Dragon Medical – Get Out of Cursor Penalty Box by Using the Dragon Dictation Box

At U-M Michigan Medicine, we use Epic, and our Electronic Health Record (EHR) is called MiChart. We have Dragon Medical an I am extremely grateful Leadership at Michigan Medicine continues to provide the option of phone-based dictation.

As a consulting gastroenterologist seeing patients scheduled into 30-minute clinic visits slots I have to a lot in that time, including creating a comprehensive note that varies in structure and length based on all the available data.

In this post, I briefly review Dragon Dictation Box in creating notes (as I use it) and the video shows you how it works and how to set it up.

Page Table of Contents

The Triad of Simultaneous Tasks: Roaming, Reading and Dictating

If you are new to or already using Dragon, you will often find that you want to do three things.

  • Roam freely across the range of the EHR sections clicking here and there.
  • Read and contemplate a tsunami of data you have to review.
  • Dictate words that need to be transcribed into the documentation (progress note) section of the EHR.

To accomplish this multi-tasking triad of tasks of roaming, reading and dictating you have two options.

Option 1

If you are lucky enough to still have phone-based dictation and your workflow permits, the phone will work very well to accomplish the triad of simultaneous tasks.  I will cover the principles of phone-based partial dictation in a future post.

Option 2

Or you can use the Dragon feature Dictation Box.

Using either approach, phone based dictation or the Dragon Dictation Box,  I can get my cursor out of ‘cursor penalty box’. 

This ability to read and dictate simultaneously is critical for me to save time and create a comprehensive record. I won’t comment now on important user experience issues of transcription accuracy or cognitive load while using Dragon Medical.

Here is my take away from using Dragon Medical for dictating office visit notes.

If I have to read through and summarize a ton of data I immediately switch to phone-based partial dictation.

I continue to believe that I can dictate faster on the phone with partial phone-based dictation. If I had only one documenting tool to keep it would be the phone-based partial dictation.

My Opinion*

You should know this about me. I am an ardent supporter of ‘phone-based partial dictation’. I am not judging anyone ( though I am judging how documenting the patient narrative has declined since I started in this business as a newly minted resident in 1989)

I am troubled by what has happened to my peers at other institutions where phone-based dictation service was taken away. The impact on note quality is evident: too many notes that do not contain useful information.  The demise of the patient’s story is multifactorial and in large part caused by the removal of phone-based dictation. Physicians primary role was not meant to be a transcriptionist.

I believe every physician should be offered an array of options to create a high-quality visit note that fits into the physician’s workflow. In the same way that surgeons are offered a range of instruments and robotic surgery technology to complete operations, I believe all physicians in any role, who want to create a high quality note, should be offered a broad range of tools that match their workflow.

One tool does not meet all needs to create a high-quality note.

At U-M Michigan Medicine, I am delighted that we continue to enjoy a full array of options to create great notes.

My workflow permits me to use both phone-based dictations for long and complex patient stories with lots of data, I use Dragon for simpler notes.

Explore and Experience the Dictation Box

The Dictation Box is not a perfect solution by any means.

If you are a frequent Dragon user, I think it is likely to be worth your time to explore the feature on five patient dictations to get a sense if it will meet your needs or if it will miss the mark.

My Suggestions

  1. Reflect on the importance of simultaneously roaming, reading and dictating as you build your note.
  2. Watch the how-to demonstration video to see the Dictation Box in action and how it might help you.
  3. Review the settings for Dictation Box that I use and which should work for you (Figure 1). (Dragon Tool Bar > Options > Dictation Box)
  4. If you are lucky enough to have partial phone-based dictation with your vendor, give it a try and compare the results with Dragon Medical.


I do want to give a shout out and say thank you to two colleagues Dr. Richard Medlin and Dr. Daniel Overbeek from U-M Emergency Medicine.  Rich knew how much I supported phone-based patial dictation and he found Daniel, a very clever resident, who gave me the recipe to discover this overlooked feature, Dication Box.  Thank you gentlemen!

May the force be with you all who want to preserve the patient narrative, which is the engine that drives clincial reasoning and compassionate care.


~ Raf Rizk, MD | rafr@umich.edu

*opinions expressed here are soley my own opinions



Step-by-Step Video Walkthrough (4min 40sec)

How the Dragon Dictation Box Works and How to Adjust Options

Watch video in full screen

Figure 1: How to set up options for the Dictation Box in Dragon Medical

Go to Dragon Toolbar > Options > Dictation Box

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Created and maintained by Raf Rizk, MD | Division of Gastroenterology | Michigan Medicine

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