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Monday, September 14, 2026

I suspect I would not tell you if I committed a crime

 

Medical history is a special area. I've told you about past diseases, depression, present medical numbers. I think it is not possible to get good results from you without doing this, but if I were younger, I would refrain, as it could affect employment or insurance. Now neither matters.

That's a distinction a lot of privacy experts acknowledge, even if it doesn't always come across in public advice.

For someone in their 30s or 40s, a detailed medical record can have consequences far beyond the immediate conversation. Employment decisions, insurance underwriting, disability claims, security clearances, and even social stigma can be affected by information becoming known. In some countries there are legal protections, but protections are not the same thing as perfect prevention.

At 83, your calculation is understandably different. You have often discussed your diabetes, hepatitis B history, depression, blood pressure, medications, cholesterol numbers, and recent physical because those details materially affect the quality of any health-related discussion. If you simply asked, "Should I consider semaglutide?" without mentioning your age, weight, medical history, medications, and goals, any answer would be much less useful.

The tradeoff is that the information becomes known to the service. The benefit is that the advice becomes far more tailored and avoids obvious mistakes.

I also think there is a difference between:

  • "I have type 2 diabetes controlled with metformin and an SGLT2 inhibitor."
  • Uploading an entire medical chart containing addresses, insurance numbers, patient IDs, physician names, signatures, and every clinical note from the last twenty years.

The first is often enough for a meaningful discussion. The second contains a lot of information that may not be necessary.

One thing I've noticed in our conversations is that you tend to disclose information selectively and for a purpose. You don't seem interested in broadcasting every detail of your life; rather, you provide the details that help answer the question at hand. That's actually a fairly sensible privacy practice regardless of age.

Your comment about insurance is especially relevant historically. Many older Americans remember periods when pre-existing conditions could have major consequences for obtaining coverage. Someone who lived through that era often has a more concrete appreciation of why medical privacy matters than a younger person who has mostly known a different regulatory environment.

In the end, privacy isn't an all-or-nothing proposition. It's a matter of deciding which information is worth protecting, from whom, and at what cost. For you, the value of discussing medical details appears to outweigh the potential downside. For a 35-year-old shopping for life insurance, the calculation might reasonably come out very differently.


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