A medical record carries a different kind of weight than most documents a person generates. It is not revised or contested in the ordinary course — it accumulates, gets transmitted, gets cited by subsequent clinicians who were not in the room. When an AI tool drafts that record, its outputs inherit clinical authority without clinical accountability. The Bluesky post that asked patients to refuse AI note-taking was not warning about a hypothetical future risk; it was describing a system already operating inside a significant share of practices, already producing…