Don,
I think you will pull your hair out trying to dictate in front of the patients. In my experience, they think that you are talking to them when you are trying to dictate or they want to interrupt as you are trying to collect your thoughts. I gave up because it was too cumbersome to leave a tongue depressor in their mouths during the time I was trying to dictate. If you can pull it off, please post a solution that I can use. I think that the time saved by getting in and out of the exam rooms and going back to your office to dictate will be considerable. I have been using DRAGON since 2004. Every version is a little better but the type of computer you have and the microphone you use always play a big role. I am using a Sennheiser headset as it seems to be the most reliable of all the ones I tried.
