Trust Me, I’m Your Doctor

We all hear about health care. Usually it’s through the microcosm of someone’s illness, or the macro-view of dueling pundits and politicians. Frequently it’s adversarial, or negative.

Thanks to long-time Trust Matters’ own trusted advisor Shaula Evans, I met Dr. Craig Koniver. He brings a fascinating perspective to the topic, as you’ll see.


Charlie Green: Craig, you’re a doctor in South Carolina. Are you a native?

Craig Koniver: No. I grew up in Delaware, went to one year of undergrad at Johns Hopkins, hated it, and transferred to Brown. I then went on to medical school at Jefferson Medical College in Philadelphia. So I did end up being a doctor, mostly in Arizona, and recently moved here.

Charlie: You say you practice “organic medicine.” How did you come to that?

Craig: First of all, I am a “regular” doctor, board-certified and all that, but I also came to believe in a certain approach to medicine. The transformative event in my life was when our daughter was colicky.

The pediatrician said what I’d been trained to say, but since it was our daughter this time, we were wholly unsatisfied. We went out and found unconventional approaches to the issue. And once you’ve seen behind the curtain, it’s hard to stop.

Charlie: What is behind the curtain?

Craig: The standard routine is label, diagnose, prescribe medicine or surgery. Repeat, repeat, repeat. The paradigm of modern medicine is medicine-based, which is to say, pharmaceutical – pills and chemicals.

100 years ago this was not the case; the doctor had a relationship with the patient. But today, the doctor is trained to see the patient as a series of chemical pathologies.

Charlie: So, on a practical level, what do you do differently than other doctors?

Craig: I am interested in helping the patient reach optimal health through natural means. I am not against prescription medicine, but I think they are highly over-utilized by doctors not interested in pursuing alternative/ natural modalities.

So with my patients we look for the root cause of disease by running specialty lab tests and then use herbs and vitamins and nutrients to get their health back on track. I am a firm believer that there is a natural option for everything–we just have to look in the right place and be willing to try any different options.

Charlie: What’s the effect on patient health?

Craig: One telling study suggested that as many as 1/3 of prescriptions get tossed away on the patient’s way out of the doctor’s building. They want more than a prescription, they want a relationship and they want options.

Charlie: What did you do as this became apparent to you?

Craig: I finally decided to move to a holistic practice. That entailed moving away from insurance, and cutting my patient load from about 4,000 to about 400.

Charlie: Wow. Now, hang on a minute; that raises all kinds of interesting issues. What does that say for coverage?

Craig: It affects many people differently. First, there are a large number of people who are quite willing to pay for personalized, holistic healthcare. It is quite valuable to them!

In addition, remember that existing health insurance policies don’t generally cover doctors suggesting things like exercise and nutritional changes; as well, procedures like bypass surgery are reimbursed while time-tested acupuncture is not.

And I now get to spend real, quality time with my patients. I take as much time as I want and they want, and they leave satisfied feeling that I’m concerned about their whole life.  Which I am! A lot of people find this hugely valuable.

Charlie: What about those who can’t afford it?

Craig: Before we get there, there are number of people who may or may not be able to afford it, but don’t see the value in it. They’re used to thinking that a doctor visit should cost the amount of a co-pay. They can’t get past a more cost-based model.

Are there those who are left out by this? Absolutely there are and it’s a real tragedy because they continue to get the acute-based, chemical-and-surgery, impersonal kind of medicine that doesn’t help them.

Charlie: Ah, interesting. You’re not a selfish doc going off to serve well-heeled patients, there really is no choice.

Craig: That’s true. I’m not abandoning poor people, I’m abandoning bad medicine. And the existing insurance system simply cannot support the kind of medicine I like to practice. Is it tragic? Yes, and a real shame.

You pretty much cannot have a holistic medicine practice that operates within the existing high-volume insurance-based delivery method we have today. The choice is not which clientele to go after – it’s which kind of medicine I want to practice.

Charlie: Does the patient-physician relationship of trust affect health?

Craig: Yes. Again, if the relationship is pill-based, then it’s not personal; that is not a good basis for trust. Before too long, patients will stop trusting a physician because there is only that basis for the relationship.

In a holistic practice, where by definition the doctor is concerned about the whole patient, you have the basis for a personal relationship. That means you have the basis for trust. And with trust, patients share more with you, they take your advice, and there is probably even the positive placebo effect.

Charlie: One implication of what you’re saying is that our existing approach, based on insurance reimbursement of pills and surgery, is basically built to minimize trust.

Craig: Yes, I think that’s an accurate statement of the current situation. The health care delivery system is tied to the doctor-patient trust level. And not in a good way just now.

Charlie: Well, this has been enlightening indeed; thanks so much for spending time with us.

Craig: Thank you, Charlie.

Market Segmentation Does Not Equal Trust

A piece from PharmaVoice caught my eye the other day. Titled Market Capitalization, it talks about how market segmentation can help pharma companies more precisely reach targeted audiences.

All well and good, until I saw this:

…just as personalized medicine is becoming a best practice for delivering optimal healthcare, personalized messaging to the physician audience is increasingly becoming a best practice for marketing.

Careful segmentation allows marketers to specifically target the audience with messages that speak directly to them. Segmentation helps deliver the right message to the right physician at the right time. Personalization shows physicians that they are intimately understood, which fosters trust and value.

No, it doesn’t.

Careful segmentation in messaging tells me there’s a better chance that your information will be relevant to me.

It does not tell me I’m intimately understood; it tells me you’ve got smart robots.

The difference matters.

Trust and Segmentation

Rifle-shot targeting and segmentation affects one out of four of the Trust Equation components: it speaks to your credibility. Credibility tells me you’re smart, credentialed, competent.

That’s helpful, indeed. But it doesn’t speak to the other three components: reliability, intimacy, and low self-orientation – particularly the latter two.

The casual conflation of credibility and intimacy is, I think, a hallmark of modern marketers. Most of them, I suspect, would say, “Oh come on, Charlie, that’s just a small matter of semantics.”

Not so. Our words belie our thoughts. When we easily slide from a mechanical formula to a claim of “intimate understanding,” we have lost something. And to trivialize the slide is to lose even more.

Trust and Understanding

The dynamic of personal trust is complex; part of it is rational and deductive. But much of it is psychological, interior, calling on other-than-frontal-lobe kinds of brain functions.

That sense of being connected, appreciated, and validated leads us to lower our guard, to accept deeper relationships, and be open to advice-giving, among other things.

In this sense of the word, we come to trust by way of being understood; and we come to be understood through the means of other people intentionally paying attention to us.

This business of paying attention to other people is what drives personal trust creation. Marketers using technology to develop rifle-shot segmentation schemes are doing perfectly good and useful work. But not in their wildest dreams does this make customers feel “intimately understood, which fosters trust and value.”

Please, marketing and communications people, let’s try and remember the difference.

Story Time: It’s Trust, Therefore It’s Personal

Our Story Time series brings you real, personal examples from business life that shed light on ways to lead with trust. Our last story illustrated how one conversation changed everything. Today’s selection highlights  the value of making a personal connection.

A New Anthology

When it comes to trust-building, stories are a powerful tool for both learning and change. Our new book, The Trusted Advisor Fieldbook: A Comprehensive Toolkit for Leading with Trust (Wiley, October 2011), contains a multitude of stories. Told by and about people we know, these stories illustrate the fundamental attitudes, truths, and principles of trustworthiness.

Today’s story is excerpted from our chapter on selling to the C-suite. It vividly demonstrates the value of paying attention to more than just the task-at-hand, and taking the risk to put personal before business.

From the Front Lines: Taking a Chance on Connection

Gary Celli tells a story of the business value of building trust quickly with a C-level client.

“I was working in California for a multi-national high-tech company. I was a project manager at the time, and the project I was leading was rife with difficulties—nothing atypical, just the usual stuff. We were also trying to position additional work with the customer.

“One day, the CIO asked specifically to meet with me. Until that point I had been dealing with his directors, so he and I hadn’t spent any time together beyond a brief interaction at the big project kickoff meeting. You can imagine I was a little on edge about the meeting.

“The first thing I noticed when I arrived at his office was what a mess it was. There were papers all over the place. One chair was so stacked with stuff it wasn’t usable. I glanced around and noticed a copy of the Scranton Journal on the floor—the magazine for my alma mater, the University of Scranton, a small Jesuit university in Pennsylvania. I looked around for a diploma on the wall, but didn’t see anything. So I asked about the magazine.

“It turns out that we were both graduates, now living nearly 3,000 miles away in California. Talking about that really helped break the ice and took the edge off. We spent 30 minutes reminiscing about the school, the campus, the local hang-out bar that all the kids went to. Then we spent about 15 minutes talking about project issues.

“It was a very successful meeting. The bond we had established made it possible for me to glean more information from him and he seemed very open to hearing my perspectives on the project. We got to the heart of the matter in no time. My company also got the follow-on work, and the CIO was a loyal client for years to come.”

—Gary Celli

What’s your next opportunity to make it personal?


Read more stories about trust:


Many Trusted Advisor programs now offer CPE credits.  Please call Tracey DelCamp for more information at 856-981-5268–or drop us a note @

Disclosure Is Not Transparency

Most people see transparency as a good thing, and disclosure an obvious way to get there.  Often, we don’t distinguish between them.

But they’re not the same thing. And confusing them just lets bad behavior sneak back in through the back door.

What’s the difference between disclosure and transparency?

Transparency and Trust

Besides “able to transmit light,” the dictionary defines transparent as:

  • easily seen through, recognized, or detected: transparent excuses.
  • manifest; obvious: a story with a transparent plot.

In the simplest business terms, “transparent” means you can tell what’s going on.

If the link between transparency and trust isn’t self-evident, here are a few citations to help clarify it:

If I can see what’s going on, I know that I am not being misled. Motives become clear. Credibility is affirmed. Transparency is indeed a trust virtue.


Disclosure is a time-honored tool of regulators to achieve transparency. Food and pharmaceutical manufacturers are required to disclose ingredients, medical authors are required to reveal payment sources, the SEC frequently proposes disclosure as a tool, and so on.

Certainly you can’t find out what’s going on if information is actually hidden.  So disclosure is a necessary condition for transparency. But it’s hardly a sufficient one.

I don’t have much to say about the cost/benefit trade-off of greater disclosure in pursuit of transparency. Sometimes the benefit is obvious, other times not so much, sometimes not at all.

What’s more interesting to me is how the blind pursuit of disclosure can actually reduce transparency – even reduce people’s awareness of the distinction.


Is it possible to have too much disclosure? So much disclosure that information gets lost in the blizzard of data?

On the face of it, disclosure is the handmaiden of transparency. But if disclosure becomes the end rather than the means, if regulators and consumer advocates become fixated on indicators rather than on what they indicate, then disclosure can actually become self-defeating.

Lawyers know that massive responses to discovery requests can overwhelm opposing counsel. Cheating spouses know that the best lies are those that disclose the most truth. Consumer lenders know to fast-talk the disclaimers at the end of radio ads, much like the small print on the ads and loan statements.

If disclosure isn’t accompanied by an ethos of transparency, it can be positively harmful. It is like crossing your fingers behind your back, taking movie reviews out of context, or word parsing a la “it depends on what the meaning of the word ‘is’ is.”

A trustworthy person, team or company will not settle for disclosure, but seek to offer transparency. A competent regulator will always remember that disclosure is just evidence. And a wise buyer will always look for the transparency that may, or may not, underlie the disclosure.

Trust relies on both data and intent.


Many Trusted Advisor programs now offer CPE credits.  Please call Tracey DelCamp for more information at 856-981-5268–or drop us a note @

When Failure is an Option–and an Opportunity

“Park the car,” the officer said to my 17 year old son who was taking his driving test.  He had put the car in drive and was about to make a left turn out of the parking space as the officer instructed.  He’d gone all of about 2 feet.  But he did not look to the right, an offense that will require retesting.

I’d practiced with my son the day before.  He is a good driver.  Obeys the rules of the road religiously.  Always goes the speed limit.  Stops completely at stop signs and for pedestrians.  Signals before turning.  I was sure he would get his license on his first try.

No Need for Blame or Shame

Was he upset?  His answer was a clear “no.”  He wasn’t embarrassed either.  “It just is,” he said.

What he didn’t do:

  • Make excuses or try to justify what happened
  • Blame the officer, me, my wife or even himself
  • Get angry

What he did do:

  • Respected the officer for calling him on the mistake
  • Resolved to pay more attention
  • Accepted the fact that he would have to retake the test and looked on the bright side — he would get to drive more for additional practice

Lessons Learned From a Failed Driving Test

We broadened our discussion about what could be learned from his experience:

  • Rules for driving are important.

He came up with that one.  If we did not follow those rules, the roads would be chaos and dangerous.  To me, that sounds a lot like reliability, a Trust Equation component.  Knowing that people stop for red lights and stop signs creates some degree of reliability.

  • Civilized society requires rules.

He mentioned that we need rules to survive as a society, so we know what is expected of us and what to expect.  Again, reliability on a more global, rather than individual scale.  Interestingly, I think he picked that up in 8th grade where the students created their own rules.

  • Failing the test was the right consequence of the mistake he made.

I was impressed by the matter-of-fact way he accepted the situation.  He realized he’d made a mistake and that he should not blame others for it.   That shows a low self-orientation, another Trust Equation component.

Intimacy Trumps Failure

After the officer terminated my son’s driving test less than a minute after it started, he told my son that he had made the same mistake a couple of years before.  The officer turned left without looking right and almost hit someone in a wheel chair.   The officer exposed his own vulnerability and he connected with my son in that moment.  The truth is, that moment of intimacy made my son’s respect and admiration for the officer grow a little and I think my son grew a little too.

My son learned a lot about failure and success.  And about living.

Story Time: An Unexpected Way to Recover Lost Trust

When it comes to trust-building, stories are a powerful tool for both learning and change. Our new Story Time series brings you real, personal examples from business life that shed light on specific ways to lead with trust. Today’s anecdote zeroes in on an unexpected way to recover lost trust and appease an unhappy client: listening.

A New Anthology

Our upcoming book, The Trusted Advisor Fieldbook: A Comprehensive Toolkit for Leading with Trust (Wiley, October 2011), contains a multitude of stories. Told by and about people we know, these stories illustrate the fundamental attitudes, truths, and principles of trustworthiness. In the coming months, we’ll share a selection of stories from the new book with you.

Today’s story is excerpted from our chapter on listening. It vividly demonstrates the value of hearing someone out, resisting the temptation to problem-solve too quickly, and being willing to always do what’s in your client’s best interests—even if that means letting go of the work assignment.

From the Front Lines: Listening to Recover Trust

Catherine Gregory, Senior Principal at SRA International in its Touchstone Consulting Group in Washington, DC, tells a story of the business value of listening.

“I had a team of four working on a long-term project with an important client who especially valued seeing the same faces year after year. In the course of three months, the entire team turned over. I had to deliver the bad news as each team member departed.

“After several turnovers, my client vented to me his frustration. I listened, and then listened some more, as he expressed his concerns and aggravation. He concluded with, ‘I know you are doing all you can. I just had to get that out.’ He was still unhappy and we were able to move forward together.

“Once things were stable with the team, I brought up the possibility of phasing out our support and letting him phase in a contractor who he felt would be more reliable. He didn’t want anyone else; he wanted our team.

“This experience proved to me without a doubt that listening is a critical business skill, and a way to recover trust in the face of challenging circumstances.”

—Catherine Gregory (Senior Principal, SRA International, Touchstone Consulting Group, Washington, DC)

Who in your life is waiting for you to give them a good listening to?

Gallup on Banking: Squandering Trust for 32 Years

When a child is untrustworthy, parenting is needed. When an adult is untrustworthy, counseling can help. When a company is untrustworthy, markets exact discipline.

But what if an entire industry has lost trust? What kind of a problem is that? And how can it be solved?

The Banking Industry

A recent Gallup survey makes the banking industry a timely poster child for low trust.  Banking is not the only low-trust industry these days; pharma could give it a good run, for example (and both are more trusted than Congress). But the trust issues raised by the poll are not just industry-specific.

First, the facts. In Rebuilding Trust in Banks, Gallup presents 32 years of survey data. That’s quite a lot of years.

In 1979, 60% of respondents said they had “a great deal” or “quite a lot” of trust in banks. By 2011 that number was down to 23% (actually up from 18% in 2010).

That is a 70% decline from peak (60) to trough (18).  Put another way–the industry squandered 70% of its trust. That’s quite a lot of squander.

The obvious two questions are: How does that happen? And what can be done about it?

How Can an Entire Industry Squander Trust?

I haven’t seen a single answer, partly because there is no One Answer. But I also haven’t seen a good list. So let’s break it down.

1. It’s tempting to blame a general decline in trust across all business. But there are three problems with this view:

a. Trust in business actually seems to be volatile, not steadily dropping;

b. The statistics usually conflate two issues. Saying “trust in business has dropped” fails to distinguish a decline in customers’ propensity to trust from a decline in banks’ trustworthiness;

c. There are notable exceptions. Nurses and pharmacists have topped the “most trusted professions” surveys for years–how do they beat the odds? (Particularly pharmacists–since pharmaceuticals as an industry ranks so low).

2. A decline in the inclination of people to trust. Dr. Eric Uslaner suggests that people’s propensity to trust in government is cyclical (it varies with the economy), but that trust in people has steadily declined since the 1970s.

3. A decline in general trustworthiness of banks. It’s not easy to isolate banking trustworthiness from customers’ propensity to trust–definitions are difficult. Two very different but powerful approaches to corporate trustworthiness measurement can be found in Trust Across America and in Laura Rittenhouse’s Rittenhouse Rankings of corporate candor.

4. An anti-trust ideology of business. We have inculcated a couple of generations of businesspeople with beliefs that drive down both propensity to trust and corporate trustworthiness.

Here are five ideologies in vogue since the 1970s:

a. Economists’ celebration of the virtues of markets–think Milton Friedman;

b. Strategists’ celebration of competition–think Michael Porter;

c. Pop philosophers’ celebration of laissez-faire systems–think Ayn Rand;

d. Financial theorists’ celebration of shareholder value–think Michael Jensen;

e. Government officials who embraced all the above ideologies–think Alan Greenspan.

If you doubt the power of beliefs to change society over a generation, consider this passage from Michael Lewis’s Vanity Fair article describing a German banker who was [recently] completely snookered by lying US investment bankers.  Why was he taken? Lewis writes:

He mists up a bit when he tells stories about the Americans he did business with back then [in the early 80s]: in one story an American investment banker who had inadvertently shut him out of a deal hunts him down and hands him an envelope with 75 grand in it, because he hadn’t meant for the German bank to get stiffed.

“You have to understand,” he says emphatically, “this is where I get my view of Americans.”

In the past few years, he adds, that view has changed.

What does this add up to? It means:

  • Low trust in business is not pre-ordained—we reap what we sow;
  • Low trustworthiness drives low propensity to trust more than the other way around;
  • Beliefs drive behaviors;
  • Leaders’ belief systems exert big influence over trust in business.

What to Do?

If you’re with me on the diagnostic, there’s a simple prescription:

Leaders, Straighten Up and Think Right.

In other words: start with leaders and thoughts.

Here’s what Gallup has to say about how to build trust:

The effort to rebuild trust must begin with bank leadership, then flow through a bank’s employees to customers, the public, lawmakers, and regulators. Every interaction matters. If bank leaders and employees do not demonstrate that they trust their own bank, other stakeholders never will.

Because the process of rebuilding trust with the public starts with the bank, Gallup recommends that bank leaders make rebuilding employees’ trust in banks their No. 1 priority.

Yes, there’s more. Uslaner has a lot to say about economic inequality and education, and it’s very valuable. But you yourself—yes, you, the reader—may not have a lot of direct control over inequality.  You do, however, control your own thoughts, and you probably influence and lead other people.

Start thinking trust-creation. When it comes to trust, thoughts have power.


The July Trust Matters Review

Trust Equation

Mary C Shaeffer reminds us that feeling uncomfortable when you give an employee bad news is about you, and that what they need is what you should be focused on.  Which is to say, it’s not about you.  Read for some very practical advice and a good head-straightening.

Ian Brodie walks us step by step through what is required to become a trusted adviser, starting with doing a good job at whatever you were initially hired to do, but moving far beyond basic competence.

Joel Spolsky meditates on who employees eat their lunch with, and how cafeterias encourage or discourage people to eat together.  Think it might have trust implications?

Burson-Marsteller’s pan-European trust survey finds, unsurprisingly, that trust in business government has crashed since the financial crisis.  Guess by how much for CEO’s, multinationals and government and then head on over and see if you got it right.

An interview with Microsoft’s Ross Smith keeps circling back on trust.  How do you get the most out of  your team?

Research shows that staying loyal is good for your health, your creativity and your pocketbook.  Read the ways, and why.  And then note the caveat—when society lets you.

J. Keith Murnighan and Li Huang ran an experiment called the trust game to try and figure out why we trust some strangers, like Bernie Madoff, virtually instantly.  The conclusions from their trust game aren’t startling, but they are interesting.

Does medical school make doctors less empathic? If so, does that mean we can trust them more, or less?  Does objectivity trump empathy and caring?

Cary Berglund and Julie Brayton report on a Pew study of Facebook and Trust.  Quick, are Facebook users more or less trusting than the general population?

Eric D. Brown writes on the corporate culture at RIM, maker of the Blackberry, who is currently having severe business problems.  The first quote, from an insider, makes me think the problem is a culture where no one trusts anyone else.

The Trust Matters Review highlights the best articles and posts on trust our research has turned up in the last month.

If you’d like to share a great article about trust, let us know, in the comments here.

For more links to outstanding articles on trust, see:

For a live stream of our trust research, follow our team on Twitter: @CharlesHGreen, @AndreaPHowe, @stewartmhirsch, and @sandystyer.