Dragonisms – Voice Misrecognition Contest


I like the Dragon NaturallySpeaking program. I like tequila, too. But I try to use both with caution.

Dragon’s speech recognition is good in that it saves a lot of time and costs in transcribing medical records, especially in complicated patients where it would take a long time to type out the patient’s history and the patient’s course.
The problem with Dragon NaturallySpeaking is that it isn’t perfect. Sometimes the difference between a doctor’s dictation of “no murmur present” and the Dragon transcription of “murmur present” can make a big difference in a patient’s workup. Other times, Dragon will misinterpret a dictated phrase for a similar-sounding but inappropriate phrase.
I’ve tweeted about a few of them.
For example, in the patient with GERD who was having repeated exacerbations, I dictated “bland diet” in the discharge instructions. Dragon apparently didn’t like the patient too much because it transcribed “plan to die” onto the chart. It’s fortunate that I didn’t miss that error while I was multitasking. Imagine those discharge instructions showing up in a patient complaint to an administrator.
Another patient was recently looking for a prescription for oral contraceptives. The Catholic hospital in which I work doesn’t allow prescription of contraceptives from the ED, so I have to recommend that patients follow up at Planned Parenthood. Dragon translated my instructions as “Follow up plan paranoid.”
And then there’s the colleague who dictated his findings that “examination of the patient’s breasts with a chaperone showed no lumps, masses ….” Dragon transcribed “semination of patient’s breasts with a chaperone showed no lumps, masses ….”
Dr. Grumpy regularly documents the foibles he has with his Dragon software as well.

Then I thought to myself … Self, you haven’t had a contest in a while.

So we’re having a contest for the best “Dragonisms.” What have you seen or read in a medical record that was misconstrued by voice recognition software? Add it to the comments section. Best Dragonism wins a free copy of Mark Plaster’s critically acclaimed “Night Shift” book (affiliate link). We’ll also try to find some EP Monthly swag for runner up prizes. I think I have an old coffee mug somewhere in my closet. Or perhaps a couple of Amazon gift vouchers.
Contest ends at 12AM on November 15.
Let’s see what shoe grout you’ve got.


It was very tough to pick a winner from all of these great entries. We smiled at almost all of them and laughed out loud at a few. The winner is …
#6 Ashley for the metaphorically true mistranscription about a referring facility transferring a patient because it had no testicles.
Ashley will receive a free copy of Mark Plaster’s new book “Night Shift.”

We also chose a couple of runner up winners who will each receive EP Monthly coffee mugs.
#14 Mati whose discussion about an advance directive turned into a discussion about an advanced rectum
#1 ndenunz whose patient’s warm feet turned into warm other body part

If the winners e-mail me at whitecoat-at-epmonthly-dot-com, I’ll get your swag to you. Thanks to everyone for their comments. Hope that the entries at least brightened your day a little.


  1. Dictated that the patient needs a lumbar diskectomy as he has a striking foot drop. Dragon advised otherwise: needs a lumbar dickectomy as he has a streaking food rod.

  2. A couple:
    “Ms. X is a 22-year-old woman with oligomenorrhea” came out as “Ms. X is a 22-year-old woman with all the gonorrhea”


    “His sleep apnea is current being treated with CPAP therapy” turned into “His sleep apnea is currently being treated with sexual therapy”

  3. “The patient was transferred because the referring facility did not have any N-acetylcysteine” came out as “The patient was transferred because the referring facility did not have any testicles”

    Saved to the chart that way before I caught it. In a weird way it was still correct though.

  4. I dictated, “Cerumen impaction present in left ear” and got “Sperm impaction present in left ear.”

    Glad I caught it.

    Although a sperm impaction sounds like more fun than a cerumen impaction.

  5. As I don’t have to do medical dictation but I do use Dragon/Siri…I was getting fired up for Michigan football and listening to the Marching Band CD.(My kid and nephew are members)
    They have a long tradition of songs.Two of them are called Temptation/Hawaiian War Chant– aka T & W (cause I’m with the band-wah,wah,wah).
    So, I was doing what I do an attempted to voice text my band kids…”T&W baby, Fire Up! It’s Saturday!” Siri heard, “T/w baby, F*@k this Saturday!”
    Uh…not expecting a bowl game this year, ahem…but the Band always wins!! 🙂

  6. Patient in the ER with herpes, MD dictated “Patient to take 200mg acyclovir five times daily for one week,” Dragon produced “Patient to take 400mg cycle of beer five times daily for one week.”

    A cycle of beer may be what got the patient into this situation in the first place!

  7. Another of my partners had:
    “This was discussed directly with Dr. X” ->
    “This was discussed rectally with Dr. X”

  8. When I say “evaluated” the patient, dragon hears “violated” the patient! Oops. Don’t want that on a chart!!!!

  9. “We discussed the patient’s advanced directive” –> ‘We discussed the patient’s advanced rectum.’
    “Essential thrombocytosis”–> “Essential full psychosis”
    “Basal cell carcinoma” –> “Ass cell carcinoma”

    I have had pelvic structures (primarily cervix and rectum) substituted for more words than I would have ever thought remotely sounded like cervix or rectum. I have wondered if the developers of this program have a bizarre sense of humor that they have unleashed on all of this

    • ME TOO!!!! All “infections” ARE “rectums” and the rest are just rectal reference points i.e. urinary infections are “her nares rectums” and retention is also a “rectum”, … so is like 10 other things…. always a rectum, rectums, rectum

  10. Steven Blackthorne on

    I had a young football player who broke his wrist in a game. I dictated “The pain was intense, so he asked the coach if he could come off the field.”

    Dragon typed “The pain was intense, psoriatic roach if he could come off the field.”

  11. What was said – Orthopedics came and consulted on the patient.

    What was transcribed, saved, and sent to God and country was – Orthopedics came and screwed the patient.

    Maybe true once they get the bill that is coming from their office, but not literally what happened.

  12. The doctor dictated “the patient had a history of diabetes, coronary artery disease and BKA”, which was transcribed as: “the patient had history of diabetes, coronary artery disease and a bologna amputation”, an unequivocal urological emergency. On the good leg the doctor dictated “the patient had a varicose vein bleed” but this was transcribed as “the patient had a very close brain bleed.” Dragon was oh so close but oh so far.

  13. Elderly male involved in a single vehicle MVA.

    I dictated:
    “He went down in a little ditch and up the other side”.

    “He went down on the little bitch and up the other side”.

  14. Although after the contest and I’m not eligible to win, anyway, I had another dangerous Dragonism pop up on one of my charts recently.
    A six year old boy was brought in for vomiting and diarrhea.
    I examined him and then dictated “membranes moist.”
    Dragon transcribed “member is moist.”
    Note to administrators: That is NOT something I check in assessing a child’s hydration status.

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