The Doctor Who Didn't Ask Was the Point

Clinical AI adoption policy treats consent as a procedural checkpoint — a form signed, a disclosure made. What it does not account for is the patient who arrives at the exam room having already rehearsed a refusal. The Bluesky account describes consulting a friend to draft a script for declining AI note-taking — labor that occurred before any clinical interaction began ^[1]. The relief she felt when that labor turned out to be unnecessary is the clearest signal that the consent architecture is producing costs it cannot see.