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Voice Recognition Not Quite There

Our emergency department switched over to a voice recognition program and got rid of the transcriptionists (and the expenses) for dictating patient charts.

Problem is that transcriptionists pick out errors in dictation that Dragon NaturallySpeaking doesn’t. The computer program has no idea bad certain transcription errors can look in the chart. If you’re dictating and not careful, something really embarrassing can show up. Twice today I almost finalized charts with … um … strange … transcriptions.

First, when describing my examination of a patient’s hip, I dictated “pain with internal rotation.” Dragon typed out “Pain when internist hit patient.” No, his name wasn’t Happy.

Later, when doing a follow up note on a different patient, I dictated “On re-evaluation, pain is better”. The voice recognition spit out “On re-evaluation, anus better.”

It’s not like I traumatize patients when I do rectal exams.


Maybe this program reads medical blogs.


  1. Voice recognition I don’t see ever really approaching near-perfect accuracy. Too much depends on the quality of your microphone and a lot of people simply pronounce things in a weird way or don’t accent syllables in a manner the software is expecting. I initially tried similar software a few years ago to control various computer functions (ala Star Trek “Computer!”). I gave up quickly since I’d spend hours training it only to have it take 3 times longer for me to do something with my voice than it would have taken if I used good ole mouse and keyboard.

  2. I use this app and like it for the most part. I get a chuckle when proofing. Indeed, it can be worrisome!! :) Maybe speak a bit slower, I find that can help.

  3. It is supposed to learn your speech patterns. There are 2 caveats to that:
    1) you need to correct the errors as they happen, in the software.
    2) you need to be sure that you are the only one using your profile.

    Remember, computers do what you tell them to, not what you want them to.

  4. Dr. Grumpy occasionally compiles his latest Dragonisms.

    Transcriptionists are not immune to misunderstanding, especially when you e-send dictations overseas to people who don’t have a good command of the English part of the dictation. One local office that tried that ‘to save time and money’ discovered it did neither once they figured in all the time spent rereading and correcting the transcriptions.

  5. My favorite Dragonism that I’ve come across was from a ED report that described a patient as having “an air of feminist left leg.” I had no clue what the doctor had meant to say but after a quick look at the cellulitis on the patient’s left leg and repeating the phrase about 10 to 15 times, it dawned on me that it was supposed to read “erythematous left leg.”

  6. WC …just the *thought* of having someone come at you to do a rectal is traumatizing …sort of like tickling ..but of course that’s not tickling…but like laughing before the actual tickle…without the laughing ..just the impending trauma at stage I.

    Then to see the implements used in said rectal exam – stage II trauma. Stage III is the doc putting on the gloves and stage IV ..well ..you know.

    I take a Bajingoland exam any day over the rectal. I pretend they don’t exist ..rectums. ;)

    And I am real glad I don’t have a prostate!

  7. I have used Naturally Speaking for years in my spine surgery practice. Everything you say is true. Best advice is to use the best directional mike with a external sound card and only the Medical version of Natural speaking. Medical has the best vocabularies and the best algorithms for our work. Work strings like “erythematous left leg” can be placed in the vocabulary to enhance your chances of getting it right the first time. Remember,you save a lot of money on transcription, and the printed report is available right away. Knowbrainer.com has the best forums, microphone, and software sales.

  8. Gotta love people other than me ripping on Happy. He’s more of a “failure to rescue” kind of guy vs. outright assault though, in my professional opinion.

  9. The successful medical use of Dragon NaturallySpeaking voice recognition software requires the medical edition, adequate training, high quality microphone and sound card, a sufficiently powerful computer with sufficient RAM upgrade properly set up, careful ongoing error correction for ongoing training, sufficient technical support, an appropriate environment of use, and an interested user. It is clearly not for everyone, but it works very well if done properly. For instance, I have found that most computers have registry settings that make the default sound quality suboptimal, and registry file changes must be made. The rapid availability of important clinical information is a distinct medical advantage, but I recommend that one gives consideration to alternate methods of data entry for those who do not wish to use voice recognition software, and when it is not the most efficient method. Even then, unusual errors will be missed in the editing process, so I always add a disclaimer…
    – This document has been prepared with voice recognition software. Please excuse unusual errors. –

  10. My latest Dragonism:

    Instead of “feet are warm” I got “Peter warm”!

    Many less errors with version 11, though.

  11. Just a few days ago I saw “high pretension” for hypertension.

  12. My “choose” became jews.
    Erma always shook her head at that one

  13. I almost want to get that system for my ER just to see the errors.

  14. Our ED uses Dragon and 95% of them do not edit. I’ve seen “overdosed on fortified aliens” (overdosed on 4-5 ambiens), “Patient repeatedly violated in the ED” (repeatedly re-evaluated), etc etc. I could go on and on. I find about 20% of the notes completely worthless and a potential lawyer wet dream since you can tell almost nothing from the strings of nonsensical sentences.

  15. I have used the program for over 7 years, through numerous software reworks. My partner has brought to me such phrases as “this 63 year old salmon”, meant to be “gentlemen” that he enjoys poking fun at. I find it most important to proof read as I go. Get a good mike, speak clealry, good sound card, use the medical version and be realistic. Most of my mistakes are clearly interpretable and not critical. They may appear silly but this is a work load reducer, when you take the time to work with it properly. Too many doctors dictate poorly, with rapid slurred together words. With proper training, the program will recognize all kinds of strung together words. I use it in conjunction with our template driven system, which is fine for “canned” patients. I use it with a digital voice recorder when things get busy, then have the computer translate each folder (patient) when I return and dock it, then just cut and paste.

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