The Emails I Get From Doctors Leaving Dragon Medical One
Most of the messages start the same way. A doctor, or sometimes the person who runs IT for a practice, writes a few polite lines about Dragon Medical One. Then comes the sentence they have clearly been holding back: it isn’t working out anymore.
I’m Jacob. I’m not a clinician. I’m a solo founder in Toronto who builds dictation software, and I ended up with a medical product because doctors kept telling me about their charting. Since then my inbox has turned into an accidental survey of what it feels like to leave Dragon. I want to write down what people actually ask, because the questions are more useful than any feature table.
The cardiology group with a spreadsheet problem
One message came from someone running operations at a cardiology practice. Eight cardiologists and four PAs were on Dragon Medical One. Dragon had been their only real option for years, they said, and it had started to fail them. They used eClinicalWorks, reached through a Citrix gateway, and more providers were joining. How much would it cost for a group that size?
Notice what they didn’t ask. They didn’t ask about accuracy. They didn’t ask about AI. They asked about price and about Citrix, in that order, and I’ve now seen that order a lot.
Dragon Medical One is quote-based, so I can’t tell you what anyone pays. What I can say is that the people who write to me tend to be at the point where the renewal quote, the support calls and the Citrix breakage have piled up into one bad feeling. They aren’t shopping for fun.
What Dragon does better than I do
Let me say this plainly, because every comparison post on the internet seems to skip it.
Dragon Medical One has years of enterprise engineering behind it. It has deep voice commands, a long history inside large health systems, and IT departments that already know how to deploy it. If your hospital standardized on it and your informatics team supports it, switching is probably a bad idea. Microsoft owns Nuance now, and a lot of clinicians get Dragon through their organization without ever seeing a price.
Voice commands are the sharpest gap. A physician who moved over from Dragon told me that “next line” doesn’t move the cursor the way it did in Dragon, and that they had no idea how to make it happen. Another person wanted a “next field” command so they could dictate through a template without touching the mouse. Both are fair. Right now DictaFlow is a text-entry tool, not a command-and-control system, and the Epic page on my own site says so. It won’t open a chart, place an order or sign a note.
If that is your whole workflow, stay where you are.
The question nobody puts in the comparison table
A second kind of email is about hardware, and it’s almost funny. A doctor who stands at a hallway workstation told me the PowerMic drivers were tied to Dragon, and that without a Dragon subscription they could use the thing as a microphone but couldn’t map its buttons. A foot pedal was out because people walk past the station.
I had never thought about a hallway. I’d thought about desks.
That email changed what I built next. Someone wanted dictation to start from a button on the microphone itself, with the keyboard shortcut as the backup. I don’t have every device mapped yet, and I won’t pretend otherwise. But it taught me something about this market that I couldn’t have learned from a spec sheet. Doctors don’t dictate in tidy places. They dictate in hallways, in workrooms, in the car between sites, and the tool has to fit the room.
Citrix is where most of these switches live or die
The cardiology group’s Citrix line is the one I’d underline. A lot of dictation software works beautifully on your laptop and falls apart the moment it has to type into a remote desktop.
The reason is boring. Many tools finish your sentence and then paste it. Paste uses the clipboard, and plenty of Citrix policies block clipboard redirection on purpose. So the text never arrives. You speak a paragraph and nothing happens, which is a very specific kind of frustrating.
Get Jacob Shrott’s stories in your inbox
Join Medium for free to get updates from this writer.
DictaFlow’s Typing Mode sends the text as keystrokes instead, the way a keyboard would. Whether that works for you depends on your connection and on what your IT team allows. I wrote that caveat on the product page and I’ll repeat it here: test it in your own managed environment before you tell anyone it works. A clinic’s Citrix setup is not a controlled lab. I’d rather you find out on a Tuesday with fake text than on a Monday with a full schedule.
What switching actually costs
Here’s the part nobody mentions. The software price is rarely the real price.
Muscle memory is the real price. If you’ve used Dragon for ten years, you know the cadence of its commands, the way it expects you to say punctuation, the shortcuts you’ve built into your day. Moving to anything new will feel slower for the first week. Slower, and a little insulting, because you were fast once. One physician told me the transition from Dragon had been “very rough” for exactly this reason, and that the app froze up sometimes. I take that seriously. It tells me where my rough edges are, and I’d rather hear it from them than find it in a churn spreadsheet.
If you’re going to try something else, I’d do it this way:
- Pick one note type you write constantly, such as a follow-up note or a referral letter.
- Use fake text in a training environment for the first day.
- Keep Dragon running alongside it for a week.
- Count how often you reach for the keyboard to fix things.
That last number matters more than any accuracy percentage a vendor quotes.
Where DictaFlow fits
DictaFlow Medical works like an input layer. You hold a key, talk, and let go. The text lands at the cursor, in whatever field is open, and you read it before it goes into the chart. It runs on Windows, Mac, iPhone, iPad and Android, and there’s an ambient scribe mode too for full visits, which I’ll write about separately because it deserves its own honest comparison.
The price is $39 a month per user for one to four seats, and $29 per user for five or more. There’s a free tier with 2,000 words a month, which is enough to try it on a few real notes. I mention the free tier on purpose. A medical dictation tool should earn its place before you pay, and a surprising number of vendors make you book a demo before you can even see the pricing.
The best fit is a small practice, an independent clinician or a specialist who doesn’t want a heavyweight rollout. The worst fit is a hospital where Dragon is the mandated standard and the command set is built into everyone’s habits.
One more honest note. Before anyone uses it with patient information, your organization needs to do its own vendor review and sign a business associate agreement if one is required. I’m happy to talk through the security documents with a clinic. I would not want you to take my word that something is compliant. Ask for the paperwork and read it.
What I’d tell the person writing that first email
Don’t leave Dragon because a blog post told you to, including this one, which I wrote with an obvious stake in the outcome, so weigh it accordingly. Leave when the pain is real and specific. If it’s price, get a quote for what you’d pay in a year and compare it to a tool you can start for free. If it’s Citrix, test typing into your actual remote session. If it’s the Mac, check which of the tools you’re considering have a native Mac app.
And if it’s none of those, if it works and you like it, close this tab. That’s a perfectly good outcome.
If you want to try the alternative, here’s the page for DictaFlow Medical: dictaflow.io/medical. Start with the free tier, use fake text in your real EHR field, and tell me where it breaks. A good share of my to-do list started as someone telling me exactly that.
I read every reply. Yes, really, it’s usually just me.
Originally published at https://dictaflow.io.
