The state of medical privacy has become quite appalling lately. I started using a young doctor in a new office and they are gung ho on modern tech. That’s fine to some extent but they want to send me invoices and all correspondence via e-mail. No PGP of course. I did an MX lookup on their vanity email address & it resolves to an MS Outlook server.
I asked them for my test results. They offered to email them.
My response: I do not want sensitive medical info coming by e-mail via Microsoft’s servers. I did not give you a copy of my email address for that reason. It needs to be snail-mailed to me.
Perhaps of greater concern is that the receptionist acted like I am making a unusual request, and that they do not mail things. Apparently I am the only patient who has a problem with sensitive medical info going to Microsoft. So the receptionist is investigating whether she can get approval to mail me my results by post.
I wonder if someone in that clinic will have to run out and buy stamps because I have a problem with Microsoft.
While you aren't wrong about the threat model, you do have to be clear with them that email isn't an acceptable transport in any way for sensitive data. Email is an inherently insecure model, and anyone in the middle of the conversation can read that traffic. It doesn't have to be a malicious email provider, just someone with access to a transit network.
I think you’re saying this because I have no way as a sender or recipient to ensure or verify TLS is in play at every hop, correct? Otherwise, if TLS is in force by both providers then I would only expect the email providers (and their hosting providers) to have access.
Yes, that's exactly correct.