The Hyper Consilium: Integrating Human Clinicians as Scored Nodes in a Fractal AI Diagnostic Swarm: A Cognitive Orchestration Architecture for Clinical Medicine

Current human-in-the-loop (HITL) paradigms in clinical AI treat the physician as an external approval gate. This architecture fails to leverage clinical expertise as a cognitive input to diagnostic reasoning. We describe the Hyper Consilium: a fractal cognitive-swarm architecture that integrates human clinicians as mathematically scored, reputation-weighted cognitive nodes operating alongside AI specialist agents within a unified diagnostic pipeline. The system implements a unified reputation economy in which AI agents, human physicians, and adversarial-challenge agents share a single reputation registry. The pipeline comprises pre-swarm deterministic barriers, adversarial triadic specialist analysis, multi-round consilium deliberation, a forensic adversarial-challenge protocol, and a continuous red-team swarm. The Hyper Consilium transforms the physician role from an approval gate to a cognitive partner while maintaining the safety guarantees of the DeepSensi Standard (DSS-001) and WP-001.