-house counsel and the communications front, marketing, legal, outside advisors, business consultants. So what do I bring? I don't have any of those credentials. I 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, it 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 and how they're processing it. And then inevitably I'm involved in what do you say about it?

11:00What do you say? Who says it? When do you say it? How do you communicate that? And 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 and integrity and a value to it. In a meeting with a client, have you ever raised your voice? No. 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.

11:47And I imagine you're doing with people who are often highly emotional. Oh, yeah. I mean, I'm in a room where there'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, what I know, I'll just tell you a few things I really have never talked about. I need to get to 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.

12:41So 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. The 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 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 absolutely direct with them.

13:29I'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. Dan 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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15:18This 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? Well, 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 has 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? that 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.

16:49The first thing they would say to me is we can keep you alive. and 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 and then it was of radiation, extensive hormones the rest of my life, and chemotherapy, and an ordeal that would be, look, 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. And immediately after he told me, you know, you can say 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. Oh, goodness. And I don't, you know, but he literally said, I'll do it if you really want me to. And, you know, no one, of course, is thinking of that. A 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.

18:34And 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 repeating 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.

19:13I know exactly what he's saying. What did 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 had figured out the tests are not clear, they're not definitive, they're not perfect, 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.

20:04I thought, I've lived my life in that room. I know what that means. So what was 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, I am 100 % confident and 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.

20:58And it was a tremendous calming experience for me. But I was blessed because of this experience. Nothing I'd ever planned on, nothing I would have ever thought about when I started this. But I've been through it dozens and 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, Dan, can trust myself on this.

21:43I can trust myself in this process. Yeah. 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. Explain that a little bit, because it's super relevant here. Because in your case, the first facts are wrong. Wrong. Wrong. Why are first facts wrong?

22:23Well, it's the kind of thing I had to learn through experience. Again, you're in a room. You have brilliant doctors, brilliant engineers, MBAs, fabulous lawyers, outside counsel.

22:39So when they're telling you something, you believe it. You're based on their 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 always know is 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.

23:31You'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. Surely 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.

24:13And that what happens is when doctors speak to their patients, they sometimes forget to communicate this fact. They pretend that they know something for certain when they actually don'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 to interview, put everything on hold for two months, and had a Zoom call with one specialist after another.

24:57So you go out, how many doctors do you interview? you? 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 treatment? 15. 15 told you what? Don't do surgery. Don't do surgery. One was split and two said yes. Tell me about the two who said yes. It was, 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 this will be a distinct minority of views that you're going to hear.

25:58If you talk to other people, almost anybody else will tell you not to do surgery and that you can't do surgery, 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.

26:25And it mattered a lot to me. And 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 get you with a lot of difficult side effects. then you're going to have to start these other treatments. The side effects for the follow-up treatments will be compounding with the side effects you're having after surgery. And I remember an oncologist saying to me, it is the absolute worst course of action you can take. So what was different about these two guys who disagreed?

27:09it's a funny thing because it it really does relate to my life experience and my work confident clear concise unemotional definitive and convincing not just words and manner but factually the way they presented it and And listening to that combined with, I had already reached a point with all the information I had, realizing that there were, you know, it's cloudy information and differences of opinion. And I thought, I know that, I'm comfortable with that now. and that I thought based here, you know, I don't think I ever took a science class in high school or college, but the science convinced me there was a very good chance that these doctors were wrong, that these tests had flaws, that some of it just didn't add up in the ways that it had been looked at.

28:16And I combined my own instincts, my own reading and information with the way these two doctors talked, and I thought, I'll bet my life on them.

28:34Dan ended up choosing a surgeon at Duke University. He wasn't a prostate specialist. He was just someone who did complex cancer cases of all kinds. He was used to looking at things that seemed impossible. He has a different lens. Yes. He's seen a broader range, presumably, of problematic surgeries. And again, that's something I can relate to. I'm in rooms. You know, years ago, Malcolm, the CEO of Disney, said, we would never be good at handling a crisis because we've never had one. And I thought, that can't be true. That can't be true. You're Disney. And what I've realized in most of the rooms I've ever been in they've never had a bet your career, bet the company crisis.

29:26We think that everybody has. You've had all kinds of tests, but for most people, it's a new experience. Or the stakes are so big. Are you talking about the doctor? So in this case, the doctor had seen real difficult. And I have been in hundreds of boardrooms. where I'm looking at a CEO and he or she's wondering, is this the end of my career? Is this how I'm going to be defined? Am I going to lose my net worth? Am I going to go to jail? Am I going to be humiliated in front of Congress? Am I going to be embarrassed with my family? That fear is there. And, you know, I've had them say to me, my God, my communications people are under their desks.

30:17They're scared to death. my lawyers are arguing with each other my board strong differences of opinions there and then you know what you also have in those situations is they've got their friends their neighbors their country club colleagues their their their business peers and friends somebody inevitably says to me my wife's brother's neighbor's cousin says i should do x you've got it coming in from all directions. So you're trying to figure out, who do I trust? As I've communicated to you before, the facts are wrong. I 100 % guarantee you. You don't have all the facts and some of the facts you think you have are wrong.