What a Cancer Surgeon Taught Me About Sales
A prostate cancer surgeon discovered why patients ignored his recommendations, and it changed how I think about selling.
By Eric Janssen
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A man in his late seventies walked into Dr. Behfar Ehdaie's office with a diagnosis of extremely low-risk prostate cancer. The kind that almost never becomes life-threatening. Statistically, his mortality risk from this cancer was under 1%.
Every surgeon and radiation oncologist he'd consulted told him the same thing: "Treatment won't prolong your life."
Yet he was still searching for someone who would operate.
Most physicians would have delivered another version of the same recommendation. But Dr. Ehdaie, a surgeon at Memorial Sloan Kettering and one of the world's leading experts in prostate cancer, did something different.
He paused.
He asked questions.
He created space.
And when the conversation widened beyond the word cancer, something unexpected emerged.
The man wasn't afraid of the cancer itself. He was exhausted from waking up three, four, sometimes five times a night to urinate—symptoms he believed were caused by the cancer and that surgery would fix.
But those symptoms weren't from cancer. They were caused by benign prostate growth. Surgery wouldn't have helped. It might have made things worse.
Once the real problem surfaced, the solution became obvious: Treat the urinary symptoms. Monitor the cancer. Restore peace of mind.
Most of us—hearing the word cancer—would have assumed we knew why he was there. But cancer wasn't the problem he was trying to solve. It was the signal that opened the conversation.
The real problem still needed to be diagnosed.
The Problem with Prescribing Too Soon
There's a moment every founder, seller, or leader eventually hits.
You're sitting across from someone—a customer, a colleague, a partner—and you're certain you already know the answer. You've seen their problem before. You know the playbook. You can see the path they can't.
So you start explaining. You walk through the data. You outline the options. You tell them what to do and why it's the right move.
And then something strange happens: They don't follow your advice.
They hesitate. They push back. They look for another opinion. Or they choose the very option they came to you to avoid.
For years, I assumed this was a persuasion problem. Entrepreneurs that I’ve worked with often land meetings with great prospects and present their best solutions, but customers don’t buy. They mistakenly think the fix is clearer reasoning, better framing, or more conviction.
People don't resist advice because the solution is wrong. They resist because they're solving a different problem than the one you think you're addressing.
Before you can prescribe a solution, you have to diagnose the problem.
When Expertise Isn't Enough
Dr. Ehdaie's challenge stemmed from a concept in oncology called active surveillance. In simple terms: when someone has localized, slow-growing prostate cancer, aggressive treatment often isn't necessary. Instead of immediate surgery or radiation, doctors closely monitor the cancer over time.
The reason is straightforward: those aggressive treatments often come with serious side effects—affecting urinary function, sexual health, and quality of life—without meaningfully extending survival in low-risk cases.
From a medical standpoint, active surveillance is often the most responsible recommendation. From a human standpoint, it can be one of the hardest to accept.
You'd think being one of the nation's top surgeons would make these conversations easier. It didn't. Despite his expertise and the data, many patients still resisted active surveillance.
Something wasn't landing. And for a long time, Dr. Ehdaie couldn't figure out why.
Then came his breakthrough: He realized he was prescribing a solution before he truly understood what mattered to each patient. He was giving them information they didn't know how to interpret. And he was assuming the decision happened in the exam room—instead of at home, in harder conversations with spouses and children.
The problem wasn't medical. It was communication.
So he did what great innovators do: he looked outside his field. He reached out to Deepak Malhotra, a negotiation and behavioral psychology expert at Harvard Business School, and invited him to Memorial Sloan Kettering to observe real patient consultations.
"He came to multiple clinics," Dr. Ehdaie recalled. "After each session, we debriefed to evaluate what he'd observed and where opportunities existed to improve."
The diagnosis was clear: "Many of the things we had perceived as being effective were, in fact, not effective."
From those observations, a new approach emerged. Not a script. Not a persuasion tactic. But a structure for better conversations—one that begins with understanding before recommending.
Four Principles for Better Diagnosis
Dr. Ehdaie and his colleagues distilled their insights into a simple, teachable framework—a laminated one-page checklist that physicians could reference before every appointment. While created for medicine, its lessons apply to anyone who communicates for a living.
Here are the four principles that stand out:
1. Lead with Questions, Not Options
Before discussing treatment, Dr. Ehdaie now asks patients what the diagnosis means to them and their family. It's an opening that invites the real story to surface.
People don't make decisions based on data alone. They make them based on identity, fear, hopes, responsibility, and relationships.
As Dr. Ehdaie explained: "Oftentimes people perceive cancer as just a choice between life and death. There may be factors in quality of life that are really important to patients. There may be financial considerations. There may be considerations about their family."
If you don't understand those interests, your prescription won't land.
This principle applies everywhere. In sales, it means understanding not just what problem the product solves, but what success looks like to the buyer's organization, career, and stakeholders. In leadership, it means recognizing that resistance to change often stems from concerns you haven't surfaced yet.
2. Lead with Your Actual Recommendation
Behavioral psychology tells us that the first option presented is often perceived as the preferred one.
Because Dr. Ehdaie is a surgeon, he used to start with surgery when explaining options—not because it was best for the patient, but because it was familiar to him. Then came radiation. Active surveillance came last.
He had to reverse the order. Lead with the recommendation you actually believe in, even if it feels uncomfortable.
Order signals priority. When you bury your real recommendation at the end, you're implicitly telling people it's the least important option.
This applies in any situation where you're presenting options. If you believe Option A is right but present it last out of politeness or hedging, you're undermining your own credibility.
3. Frame Before You Explain
One of the biggest communication mistakes is giving information without context.
Dr. Ehdaie used to tell patients they'd return in six months for a follow-up. Many panicked. Six months felt like abandonment.
So he changed the frame. He now begins by explaining that prostate cancer progresses slowly—often over several years. Then he introduces the six-month interval.
Suddenly, six months doesn't feel risky. It feels appropriate.
That's the power of anchoring: set the reference point before presenting the plan.
In business, this might mean explaining market dynamics before proposing a pricing strategy, or outlining implementation timelines before discussing project scope. Give people the context they need to interpret what comes next.
4. Prepare Them for the Conversations You Won't Be In
The real decision rarely happens in the exam room. It happens later—when the stakeholder group assembles.
Family dynamics, fear, and Google searches can easily unravel a clear recommendation.
Great communicators don't just explain the solution. They prepare people for the conversation after the conversation.
In sales, this might mean acknowledging: "When you bring this to your CFO, they're probably going to ask about ROI timeline. Here's how I'd frame that conversation."
Often, the formal sales meeting isn’t where the decision happens, but it’s where you prepare someone for the conversations that follow. You're not just making a recommendation—you're equipping them to defend it when you're not in the room.
The Power of a Checklist
What still amazes me about this story is that the breakthrough wasn't a new technology. It wasn't more data. It wasn't charisma.
It was a laminated one-page checklist—a simple system that helped doctors separate assumption from understanding, and prescription from diagnosis.
When adopted across Memorial Sloan Kettering, it led to a 30% reduction in unnecessary treatments.
Think about that: One hour of training. One standardized approach. One repeatable structure. And now, thousands of patients are making better decisions about their health.
The biggest unlock wasn't a new tool. It was a new discipline—a repeatable structure that created room for curiosity, clarity, and trust.
Diagnosis as a Differentiator
You may never deliver a cancer diagnosis. You may never step into an operating room.
But you will sit across from people facing decisions that feel just as high-stakes to them.
And in those moments, what separates trust from resistance is your ability to slow down, get curious, and understand what truly matters.
The people who earn trust fastest aren't the ones with the quickest answers. They're the ones who create space, ask better questions, and see the person behind the problem.
When you do that—when you diagnose before you prescribe—something powerful happens:
They stop searching for a different answer.
They start believing you've heard them.
And only then are they ready to move forward—not because you convinced them, but because the two of you discovered the path together.
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Eric Janssen teaches sales and entrepreneurship at the Ivey Business School at Western University. He is the founder of the Founder Sales Sprint and host of the Sales Reframed podcast, where he interviews Dr. Behfar Ehdaie in Episode 4.
