Relationship-centered care relies on trust and meaningful connection. As AI enters clinical settings, we must ask not just what it can do, but how it should be positioned to support these values. We examine a "middle, not top" approach where AI mediates communication without usurping human judgment. Through studies of CLEAR, an asynchronous messaging system, we show how this configuration addresses real-world constraints like time pressure and uneven health literacy. We find that mediator affordances (e.g., availability, neutrality) redistribute interpretive work and reduce relational friction. Ultimately, we frame AI mediation as relational infrastructure, highlighting critical design tensions around framing power and privacy.

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