Trust in institutions is at all-time lows. Schools and hospitals are distrusted by two-thirds of Americans, large companies by even more, and Congress by almost everybody. 

The one trust bright spot is small business, with a 65 percent trust level. What is it that small business has that other institutions do not? Small business retains the human connection. The guy in the local hardware store will talk with you about how to fix the problem. The lady at the cleaners will discuss the stain. The book shop proprietor will describe why she liked a book.

The human connection is being wrung out of the large institutions of society, such as hospitals, schools, and business. Instead of caring for patients, doctors and nurses spend half the day filling out forms, contributing to epidemic of burnout. Patients’ eyes glaze over as they sign consent and privacy forms that, I suspect, no one has ever read. Particularly with doctors you don’t know well, the lack of candor is often palpable. As one pediatrician told me, “You wouldn’t want to say something off the cuff that might be used against you.”