In some cases, the transformer can also be arranged to give minimal coupling (without adding internal shields). Mostly applicable to 1:1 flyback transformers, but it follows from transmission line transformer theory and any ratio can be constructed (in principle, with the higher ratios being less and less practical..).
Medical grade supplies probably use shields, and balanced windings if applicable, to minimize EMI and isolation capacitance. They typically need only 100s of pF of Y1 caps, if that.
Tim