Does the description disclose side effects, auth requirements, rate limits, or destructive behavior?
Annotations already establish readOnly, idempotent, and non-destructive behavior, so the bar is lower. The description adds meaningful context beyond annotations: recall records are correction/removal actions and do not alone prove patient harm. This is valuable interpretive context, though it doesn't disclose pagination or rate limits, which are largely covered by schema and output schema.
Agents need to know what a tool does to the world before calling it. Descriptions should go beyond structured annotations to explain consequences.