Fire the transcriptionist—but keep on dictating.
I bought a copy of Dragon NaturallySpeaking Medical, version 7, and loaded it onto my IBM ThinkPad computer. Using a headset microphone that I'd found in a local office supply store, I performed the initial training with the program and then started dictating all of my patient progress notes. The software wasn't perfect, but it was good enough for my purposes. And as I've learned more about how to use speech recognition in my office, it has become increasingly accurate.
I now document visits in about the same amount of time that it used to take me to dictate notes for the transcriptionist. I don't proofread every word afterwards. Rather, I check for content, and one of my staff members skims the note, looking for obvious typos and nonsense words. Because she may miss a few, I add a disclaimer at the end of each note, stating that my dictation was transcribed by computer.
Make sure you have a good sound card. Not all computer sound cards are created equal. Some manufacturers properly shield the electrical components, but others don't. As a result, the system can generate electrical noise that interferes with voice signals, leading to poor accuracy. If you happen to own a computer with such a sound card, there's an easy remedy: Shell out about $25 for a USB pod and plug your mike into it to bypass your system's sound card.
How will you know if you need to do this? A reputable microphone dealer should be able to tell you after you describe your system.
Get a top-rated microphone. While all microphones can detect sound input, some are much better than others at noise cancellation. If your mike picks up not only your voice, but also voices in the hallway, the sound of your air conditioner, office music, and so on, your transcription will be riddled with errors. I tried one cheap microphone after another, but none worked very well. Finally, I splurged on a $150 Sennheiser headset microphone from a company called eMicrophones ( http://www.emicrophones.com).
The Sennheiser is a version of a mike that many musicians use onstage. It's designed to cancel nearly every other noise except for the sound of the performer's voice or instrument. eMicrophones modifies the Sennheiser to remove a "reverb" effect that, while preferred by singers, muddies speech recognition.
Headset microphones are the best kind for speech recognition, because they keep the mike at a constant distance from your mouth at all times. If you move a handheld mike away from your mouth while speaking, this affects the sound level and results in dropped words.
A faster computer is better. You can never have enough speed and RAM (random access memory). One reason why older versions of Dragon didn't seem to work very well was that computers were a lot slower back then.
Many computers sold today come supplied with 256 or 512 MB of RAM, barely enough to run the basic programs that we all have. Dragon will work on computers with that amount of memory, but it'll be relatively slow. I'd recommend getting a system with 1 or 2 GB of RAM. If your computer didn't come with one of those chips, buy one and put it in.