Medical dictation on a Mac

Nuance discontinued Dragon Professional Individual for Mac on October 22, 2018 and stopped releasing updates for it. (Source: Nuance: Dragon Professional Individual for Mac end of sale) Its current desktop product, Dragon Professional 16, lists only Windows versions as supported operating systems. (Source: Nuance: Dragon Professional 16 release notes (supported operating systems))

Microsoft sells Dragon Medical One for speech-driven clinical documentation, and invites customers to move to Dragon Copilot, which it describes as an AI clinical assistant. (Source: Microsoft: Dragon Medical One) Its product page doesn't mention macOS, so if your organization licenses it, ask Microsoft or your reseller how it runs on a Mac.

Apple Dictation is free and built in, and on supported Macs and languages it processes general dictation on your device. (Source: Apple Support: Dictate messages and documents on Mac) Beyond that, health systems often license clinical speech recognition or ambient scribe products of their own; those are chosen, contracted and configured by the organization, not by individual clinicians.

A reasonable fit:

• Everyday writing outside the record: email to colleagues, reports, research notes, teaching material, grant applications and admin.
• If your organization's policies allow it, dictating into a field in an app it approves. SayWrite types at the cursor like a keyboard, and that app applies its own privacy and retention rules.
• Anyone who wants to know where the audio goes: speech is processed on the Mac, and the recording is deleted once it's transcribed.

Not a fit:

• Specialty vocabulary out of the box. SayWrite has no medical language model; you add terms to the personal dictionary yourself, and you proofread everything.
• Ambient note-taking from a patient conversation. SayWrite transcribes only while you hold or tap the key.
• EHR templates, structured fields or EHR-specific voice commands.
• Any requirement for a BAA, HIPAA certification or other compliance attestation.

Speech recognition runs on your Mac's Neural Engine, and the temporary recording is deleted as soon as it's transcribed. AI Polish is optional and off by default; if you turn it on, it uses Apple's on-device model or your own server at 127.0.0.1.

SayWrite does go online for a few things, none of which upload your audio for transcription:

• Speech-model setup, or recovery if model files are missing or fail to load.
• A daily update check, which sends nothing you've said or written and can be turned off in Settings › General.
• For subscribers, turning SayWrite on for a Mac (the license key or sign-in link, a random install ID, the Mac's model and its name) and a license check about once a week that sends only the key.
• Send Feedback, only when you click Send, with the message you typed.

Text you dictate into another app is handled by that app. The security page lists every connection and how to verify them, and confidential work covers the same setup for lawyers and therapists.

1. Ask your compliance team first. Show them the security page and privacy policy.
2. Turn History off, or keep it short. It's stored only on your Mac; keep it for as little as 7 days, or not at all. Password managers are always excluded.
3. Leave AI Polish off unless you need it, so dictation types exactly what you said.
4. Teach the dictionary your words: drug names, procedures, colleagues and local terms. SayWrite offers to remember a word when you correct it. Proofread anyway: any dictation tool can mishear similar-sounding names.
5. Protect the Mac itself with FileVault, a strong login password and your organization's device management.