What makes us trust someone?
As a naturally sceptical person I ask myself this a lot. I asked it this morning when I needed a referral to a doctor and wanted to make sure I could still go to the one I trusted the most, rather than have to face the fear of yet another anonymous scalpel-wielder in a white coat.
If you’ve read this newsletter for a while, you’re probably aware that I am absolutely terrified of doctors and hospitals. So when I meet someone who can alleviate that fear even a little bit, I stick to them like glue. The person I wanted to see was the surgeon who operated on my back in 2020.
Mr C (because as a consultant he’d earned the right to drop the doctor bit - which always confuses me, why go to medical school for so long to be rewarded by people not calling you Dr?) became my consultant because I’d already rejected two of his colleagues; the first for being late and the second for answering my question about outcomes with a shrug. I was all prepared to reject this one too, to keep batting back doctors so that I didn’t actually have to go through with any treatment. But with Mr C, it was instantly different.
Asking someone to let you root around in their spinal chord with a knife requires the skillset of being able to quickly gain their confidence. Sure, some of your patients might be desperate enough to try anything but for most of us, we need to feel there’s a good chance you know what you’re doing. We need to trust you.
I find trusting people hard. As a recovering hyper-independent, my natural assumption is that nobody will take care of the situation as well as I will. I am so sure that if I trust someone, they’ll let me down that I try and take care of everything without allowing anyone to help me. No, not even a highly qualified neurosurgeon who just wants to help me out of pain. I didn’t understand how I could trust someone to do something that seemed so complicated and which required me to hand over the reins to them entirely.
What I learned from Mr C, however, is that trust actually has a really simple formula:
Trust = competency + consistency
What this looked like in his case, was this:
He took me through a couple of similar patients he’d had recently and explained what had improved and not improved for both of them. This ability to admit that he hadn’t been able to resolve the problem 100% allowed me to trust that the bits he did claim to have fixed were true. Competency doesn’t mean unrivalled excellence, it just means “generally pretty able”. So many of us forget that, we think we have to reel off our greatest hits to get anyone to trust us, when really we just need to be good enough.
Most importantly though, Mr C was consistent. Largely, he was consistently a bit of a dark-humoured, grumpy old man. He’d always give me the worst case scenario. He repeatedly reminded me that it could all go wrong. On one occasion, he gently mocked me for turning away from the monitor rather than watch him inject a 12 inch needle into my spine. And he was delighted when I described one of his colleagues, a knee surgeon who’d operated on me a few years earlier, as looking like Boris Johnson. “Oh, I look forward to telling him that,” he’d chuckled. But he was a dark-humoured, grumpy old man who cared about his patients. He wouldn’t let me go for the most extreme care option until I’d tried everything else. He interrogated me about my job and feminism, and congratulated me when he’d seen me shut down Piers Morgan on GMB one morning. And after the surgery he came to see me in recovery himself, rather than sending a junior doctor.
Every time I went to see him, he was the same. I found that very comforting.
When I coach people, our early conversations are very much centred on how they think they should behave, the attributes they don’t have that they think they should acquire. Whether it’s their romantic relationships or at work, it doesn’t matter. The key is, they want to be someone else.
The problem with that, I point out, is that it’s hard to consistently be something you’re not. Far better to own who you are and show up time and again as that person. That doesn’t mean that you can’t grow but it does mean that you know yourself. Know what enlivens you and what drives you mad. Are honest about your skills and your weaknesses. Disappointment happens when someone pretends to be something they’re not, that’s what breaks our trust.
Recently my back has been hurting again. I looked up Mr C to see if he was still at the same clinic and I could get a referral to see him. Instead I found out that he’d died at the beginning of last year.
When I read the report of his death I cried for him, for his family and for every scared patient who won’t get to experience his particular flavour of competence and consistency. I cried for myself too, cried for the fact that this man I trusted to hold my fear wouldn’t be there to do it again and that I hadn’t told him how much he’d helped. So it felt important to put down in words how much I appreciated him and what I’d learned from him. Maybe you can learn it too and then we will all be a little more trustworthy and a little less afraid.
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I’m sitting in a waiting room as I read your words, Harriet. 2nd visit with a new doc; it felt a little rushed and left some questions for the next visit. I’ve been especially fortunate in the past to have had a Dr. such as Mr. C. It isn’t at all ubiquitous. Mine, was Dr. W. She could be grumpy, but it was evident that it was because she cared, that she intended to engage her energies on one’s behalf. She was, as you highlight, super competent & consistent. No other Dr. had ever been as astute at diagnosis and then effective treatment planning. She showed she knew and remembered my history, as well as my current case over the years. It was a sad day when I learned she’d died of cancer; for me, her other patients, and her family.