Get Dragon's medical version. Dragon comes in five flavors: Standard, Preferred, Professional, Legal, and Medical. The latter offers specialized vocabularies for cardiology, emergency medicine, family/general practice, gastroenterology, general surgery, mental health, neurology, ob/gyn, oncology, orthopedics, pathology, pediatrics, and radiology. This version sells for a bit more than $1,000 (it can be found more cheaply on the Web), but the inclusion of medical vocabularies makes it much more useful than the less-expensive programs.

Speak more slowly and distinctly. I hail from New Jersey and, as a result, can speak pretty fast, so I make a conscious effort to slow down and speak more clearly when I dictate. The results with Dragon and the new Sennheiser microphone are very good, but Dragon doesn't do well if you mumble or slur words. Of course, voices can change as the day goes on, and speech tends to become sloppier when you're tired. But enunciation is always the key.

When you first get the speech recognition program, you have to "train" it to understand the sound of your voice by reading sample medical reports provided by Dragon. You can always retrain it if your voice changes for some reason.
Dragon saves the speech files from each session and continues to adjust as you use it. After a while, you should run the Acoustic Optimizer (found in the Accuracy Center of the Tools menu). This uses the saved speech files to improve the "IQ" of the program so that it works better in the future.

A few final comments: I try to dictate a note after I see each patient. To speed things up, I created a template of a SOAP-style progress note. I move the cursor to the beginning of each field and dictate into it.

Sometimes, when I'm running behind, I'll have to dictate some notes later into a high-end digital recorder. But I've found that connecting my recorder (a Sony ICD-BMI) with the speech recognition program doesn't produce very good results. Dragon can transcribe this dictation, but there are a lot of errors. It's okay for jogging my memory, but not for creating an actual patient progress note.

The vast majority of my notes are completed within minutes of the visit. And they're immediately available so I can send them, if needed, with a patient to a specialist or the emergency department. Best of all, I'm saving $1,600 a month!

You, too, can become a pro on speech recognition software with just a little bit of effort. If you decide to go this route, remember, use the best equipment. Also, I'd strongly recommend visiting the Web sites listed at left to find out how other doctors are using the software in their offices and what they recommend.