Return to sender.
No address known.
Autonomy Postal Service.
That is the stamp
on a decision no one owns.
It already reached the patient.
There is no return address.
McKinsey asked 500 organizations
whether their AI agents
had done something risky.
Eighty percent said yes.
Not said something wrong.
Did something wrong.
Took an action.
Misused a tool.
Ran past the guardrail.
The vendor calls it autonomy.
A system that moves without pulling you in.
At the bedside
that is not the cure.
That is the gap.
A tool is not an owner.
It is another stop on the path.
A decision that moves
without a named owner
reaches the patient
with no return address.
The action executed.
The damage landed
before anyone saw the log.
Autonomy did not remove the risk.
It removed the person
who was supposed to catch it.
McKinsey found the fix
the bedside already knows.
The mature institutions
name a human
accountable for the call.
Not a team.
Not a department.
A person.
The Accountability Gap™ (TAG™)
does not open because the agent is too capable.
It opens because the agent
runs with no name on the outcome.
A system that runs without you
is the pitch.
A system that runs
with one name on the call
is the cure.
Every autonomous deployment
is a package already in transit.
You already know
which one carries no return address.
The only question left
is whether you name the owner
before it arrives.
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