Nobody decided it.
The chart says someone did.
Two calls.
Same entry.
Same signature.
Only one was a decision.
The AI recommends.
The clinician signs.
Sometimes that signature means judgment happened.
Sometimes it means agreeing was faster.
The chart cannot tell you which.
Overriding costs something.
Time.
Justification.
A note nobody asked for.
Agreeing costs nothing.
The path of least resistance
became the clinical default.
The title still says decision maker.
The chart says reviewer.
Count last week honestly.
Sort every call into two piles.
The calls your judgment made.
The calls the recommendation made while you signed.
Most institutions have never run that count.
They assume the first pile is bigger.
Not output.
Allocation of judgment.
↳ The Governance Owner
names what the agent is authorized to do.
↳ The Decision Owner
holds the clinical call.
↳ The Handoff between them
is where the gap closes.
The Accountability Gap™ (TAG™)
does not open when someone decides badly.
It opens when no one decides at all.
And the recommendation
gets treated like they did.
Count your calls.
The ones your judgment made.
The ones the recommendation made
while you were the name that signed.
You already know which pile is bigger.
You have just never counted it.
Mo Johnson, MD MBA is a cardiothoracic surgeon and the founder of GPe Research. Field Notes are short dispatches from the clinical AI accountability frontier, published alongside the MedicoVigilance™ newsletter at medicovigilance.org.
Follow the work on LinkedIn: linkedin.com/in/mo-johnson