I wuvs my Dragon. I developed tendinitis in my wrists this year (my right wrist and thumb are killing me as I type this). I couldn't operate an EMR without Dragon.

Furthermore, my exam rooms are too small to allow me to settle down comfortably with a computer in the room.

I started out using some templates in the HPI, but I found I was spending a lot of time customizing them anyway. It seemed like a wash.

Now, I use only one, and I use it every time:

"%Mr %FNAME %LNAME is here" and then I Dragon-dictate from there.*

This saves me a lot of trouble with misspelled names because so many kids these days have names like Destynee and Brailer.

I do use templates for some left-screen entry. If I am on the phone, I can mouse around and click-click-click through Chief Complaint, most of the Family History, Social History and Allergies.

Templates work well for Physical Exam elements and frequently-used Plan elements. They are great for Orders, and of course I am making extensive use of them for the Instant Hospital Orders in the Letter Writer.

However, I really don't see how I could do without Dragon for the HPI, PMH, and Plan sections.

I feel your pain about accuracy problems. I wandered in the wilderness for a while. I will tell you that I probably did everything wrong with Dragon to begin with: wrong version, wrong computer, wrong mic, and I tried to "customize" it with flawed data.

I started over with Dragon Medical 9.5, fed it a spell-checked patient name list and about a year worth of my old spell-checked clinic notes (not necessary, but I think it helped).

I will tell you plainly that you need to lose the mic that came in the package with Dragon. Dictate the sample paragraph in the "Adjust Sound Levels" section, and hit "Play Back". It is really dismal sounding with the mic they send you. I have a little $20 Digitek headset from WalMart that plugs in the USB port and sounds like a dream in comparison.

You do have to put a little into it, but I think I get I get 98-99% accuracy now. I have posted links in the past to websites devoted to increasing Dragon accuracy (there are many).

Here's a good old thread on the topic:

http://www.amazingcharts.com/ub/ubb...Cen&topic=0&Search=true#Post3126

The more insidious problem relates to the nature of Dragon dictation errors: they aren't spelling errors, they are misstatements. A spell checker won't find them. You have to read them over. The best way to do that is to click Ctrl-D when you are through dictating, and look over the "Print Preview" that comes up. It forces you to read it with fresh eyes.

Gotta put the wrist on ice now! Sweet dreams. See you all tomorrow.

Brian

* P.S. - For those who don't know about Vinny's MR% template parser, here are the relevant threads:

http://www.amazingcharts.com/ub/ubbthreads.php?ubb=showflat&Number=4478&page=2#Post4478

http://www.amazingcharts.com/ub/ubbthreads.php?ubb=showflat&Board=3&Number=1114&Searchpage=1&Main=253&Words=%5C%25FNAME&topic=0&Search=true#Post1114

Brian Cotner, M.D.
Family Practice