Looking back: April 2026
I’ve been thinking lately about what medical technology sales taught me earlier in my career. Almost every framework I use today for understanding trust-based selling traces back, in some form, to patterns I first saw playing out in hospitals and physician offices.
Medtech is a compressed laboratory for trust economics. What takes years to show up in other industries shows up in quarters in medtech, because the stakes are clinical — the buyer’s decisions have patient consequences, and that raises the trust threshold for every interaction.
Three patterns shaped how I think about selling generally.
Clinicians Talk to Each Other More Than They Talk to Reps
In most B2B industries, the buyer’s information flow includes the vendor heavily. Case studies, webinars, sales conversations, demos — these shape how the buyer understands their options.
In medtech, the information flow runs primarily through other clinicians. A physician evaluating a new device talks to three or four peers before they’ll seriously consider it. Those peer conversations happen in hallways at conferences, in text threads between specialists, in informal networks that predate any sales cycle.
What this meant practically: your reputation among clinicians was almost entirely shaped by conversations you weren’t in. The rep in the room during a sales call was far less influential than the three physicians at a different hospital who had mentioned you (or hadn’t) in passing.
Looking back, this was my first real lesson in reputation as infrastructure. You can’t engineer it directly. You can only behave, over years, in ways that make the conversations about you land well. Everything else is downstream.
The Reference Check Is Informal and Constant
The formal reference conversations in medtech — scripted, polished, compliance-aware — are the least important ones. The real references happen sideways: a department head asks a friend at another institution “hey, have you used them?” The friend gives a 30-second answer. That answer decides more than any prepared reference call will.
This shaped how I think about customer success in every industry since. The goal of customer success isn’t to produce good references. It’s to produce a customer who, when asked casually, gives a 30-second answer that advances your deal — without knowing they’re being asked for anything.
Most sellers optimize for the formal reference. They should be optimizing for the informal one.
Small Reputation Mistakes Compound Rapidly
In consumer markets, a bad experience is a marginal data point — the company is big, the customer is one of many, the reputation absorbs the hit. In medtech, the physician community is small enough that one bad experience propagates quickly.
I watched reps lose entire territory coverage over a single bad interaction with a senior clinician. Not because the clinician complained publicly — because they mentioned it, once, to a colleague, who mentioned it to another, and within six months the rep was persona non grata across five hospitals they’d never visited.
This is the trust-decay pattern you read about in theory. In medtech I watched it operate in real time. It made me permanently cautious about small interactions that seem low-stakes in the moment. The senior clinician whose call I didn’t return was not, in any individual moment, a big deal. Cumulatively, those misses were career-altering for some reps.
The thing medtech taught me that I carry into every industry since: trust-based selling isn’t a style preference. It’s the load-bearing infrastructure of any long-term revenue relationship. Every industry has its own compression rate on how fast the infrastructure shows up — medtech’s is faster than most.
The operators I watched win in medtech weren’t the best pitchers. They were the most consistent depositors. They returned calls. They kept promises. They didn’t play games with reference lists. Over years, their reputations compounded, and their pipeline started showing up before they’d done anything to generate it.
That’s the whole game, in every industry I’ve sold in since. Medtech just taught me to see it earlier.
The people who think of trust as a “soft” variable have usually never sold into an environment where trust failure meant being shut out of an entire professional community within months. Medtech operates at that compression. So do a lot of other industries, eventually. Start treating trust as load-bearing infrastructure before your industry forces you to.