I had to see the only available primary doctor to see anyone else, which automatically prompted medical releases that, even if unethical, would have still made it technically legal. If it was an emergency room trip, there were always the same 2-3 physicians there, so they were all fully aware of me from the first episodes. Same deal with labs when you've got only one or two options in town for anything, and they have your consent to release PHI since that's the only way to send results.