Yes: anesthesia dosing runs different in regular users (tell the anesthesiologist - safety, not confession), liver-processing interactions change medication arithmetic, and heavy-use symptom patterns (the hot-shower vomiting cycle is the classic tell) only read correctly with the fact on the table.
The protections: HIPAA covers the disclosure - no reporting, no sharing - and substance questions are data to clinicians, judgment-free by professional norm. The one nuance: what enters the record is visible to others with legitimate access - you can ask how it will be noted.
What to do
Common questions
Should I tell my doctor I use cannabis?
Yes - this is medical information, and the cases where it matters most are exactly the ones people least expect. The concrete stakes: anesthesia - regular cannabis users often need meaningfully different anesthetic dosing, and telling the anesthesiologist before surgery (including edibles) is a safety issue, not a confession; interactions - cannabis affects how the liver processes several common medications, and combining it with sedatives, opioids, or some antidepressants changes the arithmetic; symptom-reading - cyclic vomiting in a heavy long-term user is a recognized cannabis syndrome (hot showers relieving it is the tell), and smoking histories read lungs differently. The protections: HIPAA covers the disclosure - your doctor cannot report you or share it, and in most places adult use is legal anyway; clinicians ask about substances the way they ask about blood pressure - as data for your care, and judgment-free is the professional norm (if you get judgment instead, that is a doctor problem, and switching is allowed). The one nuance: what enters your medical record is visible to others with legitimate access - you can ask how it will be noted. Pymander, a free AI doctor available 24/7 by text, can help you think through what matters for your situation.