A doctor in the loop is not a safety guarantee

If a hospital tells you a clinician checks the AI, that sounds reassuring. A new peer-reviewed review asks the question hidden inside that reassurance: what happens when the automated advice is wrong? Its evidence concerns the performance of the human-and-system combination, not simply whether a person was present in the workflow. The review includes 46 reports representing 41 independent cohort clusters, with 40 core cohorts. In four heterogeneous real-world computerized ECG studies, the pooled proportion of erroneous interpretations not corrected or recognized was 26.6%, with a very wide 95% confidence interval of 6.4% to 65.6%. That is not a failure rate for all clinicians, modern chatbots or clinical AI. The newer AI and language-model studies were too different to combine in the same way. Patient-level adverse events appeared in only one retrospective cohort. For a patient, the implication is neither to distrust every tool nor to assume a professional signature settles the safety question. For an institution, it is to test the actual review process using deliberately incorrect recommendations before relying on it. Does the reviewer see the underlying evidence? Can they disagree without friction? Is there enough time to check? Those are proposed design tests, not interventions this review proves will work everywhere. The study supports a harder standard for oversight: demonstrate error interception in the intended setting, then keep watching real outcomes.