The Trust Diagnosis Malcolm Gladwell

TITLE: The Trust Diagnosis | Malcolm Gladwell’s Revisionist History CHANNEL: Malcolm Gladwell DATE: 2026-05-25 ---TRANSCRIPT--- [music] [music]

Pushkin I 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. Uh 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. I 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. Um and it was reinforced when I when connected with the urologist who said to me, “Anytime 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 it was And I had to draw it out of the physician and it was a casual matter of fact. And that was it 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 And I And I was even embarrassed and hesitant to ask cuz I thought it’s such a minor problem. And it felt like an imposition. And my friend wanted to do it and I I was even hesitant and reluctant. And they uh a doctor which I will name, Dr. Master at Emory, looked at it and said, “You have a big problem. And 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. Uh but you have an urgent matter.” My name is Malcolm Gladwell. You’re listening to Revisionist History, my podcast about things overlooked [music] and misunderstood. This episode, where we explore how and when trust [music] decisions are made, is sponsored by PayPal Open, trusted by consumers, built for all [music] 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 [music] back. Head to paypalopen.com to learn more. Over several episodes, [music] we’ll dive into the topic of trust, where it comes from, the moment it’s earned, [music] 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 [music] was actually threatening his life. And you had to decide under the most emotionally overwhelming circumstances imaginable, who to trust. He 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 galas. 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. Um for the past nearly 40 years, I have lived at what I refer to as the intersection of bad luck and bad judgment. Uh I help people who have managed to get themselves into really serious trouble. Uh the kind of uh trouble that is career defining, uh can be threatening to the existence of a business, brings a level of scrutiny from the Justice Department or Congress or media uh that is uh inescapable. Usually, to borrow the words of Hank Williams, uh these are folks who see their name at the top of the page. Mhm. And you are if you you’re not going to blow your own horn, but literally like if some big shot person gets in trouble, you’re like say Ghostbusters, it’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. 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. Mhm. 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 on what I can say about what I did, but I get I get the call. Now, why do Let’s talk about this in the context of trust. So, you 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? It’s It is It’s an interesting thing. I’ve thought about it sometimes, cuz I’ve I’ve wondered about misplaced trust. The genuine trust comes through the process. Mhm. It isn’t in the beginning, it’s hope. It’s 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. You know, an irony for me in my 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, you 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 is focusing in a way that nothing else uh matters. And then I end up in this uh situation needing my urologist, but it is um what I what I know is they know quickly if they can trust me. Mhm. You they can tell. Your tone. The the the first things you say are so critically important. The the the manner, your style, uh your sense of confidence. All those things communicate absolutely instantly. People are processing. Is this a person in my 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 it’s a good question. It’s a hard question. Because [gasps] as I’ve explained, I will be the least knowledgeable person in any room I’m in. Uh I’m and and partly it’s because I’m in the rooms on calls and meetings and 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 lack for accountants, an health council, on the communications front, marketing, legal, outside advisors, business consultants. So, what do I bring? I don’t have any of those credentials. Um 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 so great. Um, I think if I have a particular skill is synthesizing clarifying. Um, I 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? 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 you know the all the technical aspects, the factual side of that. You 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 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 uh there’s something dispassionate about the way you see the world. And I’m imagining you’re dealing with people who are often highly emotional. Oh yeah. I mean I’m in a room where there’s always there’s lots of screaming. Um, there’s talking. People are desperate to sort of seek an an advisory role. Others are trying to get out of it. There are people who are trying to take credit. There are people trying to um lay blame. And there’s just tremendous emotion. You You when I when I know I’ll just tell you a few things that I 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 see the the personal emotional toll of these things is never really factored in and that plays a huge part in what they’re going through. So, I I it’s not as much what I say as what I hear. I want I want them to feel if they reach a point where they want to truly confide in me then I know um I’m 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 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 with all the factual command that they have. I have a sense of it and that I am going to be absolutely direct with them. I’m not going to I’m not trying to shock. I’m not trying to uh make them feel worse, but I’m unafraid to tell them what I think. And that’s absolute and and those first literally those first conversations, it’s it’s critical to your role. Mhm. So, you go and see Dr. Master. Yeah. And the tables are turned. Dan [music] had become the client, the person in a state of emotional distress [music] and confusion. Talking to a stranger and trying to decide whether to trust him. We’ll be right back. This is fascinating though, Dan, because in a 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 yes you 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 that’s when this whole thing turned. When do you when do you have that sense of oh, this is something I’ve been doing my whole life. Well, I so Dr. Master is telling me I have a serious problem that it 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 um who said to me surgery’s out of the question, can’t be done. And that my problem was a lot more complicated, a lot more advanced. And now the script is flipped. I’ve 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 what what So what are they telling you your options are at that moment? Um that you’re going to need other all the treatments that are available and they kept saying Malcolm it’s a very interesting thing cuz 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. 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’s not an option, you’re too far gone. And then it was uh radiation, extensive hormones the rest of my life uh and chemotherapy and an ordeal that would be I’m like I’m grateful for anything, but exceedingly unpleasant a life that was tremendously compromised. Mhm. Mhm. So, I talked to these surgeons and their language was one surgeon said, “Oh, oh no, no, no, no, no, no.” Immediately after he told me you know, you you can stay alive, but I you you don’t want the surgery. He said, “I 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 if you really want me to.” And you know, no one of course is thinking of that. The second surgeon that I talked to uh kept saying and and 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 it’s probably below 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 I the stress, interestingly, the challenge was great, but the stress receded. I thought, I know this. I know I 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 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. I thought, I’ve lived my life in that room. I know what that means. Mhm. Mhm. So, what was your next step? Um 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 did he spend his entire life doing? Solving crises. What was the change in your perspective that moment? Did you So, you said How’d you Tremendous comfort. Yeah. It was it was I am 100% confident and comfortable making this decision myself. Mhm. 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 I’ve It was It was a tremendous calming experience for for Mhm. 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. Uh 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 I 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.” I 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. Wait, describe explain that a little bit cuz it’s super relevant here. Cuz in your case, the first facts were wrong. Wrong. Wrong. Why are first facts wrong? Well, um it’s it’s the kind of thing I you know, I had to learn through experience. Again, you’re in a room. You got brilliant doctors, brilliant engineers, MBAs, savvy lawyers, outside counsel. You would So, when they’re telling you something, you believe it. Um you’re ba- you’re based on their credibility, their integrity, their experience. The problem is where did they get what they know? In a crisis, it’s coming too fast. How’s is 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 a bias, but what I what I 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 decisions you’re making based on those facts and what you’re saying. Because you’re going to be reversing some of those decisions and 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 uh experienced doctor. I’ve got other experts who 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. And then 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 2 months. And had a Zoom call with 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 treatment would 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. Um it was uh and I never shared the information between the two of them. Mhm. 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. If you talk to other people, almost anybody else will tell you not to do surgery and that you can’t do surgery and that but they’re wrong. And um 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 mattered a lot to me. And you know, in the other calls, again, good doctors, experienced doctors, but saying likelihood of being successful almost nothing. Uh not even We know from the start we’re we’re not going to be able to get it all out. Um it’s going to give 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 a 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? Um it’s a funny thing because it uh it really does relate to my life experience and my work. confident clear concise unemotional, definitive and convincing. They I’m not just words and manner, but factually the way they presented it. And listening to that combined with I’d 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 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. Um that they that these tests had flaws, that some of it just didn’t add up in the ways that it had been looked at. And 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. Dan 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 But again, that’s something I can relate to. I’m in rooms you know, years ago Malcolm, 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. It 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. We think that everybody has. You’ve had all kinds of tests, but for most people it’s a new experience. Or the the stakes are so big. Are you talking about the doctor? So, in this case, the doctor had seen Yes, and I’ve 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 at my with my family? That fear is there. Mhm. And, you know, I’ve had them say to me my God, my my communications people are under their desks. They’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 The 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 you’re trying to figure out who do I trust? I I I as I’ve communicated to you before, the facts are wrong. I 100% guarantee it. You don’t have all the facts and some of the facts you think you have are wrong. Mhm. So, how am I supposed to make a decision now? And so, I end up with this surgeon and he he broke it into two pieces. Can I do the surgery technically? Absolutely, yes. Is the surgery going to be a success? Different question. Different question. Uh will it save you? Um you know, that’s a whole separate conversation from can I perform the procedure and and succeed at that so that you can have the chance to talk about these other things. So, his first was 100% yes. His second was 50/50 that it’s going to help you at best. And if the studies are what these other doctors are saying, you do have a single digit likelihood of success. If they’re wrong, you could have 50% or better. So, it’s how do you interpret all the information we have? [clears throat] And and then it was also saying to him, I’ve got to have sort of the free reign to do whatever I think I need to do once I get in. And how quickly do you move from this is my guy to the actual surgery? What’s the time? Um I by the time I spoke to him, um one of the things I liked about my conversation with him, I was told that you should talk to this guy and he’s confident he can help you. When I talked to him, he said, “Oh, no, no, no, no, I’m not confident. I’m confident I can do this procedure successfully. I can’t give you false confidence about your outcome. And that was helpful to me. He was honest. Mhm. I didn’t need somebody It’s in another view of mine. People who tell you they can solve your problem, be extremely suspicious. Extremely suspicious. Your problem is multi-layers, evolved over a long period of time, all kinds of dynamics at play. And so in this case, um I knew that he could do the surgery. I’d already factored all the calculations from the others. I knew it was my only really good chance. And I had concluded that the uh the analysis I was getting was flawed from the others. And I just I said, “Let’s go.” And within 3 weeks, I went from my first conversation with him to having surgery. Tell me what that first conversation you had with him after the surgery was over. The first thing was there were certain cancerous spots that were in doubt, could he get them? And so I needed to know immediately, did you get them? And he said, “Yes, got them.” Cuz the cancer had metastasized. Yep. And he got them. And then it was, you know, how far? And he, you know, he had to He said, “I had to nip, cut, trim, remove most of the things inside you.” Um I told him, “Thank you, but I’m as partial to as many parts as I can keep.” So, he had to do a lot. Uh but he was confident uh he got everything he wanted to get. Mhm. And the initial pathology after the surgery was positive, but you don’t know. But it was a it was exactly what he said, which is the surgery was successful. Now we wait on the outcomes. And and I was I was relieved, but I if I I don’t want to sound overconfident, but it was what I expected. Mhm. And how long I forgot now. There was six There was a six There was a six week There was a two week weeks and you get a blood test and my you know, you get a PSA score and mine had gone down significantly. It was not in a great zone, but in a good zone at six weeks. And then at another six weeks uh I went down and I you know, I have my my text um from him which I will keep because it’s the only time I’ve ever gotten a text from a doctor where he used miraculous three times and and one paragraph to me for the outcome of my test scores. I believe I got a screenshot of that one. Yeah. So and my you know, my doctors the two they’re like kids high-fiving, you know over the phone to each other. They both um joined on a conference call to call me to tell me the results. They were ecstatic. So there’s there’s three trust layers here. There is the misplaced trust in the beginning, understanding that you had you would offered you would extended trust prematurely. Um both to doctors and to assumed that trust was justified. Trust in the doctor, trust in his experience, his approach, and trust in the tests. That was misplaced. And by the way And and and and I’m I’m you know, I’m more critical of myself than I am of the doctors. And then the second layer was understanding I can trust myself in this. This is I know this. I’ve done this. I have experience in this. Yes. And then the third layer was this is the person who I’m going to place my trust in for this surgery. It’s exactly right. I mean, I trust myself. I don’t know how people that may sound to people. It may sound arrogant or naive or whatever. It’s it was hard earned from Mhm. decades in rooms where people would turn to me and say, “Now, what do you think?” Mhm. And if you can’t add value or if what you’re saying doesn’t make sense, you’re going to be out of that room. You’re never going to be around. And my my my work was 100% referral base. So, if they don’t have value in the room, I don’t have any I don’t have a career. So, it was that and then it was the person and the process he laid out. What he said he would do and how he would do it and what the equation was. Putting all that together along with my reading and analysis, I had a high degree of confidence that that was right choice. And I And I can honestly say I didn’t lose a moment sleep. Had no second thoughts. I was certain I had chosen the right course. The The idea that you didn’t lose a have a moment sleep is is so I lost Why is it that I lost more sleep over your condition than you did? I was waking up in the middle of the night worrying about you. And you’re like sleeping like a baby. I was Once I decided I was I was truly confident. I can’t be confident that it’s Now, it’s going to turn out. Mhm. I was confident that I had all the information I need to make an informed decision. That I had processed it thoughtfully in a way that with the same rigor that I would give to a client and that it was the best option available. What what’s going to be is what’s going to be, but that’s what I came to. And with that, I was at peace. In the span of 6 months, he went from you should get this looked at at some point to you should put your affairs in order to we can’t find any more cancer. I I think that I discounted the idea of instincts and intuition in my work. I lived by it. But there was an element that discounted it that it wasn’t a credentialed. I didn’t bring a Harvard MBA to this. I wasn’t a lawyer at a at a major firm. And I look back now. My instincts, intuition, judgment were everything in my work. Mhm. And it wasn’t that what I had replaced the other people in the room. What I say to people is you don’t want a room full of people like me, but you want somebody like me when you’re going through this. And it is this intuition and instinct and the sense that you’ve described in Blink of processing and making a decision and there thousands of things going on in your brain you don’t even know as you’re making that decision. And I have lived my life by it and lived my career by it. Mhm. And trust so trust is all tied up in that. It’s a fascinating field. It is what I did with clients because what they would say to me is how do I get people to believe us again? How do I get my customers back? How do I get them to give me more time? How can I get them to look at this in a different way? How do I do that? What what do I have to do? So, it’s all of that that plays into it. I just never figured I would end up processing it for myself. Revisionist History is produced by Nina Bird Lawrence, Lucy Sullivan, and Ben Netaff Haftree. Our executive producer is Jacob Smith, engineering by Nina Bird Lawrence, original music by Luis Guerra, sound design and mastering by Marcelo Di Oliveira. Special thanks to Kira Posy, Morgan Ratner, and Eric Sandler. I’m Malcolm Gladwell.