How To Know When To Dial Your Confidence Up -- Or Down

Therese Huston

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In her book
How Women Decide: What’s True, What’s Not, and What Strategies Spark the Best Choices, cognitive psychologist Therese Huston is changing the conversation about women as decision-makers. Therese presents expert, accessible analysis of what the science has to say about a woman’s decision-making process as well as relatable anecdotes that allow you to dive into the details. Read on for Therese’s take on using confidence as a strategic tool to decide between staying curious and making the call.

Dialing it down, then dialing it back up

How do you finesse your use of confidence? Successful leaders dial their confidence down when they’re in the process of making a decision. With your confidence turned down, you listen carefully, remain receptive, and take in all the necessary information. “Stay curious” is your mantra. But once you’ve made a decision, when you are pushing forward an agenda, strategically dial your confidence back up.

What does this look like in practice? Take Lila, a pulmonary specialist at one of the top-rated hospitals in the United States. She works in the intensive care unit, but she told me a story about a patient in a different wing of the hospital. This patient had undergone heart surgery, and although his heart was recovering on schedule, his lungs weren’t. In the days following his operation, a breathing setback meant he had to be placed on a ventilator. When the patient was still struggling to breathe, his doctor had made an incision in the front of the man’s neck and inserted a tube in his trachea. Would this become the permanent solution? The heart surgeon asked if someone from the pulmonary department could swing by to offer input. Lila got the call.

She went to this patient’s room and started with his chart, but, like any good doctor, she couldn’t decide what was going on from that alone. Usually she’d talk with the patient, but he couldn’t speak to her because he was on the ventilator. Lila could understand his mouthed words, but she needed details. Thankfully, the patient’s wife was at his bedside. Lila learned the man had never been officially diagnosed with asthma or bronchial problems prior to the surgery, but, his wife told her, he had occasionally felt short of breath if he pushed himself too hard exercising. As Lila listened, she picked up the man’s hand and held it to reassure him that she was paying attention to him as well.

This might have been a clear-cut case, but Lila wasn’t sure, so she kept asking questions. She studied the breathing machine. She asked to speak to his nurse, who was in the next bed space. “No one likes to have an invader come in to see their patients, and even though I’m wearing the right coat and have the right badge, I’m not known in this part of the hospital like I am in mine,” Lila told me. “So when the nurse comes over and I ask how he’s doing, the nurse says, ‘Well, you can see him right there.’ I said, ‘I appreciate that, but I work in a unit where the nurses and doctors work closely together, and I’d like a little more information from you.’” Lila saw she had two problems: she needed more subjective information to judge the best course of treatment, and she needed it from this person who was disinclined to help. She kept her confidence level dialed down, both internally and externally. (I couldn’t help noticing she’d kept her anger down too.) She could have peacocked her credentials, but she knew that this nurse, who had been overseeing this patient for more than a week, probably had concrete observations, and Lila needed to hear them.

Slowly, with Lila’s gentle encouragement and persistence, the nurse offered more detailed information about the patient’s daily symptoms, nuances of how he was or wasn’t reacting to different medications. The pieces began to fall into place. The patient’s heart regimen was appropriate, but there was a less invasive solution to his breathing problem. Lila reached her decision—he needed to be moved to a different unit where they could adjust his breathing regimen. He might be on a ventilator indefinitely if they continued this course of treatment. Now Lila ramped up her confidence. She called the doctor who’d requested a pulmonary specialist and said, “I would love to bring him over to our unit. We can get him off that machine. Let us take care of this for you.” The patient was moved the next day.

Several months later, Lila received a letter from the patient’s wife. She wrote that after 66 days in the hospital, her husband was finally back home. The tube in his trachea had been removed, and he didn’t need an oxygen tank. He was breathing completely on his own. We were lucky you were there, she wrote, to get us from one part of the hospital to another. You rescued us.

There are many tools that Lila employed to make this judgment and get this patient moved, including her knowledge of different ventilators and her interpersonal sensitivity. But let’s look at how her ability to turn her confidence up or down at the right time was indispensable.

What might have happened if she had gone into that patient’s room overly confident? As we learned earlier, overconfidence gives people a reason not to seek extra data. As soon as all the information in front of them fits into a clear, tidy story, they stop asking questions. If you’re expecting to feel confident, you don’t want a messy story where you walk away looking and feeling unsure. If that had been Lila, she would have read the patient’s chart and found that everything there told a coherent story that fit the other doctor’s diagnosis—it was a textbook case of respiratory failure—and she would have agreed that the trachea tube was the right course of action.

But Lila didn’t settle for that story. She stayed curious even when she had an acceptable explanation for all the obvious data, and she kept asking questions to see if each new piece of information would still fit. She wasn’t afraid to discover something she didn’t understand. She fiddled with the ventilator. She asked which positions in bed made the patient cough and when his coughs were wetter than others. Now she was uncovering data that didn’t fit that original story. And because she kept seeking data, because she wasn’t trying to experience an immediate click of confidence, it gradually came to her that all of his symptoms, even the small ones, needed to be treated simultaneously, not one at a time.

It’s a small consolation, but the patient’s doctor was following a well-recognized course of treatment for lung complications. Remember, Lila works at an excellent hospital, one you would probably know if you heard the name. This wasn’t a problem of insufficient care; it was a problem of insufficient data and using only that data to make a judgment. Lila believes that if she’d projected certainty and superiority, that nurse who had been taking care of the patient wouldn’t have shared those small but crucial observations that helped Lila diagnose him.

Keeping her confidence turned down was important while Lila was still gathering data and deciding, but what if she’d continued to keep it down? What if she hadn’t turned up her confidence once she decided, what if she hadn’t gone to the surgeon and declared, “We can get him off that machine”? The surgeon might have kept the patient in the ICU and made the trach tube permanent, which means the patient would still be using it to breathe today. Or the doctor might have authorized the transfer even if Lila had been deferential and uncertain, but he might not have trusted Lila with all aspects of the patient’s care and might have sent mixed messages to the family and the patient. If patients don’t believe in their care teams, Lila told me, they don’t recover as well.

What’s especially impressive? Lila didn’t even treat this patient. She ushered him into someone else’s care, a trusted colleague who she knew would be able to help the patient breathe on his own again. She didn’t size up the situation and say, I’m better. She sized up the situation and said, There is better.

Want to know more? You can read about how women approach decision making in How Women Decide: What’s True, What’s Not, and What Strategies Spark the Best Choices by Therese Huston, Ph.D. Copyright ©2016 by Therese Huston. Published by Houghton Mifflin Harcourt.

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