Clinical AI adoption has run into a wall that its advocates did not model: patients who say no before a single high-stakes diagnostic tool goes live. The encounter documented in the source records is not an edge case — it is a leading indicator. A patient asked whether AI could be present for their appointment declined immediately [5], and then, on learning the 'AI' in question was dictation software, responded with something closer to fury than relief . Both reactions are informative. The refusal reveals that patient consent cannot be…