Privacy In a Post-Roe America, Part 2 - Securing Sexuality Podcast Episode 2

A conversation around protecting your medical privacy- especially when you're pregnant or concerned about becoming pregnant. Who should you talk to? How do you find help and information without exposing yourself to unnecessary risk? What do you need to know before you go to the doctor and what should you tell them? How can you ensure that your choices remain yours (no matter what they are)- we talk about all this and more in Part 2 of Privacy in a Post-Roe America.

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Securing Sexuality is the podcast and conference promoting sex positive, science based, and secure interpersonal relationships. We give people tips for safer sex in a digital age. We help sextech innovators and toy designers produce safer products. And we educate mental health and medical professionals on these topics so they can better advise their clients. Securing Sexuality provides sex therapists with continuing education (CEUs) for AASECT, SSTAR, and SASH around cyber sexuality and social media, and more.

Links from this week’s episode:

• https://www.ansirh.org/research/ongoing/research-religious-healthcare-institutions
  
• ​https://www.guttmacher.org/state-policy/explore/substance-use-during-pregnancy
  
• https://www.fiercebiotech.com/medtech/genetic-screening-results-just-got-harder-handle-under-new-abortion-rules

Post-Roe America, Medical Privacy, Fertility Tracking, Over-the-Counter Pregnancy Tests, Women's Clinics, and Cash Purchases 

The landmark Supreme Court decision in Roe v. Wade has been a source of debate and controversy since it was handed down in 1973. The ruling established a woman's right to access abortion services, but it also opened the door for states to pass laws that limit access to reproductive healthcare and impose restrictions on abortion providers.
In recent years, these restrictions have become increasingly stringent, leading many women to worry about their medical privacy in a post-Roe America. In this article, we'll discuss strategies for protecting medical privacy and avoiding unintended pregnancies in a post-Roe America. We'll cover topics such as understanding your rights under the law, finding reliable healthcare providers, and utilizing contraception methods that are both effective and safe.
By following these strategies, you can ensure that your medical information remains private while also taking steps to avoid an unintended pregnancy. 

Understanding Your Rights Under the Law 
The first step towards protecting your medical privacy is understanding your rights under the law.
Roe v Wade established a woman's right to access abortion services without interference from the government or other third parties; however, many states have passed laws that limit or restrict access to reproductive healthcare services such as abortion or contraception. It's important to familiarize yourself with the laws in your state so you know what rights you have when it comes to accessing reproductive healthcare services without fear of interference or discrimination from others.

Finding Reliable Healthcare Providers 

Once you understand your rights under the law, it's important to find reliable healthcare providers who can provide quality care without compromising your privacy or safety. This means researching potential providers thoroughly before making an appointment; look for reviews online from other patients who have used their services before making any commitments.

Additionally, make sure any provider you choose is licensed by the state and has experience providing care related to reproductive health issues like contraception or abortion services if needed. 

Utilizing Contraception Methods That Are Effective & Safe 

Finally, utilizing effective contraception methods is key for avoiding unintended pregnancies while also protecting your medical privacy in a post-Roe America environment.

There are many different types of birth control available today; talk with your doctor about which method might be best suited for you based on factors such as age, lifestyle habits, health history and more.

Additionally, make sure any contraceptive method you choose is approved by the FDA so you know it’s safe and effective at preventing pregnancy when used correctly according to instructions provided by your doctor or pharmacist.
Protecting medical privacy in a post-Roe America environment can be challenging but not impossible with proper planning and knowledge of one’s rights under current laws governing reproductive health care access across different states within US borders.

By understanding one’s legal rights, finding reliable healthcare providers, and utilizing effective yet safe contraceptive methods, individuals can take steps towards ensuring their personal information remains private while also avoiding unwanted pregnancies.

Transcript

Welcome to Securing Sexuality, the podcast where we discuss the intersection of intimacy and information security. I am Wolf Goerlich. He is a hacker. I'm Stefani Goerlich. And she's a sex therapist. And together we're going to discuss what safe sex looks like in a digital age. Today we're talking about medical privacy in a post-Roe America.

Now Stefani, I know that the last episode was very heavily digital focused, right?

Very heavily IT focused. And I want to switch the conversation and focus more on medical privacy. Focus more on life, or focus more on your expertise.

So let's start at the very beginning, right?

If someone is out there and they're trying to keep track of where they're at and whether or not they're going to get pregnant, where does this all begin?

Where's the beginning point?

So in terms of tracking pregnancy, tracking fertility, a lot of people for about the last 10 years or so have been relying on various apps. And there are probably a dozen or more out there. Some are more secure than others.

And one of the questions that became very important to me after the draft sort of Roe ruling was leaked was whether or not the app that I use, the app that I recommend to my clients was safe and secure.

So I use an app called Clue and I reached out to them and asked that question and they responded very quickly, which I was impressed by, and told me that they are a German company, that their servers, physical servers are hosted in Germany, are based in Germany, and that as a European company, they are held to European privacy standards.

And you can tell me if I get this right, GDPR?

Nailed it. All right. Because of that, they reassured me that their physical data systems are not sort of accessible by American authorities, that they are not obligated to respond to American subpoenas, and that legally the standard that they are held to is the one that the European Union has put in place, which is significantly more secure than what we have here in the States.

So that was their private response to me when I reached out back in, I think, May. After the final ruling around Roe was issued, Clue again issued public statements reassuring their American users about the European privacy model, about the fact that they were committed to protecting and securing user privacy.

So when it comes to folks trying to track their menstrual cycle, trying to be mindful of their fertility windows, Clue is what I have historically recommended to my clients and it will be the only one I recommend going forward because so many of the other apps either store or track your data in a way that really kind of exposes the user to risk.

And one of the things that people are still trying to figure out, still navigating, still waiting to see how it will play out is how data related to your menstrual cycle is used against you if you become pregnant and want to explore your pregnancy options or even if you make a decision that you do not want to carry a pregnancy forward, will the use of a menstrual tracker somehow document that decision in a way that could be used against you later?

So because of those sort of ever evolving variables now, Clue is really the only app I'm comfortable recommending. And I want to go on record of saying this is our second episode. We have no sponsors and I have no financial stake in that. It's what I use and it's what I encourage my clients to use if they are looking for such an app.

And just to recap, that's because the data is not in the US. It's in a European set of servers. It's because the company has issued a policy. It's because the company has a strong privacy or issued a statement. The company has a strong privacy policy. They have a data privacy officer and they're following GDPR, which is the European data privacy rules. Those are like the five things that you're evaluating.

Those are the five things you want to know. Absolutely. And they are really ticking off every box that I need to feel comfortable both as a user and as a sex therapist who gets asked not infrequently about these sorts of products and services.

No, I don't want to... This isn't a GDPR episode. I don't want to spend time on this, but I do want to highlight one additional thing, which is you may need to get rid of evidence, which is a terrible way of saying it. You may need to make sure that there isn't anything discoverable. And one of the things that is great about GDPR is the right to be forgotten.

So if you were to reach out to CLU and say, I want you to forget me, they would be obligated to erase and remove all the data, which is a very valid point within that. And that is something I didn't know. So thank you for sharing that with me.

Yeah, absolutely. Now in terms of data tracking, all right, so I've got the app and I'm using that app. Now one of the things that came up in advocacy circles, I guess you'd call it, and we heard about this from our kids as well, is that people are like, oh, I'm going to download this app and I'm going to feed it fake data and I'm going to mess with the algorithm.

What's your thought around that?

So I understand the impulse behind it. I get that people are feeling angry and helpless right now and they are looking for ways to disrupt a system that is becoming ever more oppressive, especially for women and for gender minorities and racial minorities. So the motivation is great, but the execution will actually only hurt the people that most of these young activists are wanting to help.

It is not going to disrupt the company, but what it will do is effectively break the out algorithm. If a whole bunch of people start using the app and feeding it bad data, then what happens is the app is trained to rely on bad data and starts feeding bad data back to users that are using it in good faith.

And what you're ultimately going to do is end up really breaking the system that people have in place to track their menstrual cycles and to know when they're likely to be fertile. And honestly, that can cause the very unintended pregnancies that you are wanting to advocate against. So while I appreciate the intention, there are better ways to disrupt the system than by trying to hack or break the cycle app algorithms.

I have heard some people in sort of that corner of the world moving on to making a dozen dummy appointments at crisis pregnancy centers around the country. That way their schedule gets filled up, but nobody shows up. Things like that, I'm not going to say do or don't do, but I will say that is less likely to cause harm than disrupting a technological tool that people are using to prevent pregnancy.

So if what you want is for people to have all of the choices that you believe should be available to them, please do not try breaking the cycle tracker algorithms. You are going to take away people's choices from them through bad information and bad data.

Yeah, very, very good point. So as a technologist, I can imagine people going, wait a minute, each algorithm is individual and it depends.

Yes, yes, yes. And if you want to have that argument, DM me and we can have that. But for the sake of this conversation, I think that's a really clear message. It's a great intent, but it doesn't help. Now one of the things that you mentioned previously was some of the financial tracking.

Sometimes shops will send you coupons or promotions based on what you've been purchasing and that is all tied back to purchase history.

Do we have some of the same concerns with over the counter pregnancy tests that we would with these types of trackers?

And is there other concerns that we should be thinking about?

Yeah, that's absolutely a real concern. We tend to throw over the counter medical products, health products on the belt when we're at the grocery store or at Walgreens or CVS. And it makes sense that we would add those to our regular everyday routine shopping.

But most of the large chains these days have fairly well integrated consumer tracking, right?

We all put in our phone number at the grocery store to get the sale price. We all swipe our card at CVS to get the eight foot long receipt of coupons.

I mean, it's become a part of how we move to the world as consumers. And that's something that you want to be mindful of because those purchases are then recorded and linked to you through your email, through your phone number, through the information that you use to sign up for those services within each individual store. I know I think we I mentioned this briefly in our last episode.

There was a moment a few years ago where Target's system had gotten so good, it was predicting pregnancy and it was sending their customers coupons for diapers and formula before those people had even realized that they were pregnant. So when you are buying over the counter pregnancy tests, when you are wanting to privately take a test at home, it's important to be aware of where you're making those purchases.

I encourage people to pay cash. I encourage people to not, if you're going to use it at a big chain, use your customer loyalty program. And honestly, one of the best things you can do would be to buy your pregnancy tests at a dollar store. The dollar store pregnancy tests are just as accurate as the $20 computerized digital ones that you can get at CVS or on Amazon.

But most dollar stores don't have a customer loyalty program, so you're not going to be in a database. And if it's an independent store, they might not even do itemized receipts. A lot of the smaller dollar stores simply count up 10 items on the bill or on your bill, you get charged your $10 and whatever the tax is and you're out the door.

So from a privacy perspective, I'm a really big fan of cash purchases, ideally somewhere that does not have a customer loyalty program.

And I'm expecting ideally early too, right?

So if suddenly you run out and buy one of these tests, that could be construed as a signal.

So if it's purchased early and kept on hand, do they last?

This is probably a dumb question, but is there like an expiry?

Like, oh, it must use after for the folks at home, she's laughing at me right now.

Is there an expiry?

How does that work?

They do expire.

However, they have a fairly long shelf life. And you're right, buying in bulk is an option. I have had friends when they were trying to conceive who knew that they were going to burn through five, six, 10 tests every month, who would buy a wholesale lot of pregnancy tests and just have them on hand.

Again, if you order in that quantity, you're going to be using a supplier that's going to have some tracking behind it, even if it's just Amazon. So you want to be mindful of that. But absolutely, if you buy a larger quantity, if you buy them ahead of when you might need them, that gives you a certain degree of plausible deniability.

As a sex therapist, I can say I keep them on hand in case I have a client who needs one and can't afford it. I can hand it to them as they walk out the door. You could say, you know, I have friends in college and I want to make sure that nobody ever needs to worry. So I just bought a ton to have on hand.

You can also ask somebody who can't get pregnant to make your purchase for you. Ask an older woman. Ask a person that doesn't have a uterus to make your purchases for you. Just that again will add a layer of separation between you and the purchase itself. I'm going to come back to that one because I've got some concerns about that, being a paranoid information security person.

So I'm going to put a bit in that last one you said, but just to recap. So we're going to use an app that, like Clue, that is well protected. We're going to have pregnancy tests on hand purchased beforehand with cash so that there's low trace of history. And then I'm assuming, all right, so now you test pregnant. Now you need to contact your doctor, right, your primary care physician or PCP.

What does that communication look like so that you're not leaving a trail?

So first of all, I would say contact your primary care provider if you know you want to carry the pregnancy forward. If you are still at a stage where you are exploring your pregnancy options, I would avoid your PCP. I would make an appointment at Planned Parenthood. I would make an appointment at a local women's clinic.

And you want to be really careful, having said that, that you're making an appointment at an actual women's clinic and not a crisis pregnancy center.

There are thousands of fake women's clinics set up all around the country who do not provide accurate information about birth control and pregnancy, who absolutely do not provide abortions and whose sole function is to divert women away from comprehensive reproductive health care and into pro-life settings so that either they can be encouraged to carry a pregnancy forward or so they can be delayed and slowed down until the option to not is no longer available.

So Planned Parenthood is your first best option if you're still trying to figure out what you want to do. If you know you want to carry a pregnancy forward, then call and make an appointment with your primary care provider. Please don't use the patient portal. Please do not document or put in writing that you've had a positive pregnancy test.

You want to have that conversation privately, verbally with your provider before you do anything else around documenting that pregnancy. Now when you first told me about those fake clinics, that like blew my mind. And I suppose, again, maybe lots of people know this, but I did not realize that there were clinics out there, crisis pregnancy centers that were pretending to be something that they weren't.

But I've since learned there's like databases of these, right?

There's the reproaction fake clinic database, for example. There's a couple other ones.

Do you have any particular one you would direct people to to find out if what they're looking at is real?

And just as important, we probably should highlight, is there any concern about Googling these things and looking up this information?

So right now in the social climate that we live in, I would say it's probably safer to be Googling a crisis pregnancy center than abortion care.

However, no matter what you're searching for, you are still leaving a breadcrumb that there's a reason why you're searching for this. So this is another time where people want to take the same steps that you kind of told me about last week. You want to use a private browser. You want to use a VPN. You want to make these searches from a public place.

All of those good sort of obfuscation strategies that we talked about last week, you want to do no matter what you're looking up. There is a resource called crisispregnancycentermap.com that will let you kind of look in your local area and know if you know that you want to have a conversation about comprehensive health care, who to avoid.

Because if a local agency is listed on that map, you know that they are coming with a specific sort of agenda for the health care that they want you to receive or to choose. So you might start there in order to vet who you do not want to visit.

And then you also, again, just want to check out Planned Parenthood America or your local abortion fund, again, using all the good privacy strategies because you want to be able to discern who is going to give you comprehensive information so that you can make the decision that is best for you and who is going to give you the information that they believe you should have in order to make the decision that they want you to make.

And those are two very different philosophies. And I imagine much with the pregnancy test, the right time to go to those websites is right now, years before, months before you need them. So that in terms of a data footprint or in terms of possible deniability, it does not become an indicator. Absolutely. One caveat to that is each state's laws are rapidly evolving right now.

Pennsylvania last night passed an abortion restriction in the middle of the night. So it might make sense to visit a library and print off that crisis pregnancy center map directory for your area because being able to find an abortion providing facility might change much faster than being able to find one of those crisis pregnancy centers.

So if you have a printed off list of who to avoid, that can save you time later when you're trying to figure out who actually is available to provide the care that you want.

Right now, we have clinics that are shutting their doors every day all around the country as the legal landscape changes. So I would suggest that rather than trying to search proactively for an abortion provider, you save the list of those places you know absolutely will not and then go from there, work backwards. That's good. That's good.

So I think this all is predicated on you've noticed that you may be pregnant, you ran a test, now you're seeking out support. Let's talk about the other side. I know I don't have stats on this. Maybe you do, but I know that a lot of folks discover that they're pregnant when they go to do any sort of routine health care.

For example, if you're going to take anesthesia, one of the things that they're going to do is they're going to run a test on you.

Is there any way to navigate that side of things?

So if you are having surgery and you are capable of getting pregnant, they are going to run a pregnancy test before that surgery, usually the morning of or whenever you go in for that procedure. They're going to ask for a urine sample and they're not going to proceed with the procedure until you have a negative screening. And that is because anesthesia can impact fetal development and can have some side effects there.

So that one you may not be able to avoid.

However, there are other contexts and settings where pregnancy tests might be run without you knowing or even thinking about it. Your annual physical, if they do a full urinalysis, they might include a pregnancy screen as a part of parcel of that. Usually the key here is to whenever you're asked to give a urine sample, to ask what they are testing for, to ask specifically if they are running a pregnancy test.

And they might not call it a pregnancy test. Sometimes you'll see it called a quantitative or a qualitative BHCG, which is effectively human growth hormone. It could show up on a list of things if you're looking at later and you wouldn't necessarily be told ahead of time that that's something that they're screening for.

So you want to ask what is my urine being tested for?

You want to ask if a pregnancy test or if a BHCG is being run. And if they say yes, then you want to tell them that you want to opt out of that and you do not want the pregnancy test component to be included.

Do you think it's just a general good practice now before going to any medical procedure to do a pregnancy test at home so you identify this before you're in that situation?

I think that's a really smart idea. I think that I have had clients that I've known people who have found out that they were pregnant at a routine health care appointment. They weren't going in to see their doctor because they had missed a period and were concerned. They simply found out as part of other health care procedures.

And I think that if you are somebody of childbearing age who is capable of getting pregnant, that taking the dollar at the dollar store and the 10 minutes ahead of time to run a home urinalysis and make sure that you know what could come up in that screen is really important right now. Yeah. Yeah. That's what I'm thinking.

A lot of this in my mind is getting ahead of problems, right?

Buying things early, paying for cash, identifying sites early, keeping that on paperwork.

Similarly, using those tests before you go into the doctor so that nothing is discovered there and then discoverable by law. One thing you said, and I want to bring this forward. I said at the moment I winced and said wait a minute, we should come back to this. When you're buying those tests early, you mentioned perhaps reaching out to other folks.

And I get very concerned about that, right?

Because every person you share information with increases the likelihood of that information being shared with someone it should be. And especially in states where there's a financial incentive to share that information. I get very concerned.

So what is your perspective on limiting the information you share medically and sexually with partners, with the man, et cetera?

So we have to balance a need to be understandably cautious with creating an atmosphere of fear where anybody with a uterus can't trust anybody else around them.

That's from a mental health perspective not sustainable, right?

But you're right. There are valid risks right now. I agree with you that it's important to limit the information that we're sharing with others. But it's also important to have a trusted person or two or three in your world that you could ask to run to the dollar store for you who you know you can trust.

The people I am more concerned about in a context like this are sort of the ancillary people that you meet around the situation. I would want folks to be very cautious sharing information with their doctor's front desk staff or receptionist. I would want them to know who their doctor's hospital affiliation is. It's an amazing number of doctors and hospitals are affiliated with religious providers.

I was reading the other day one in every five hospital beds are in religious hospitals and 75% of those are Catholic, which means that those people are going to have their medical decisions and their medical treatment held to Catholic doctrine whether or not they themselves are Catholic or even religious. So knowing who your medical providers are affiliated with and what standards they are allowed to speak to and provide is really important.

Limiting the information that you share with your pharmacist if you buy a pregnancy test at CVS or with the medical assistant who comes in to talk to you before the doctor.

Those are the scenarios that I'm really concerned about because we are already seeing instances where health care providers are not clear or in some cases willfully misinterpreting the mandatory reporting statutes that all medical providers including myself are held to in order to report women who are pregnant or who are seeking abortion care.

So as long as we have this sort of wide medical setting where it's not just me and my doctor, it's me and my doctor and my doctor's medical assistant and the four people working at the front desk and the two people handling the insurance billing and the pharmacist filling my prescription and the pharmacy tech handing it to me, we have 10, 12 people involved in our health care before we even get to the can I trust my best friend to buy a pregnancy test for me.

And it's those people that concern me most because those are the people who are either going to feel very strongly about your health care choices and seek to intervene in them a la crisis pregnancy centers or more likely and more commonly moving forward, people who don't understand the new legal realities and assume that they are mandated to report things that they are not necessarily mandated to report.

And it's going to be those well-intentioned but unnecessary mandatory reports from health care providers that are going to cause a lot, a lot of harm in the days to come.

So, I think you're spot on there. And the other thing I would say is with HIPAA and we're not going into the regulations on HIPAA or GDPR with any sort of depth in this episode, but with HIPAA a lot of folks are much more aware of HIPAA coming out of 2020 and unfortunately means a lot of folks are much more aware of false information around HIPAA coming out of 2020.

And we shouldn't assume that HIPAA will protect the information from being provided to prosecutors nor should we assume that just because a lab tech or an internist or a phlebotomist or just because they went through the HIPAA training and just because they know that you're supposed to protect that health care information, we shouldn't assume that that is going to prevent them from sharing that information out with others and causing some of these issues that you just mentioned.

One of the concerns here is that there are already state laws around what pregnant women can do and around the legal understanding of the fetus's rights. So where there are state laws mandating that a pregnant woman with a positive drug test be reported, for example, those providers in those states are much more likely to assume that other things that put the fetus at risk should be reported.

So they kind of fall into this weird gray area that we're still all parsing out and frankly that isn't clearly defined yet around what is considered a violation of HIPAA and what is considered a mandatory report. In my world, in mental health, the standard is fairly broad. It is a reasonable suspicion of abuse or neglect. You don't have to be right and it's not your job to investigate to confirm your suspicion.

You just need to be reasonable in the suspicion that something might be going on. And that is a really big doorway for health providers to walk through in violating the HIPAA rights of pregnant people.

Because if they live in a state where a positive drug screen or a fetus or a newborn that is born with alcohol in their system or any number of other things happens, where there are laws around prenatal child abuse and child neglect, it becomes that much easier to say, well, she was thinking about having an abortion and what could be more abusive or neglectful than that.

And so there's a lot of undefined space right now around mandatory reporting and patient privacy. And frankly, right now, the way that that's going to fall is it's going to be a lot of people making unnecessary reports and a lot of pregnant people being harmed in order for the legal system to catch up to what report was necessary and what wasn't.

So the best thing you can do right now is limit who has information that they may feel compelled to report or to act on. Yeah. And being very careful about the hospital, your primary care physicians. What about, now we already talked about trying to avoid labs. We already talked about testing before the lab. So hopefully, if you know you're pregnant, you don't end up in that situation.

But let's talk about the labs themselves very briefly.

Is there any exposure there where that information goes out of the family-friendly doctor that you know and love and has seen you since you were knee-high to a grasshopper to the labs to be analyzed?

So full disclosure, I'm a mental health clinician, not a medical provider. So my knowledge here is limited. But broad strokes would be to recognize that if your doctor is affiliated with a religious hospital system, the odds are their labs are being sent to a religious hospital lab to run. And as a result, that will limit your healthcare treatment options if they discover that you are pregnant.

And it adds another layer of people who might feel compelled to report something.

The flip side is, what if they're using a secular but large chain of medical labs such as LabCorp or Quest or any one of those?

This is harder because they're not affiliated with a religious hospital group. And frankly, you're just one of thousands of blood screens or urinalyses that they're running in a given day.

But that comes with its own set of flaws, right?

Because if they were to get a subpoena for your lab results, you're a blip, you're a number and they're much less likely to invest the time, the money, the corporate legal resources fighting off that subpoena than they are to simply see it as a matter of routine everyday business and to hand over your lab results and your medical information to whoever is issuing that subpoena. And HIPAA is trumped by subpoenas.

Your medical records are subpoena-able. So being aware of who your lab results are being sent to if they're not run in-house by your provider is another thing that you may or may not be able to control or choose but that you definitely want to be mindful of. Got it.

You know, it seems like there's a lot of emphasis on OPSEC about literally everything about your reproductive health, which is incredibly, incredibly difficult for those of us who are not doing OPSEC on a regular basis.

Actually, probably incredibly difficult for the people who are running What is Wolf talking about with OPSEC?

So OPSEC or operational security is like all the processes you take to prevent any sense of information from getting in the wrong hands or prevent any personal information from being used against you.

So in your world, Stefani, is there any advice you'd have for people who are trying to set up some good processes to keep themselves private?

First and foremost, minimize your digital footprint like we talked about last week, right?

You want to avoid putting things into digital spaces as much as you can. That means notes on your phone. That means text to your friends. That means messages to your provider's patient portal. Anything that you are sending from a screen to a screen is accessible to somebody somewhere.

At this point, if you are concerned about becoming pregnant and if you are concerned about what you would want to do in a situation like that, this is a time to be having lots of conversations in person and this is a time to be using a lot of pen and paper notation rather than the more modern and therefore convenient options like debit cards and cell phones.

And is there any sort of conversations that people should have with their family doctor or obviously in your world, I know I keep talking about medical, you keep reminding me, well, Wolf, I'm a therapist. I'm not a doctor. It's sort of like the opposite of Star Trek.

Damn it, Wolf.

Anyways, is there any sort of conversations that you'd recommend people have with their family doctor, with their therapist, with their mental health professionals now before they find themselves in the situation?

Yeah, and I think that this is a conversation that people of all genders, ages, reproductive capacity should be having, right?

Because if you discover that your healthcare dollars are going to a provider or to a practice or to a hospital group that does not align with your values, you want to know that whether or not you are directly impacted by that or not. I've spent a lot of conversation in the last few weeks around whether or not it's appropriate to ask your therapist about their abortion reproductive health opinions.

And some therapists have told clients, well, that's not relevant. My opinion and my private views are not impacting your healthcare decisions. It's not my job to impose my opinions on you, so it's not necessary for you to know what they are. I would push back on that.

I think that not only do we have that sort of spend your dollars in places that reflect your values piece, but there's also the fact that therapists and doctors do document every conversation that you have.

Even if it is I came in for a cold and I wanted to get a flu shot and I wanted to make sure that my birth control was refilled and I'm just having a conversation with my family doctor, they're still documenting that we had a conversation around preventing pregnancy, even if the primary reason there was flu shot.

If you are talking about your feelings around what's happened with Roe, odds are your therapists are documenting that hopefully in a vague way. In my world, I would say my client processed or thought some feelings around the changing social and legal landscape and I would leave it vague. I might even be more vague than that. But the content of your conversations with therapists is documented in some way, shape or form.

We are trained to be vague in our treatment notes because our progress notes are subpoena bull. Now this is an important distinction. There are two kinds of records that your therapist can keep. We have progress notes which track your goals and your efforts towards those goals.

And then we have process notes, which is our personal space to write down our treatment modalities, our strategies, our reflections on what we're seeing, what exercise or technique we might want to bring into your next session. It is not documenting the content of the therapy. It is documenting our thought process behind the therapy that we're providing. Process notes are not subpoena bull.

So you want to have a conversation now with your therapist, with your family doctor and ask them what do they write down?

What are they documenting in your progress notes, in your medical notes?

What are their feelings about reproductive access, abortion care?

Because that might impact your desire to stick with them as a provider and you want to know how they would handle a request for your records. While progress notes are subpoena bull, I pay a lot of money to have insurance that would provide me with an attorney to fight that subpoena.

The vast majority of ethical mental health providers, even when subpoenaed, are probably going to say no first and consult with counsel before they hand over notes. Whether or not a supportive attorney would be able to squash that subpoena or not will vary from case to case. But everybody needs to know that there are circumstances under which elements of their medical record, including their therapy record, is available to outsiders.

So it makes a lot of sense to me to have that conversation with a provider now. Because if your provider is not aligned with your values around reproductive health care and you're having conversations around these topics, the way that they notate that and the way that they interpret that is going to be reflected in the notes. We're human beings, we can't help it.

We bring a perspective and a lens to the work that we do. So you want to know what are they writing down, how do they feel about these topics, and what is their process if their notes are subpoenaed. And I'm hearing that recurring theme of do it now, do it before you need it. Have those conversations early, have the tests on hand early, do the research ahead of time. Absolutely.

This ruling is incredibly new. It just happened in the last month. And so this is a really good time for everybody to be having these conversations and taking these steps while they can point to the ruling and say, I wanted to understand what was going on because this just happened.

If you take these steps three years from now, people are going to wonder what was happening in your life that motivated you to do these things. So better to do it now and be prepared should you ever need it, or should a friend or family member or loved one need it, than to wait and have this become a paper trail leading towards actions that you would rather keep private. Absolutely.

I think we've had a good conversation. We covered all the things that I wanted to know and I really appreciate the time today. Happy to. Thank you so much for taking turns sharing your knowledge with me and letting me share my knowledge with you.

I know that we live together and we work just down the hall from one another, but it's always fun to take turns being the expert, isn't it?

That it is. Absolutely it is.

With that, any final words as we wrap up the podcast?

I know that this is a scary time. I know that these conversations, both this episode and then our last one, can feel overwhelming to a lot of people, but we will get through this. The landscape, whatever it is going to be in the future, will settle down. The scariest time for most people is that time of liminance in the middle.

And just trust that as vague and unsettled as everything is right now, things will become clearer. They might not necessarily become better, but they will become clearer. As they clarify, we can all work together to make the best choices possible with the circumstances that we find ourselves in. Absolutely. Standing by, we've now turned our intimate side to a final episode. Until we see you on our next one. Oh You

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