You may be a nurse, doctor, pharmacist, physiotherapist or optometrist but this page and all its 12 pages are for you. Although this page focuses more on Nursing, it has almost all that you need – formats, vocabulary, passive voice, tense, connectors, corrections and a number of new phrases you can try in your referral letters.
Many medical professionals have said that this website’s content is a treasure for them because it is simple, constantly updated and of course, FREE.
Who should Read This Page?
- If you do not know that “The patient has been adviced” is incorrect, this page is yours.
- If you still think that the comma in “I am writing this letter to refer Ms Abigael, who is being discharged…” is okay, you should read this page.
- If you think that “the patient was undergone” is a correct usage, you can’t skip this page.
- If you think that Ms Roy and her baby are equally important in the sentence, “Ms Roy as well her baby needs your service,” you cannot proceed to self preparation without this page.
- If you think that there is no difference between “She was commenced” and “She commenced,” take a break and start reading this page today.
Kinds of OET Letters
Most of the OET Letters are referral letters although a very few are addressed to the patient’s relatives such as spouses or parents. In most cases, a medical professional writes a referral letter with a request to take care of the patient who is being discharged. Here is a situation:
- You are a nurse and Mr Albin has been your patient since he was admitted on 12th March, that is, a month ago.
- He has improved a lot since his admission and tomorrow he is being discharged. Mr Albin has strongly recommended sending him home but his doctor has advised him to continue his medicines for a month in a care centre.
- As Mr Albin is very old and has memory failure, you (the nurse in-charge) think that it is better to send a nurse who could take care of Mr Albin.
- Unfortunately, your hospital doesn’t provide nurses for home-care so you have to find another solution.
- You have been told that Aster Home Care is a reputed nursing agency that arranges nurses for home-care.
- Upon your experience and consideration, you decide to write a referral letter to Aster Home Care to send a nurse to Mr Albin’s home.
1. Address Lines
Community Child Health Service
41 Jones Street – Ekibin.
Ms Edith Mehbooba
Mind It Care & Service
Park Road, Adelaide
Mr Ivan Stallone
- 25 July, 2009
- 30th March, 2018
- Ref: Master Vamuge Obeki, DOB: 23 May, 2005
- Re: Mr Oliver Ghosh, 28 years
- Dear Ms Steven
- Dear Dr Smith
- Dear Mr Sainuddhin
- I am writing to request follow-up care for Master Vamuga and his family from your facility. He is due to be discharged today.
- I am writing to request an emergency admission for Mrs Olsen who requires further support and management from your facility. She is presented with us since December 2007.
- This is in connection with the discharge of Ms Venora Arizona, a patient for the last fifteen days who has undergone multiple surgeries. She is ready to be discharged in two days.
- All parents are informed of a sudden outbreak of dengue fever and subsequent body pain that is rampant in the city. As many of our students have been diagnosed positive by our resident doctor, parents are advised to follow the instructions given below.
6. Admission History
- Master Vamuga was admitted to the Children’s Emergency Department on 15 July, 2009 with acute meningoencephalitis as a complication of mumps.
- Ms Thompson was admitted to our hospital three days ago after she had fallen on rocks and injured her leg and foot. In addition to this, she underwent routine blood investigations and wound-swab to check for infection and hydrosol dressing for minimising exudation.
- Ms. Tracy was presented to the hospital on 19 September 2009. During admission, she was suffering from severe pain and tingling sensation because of the damaged nerve fibres in the spinal cord. Consequently, she developed loss of movement along with bladder and bowel incontinence. Sadly, her body balance and walking ability also impaired.
7. Medical History
- Worthy to note, the patient has had diabetes for the past two years and got admitted in the hospital due to high blood pressure in 1992.
8. Diagnosis and Treatment
- Presently Ms Tracy is recovering well and she can walk with the help of her daughter. Except for her irregular back-pain, the patient is doing well.
9. Nursing Management
- At present, she is recovering well and her vital signs are all within normal limits. She is being assisted for activities of daily living and her wound site is being kept clean and dry as well.
10. Social History
- Master Vamuga lives with his parents in a rental house. His father, Mr Abdullah Obeki is an employee at Golden Circle pineapple factory and his mother, Mrs Miri, is a housewife. They are refugees arrived in Australia from Sudan in 2008 and have one more 2 year old child. In addition, they know only Dinka and Arabic. Now, Mr Obeki attends English classes and understands spoken English. However, he has limited writing skill as they require a language interpreter.Master Vamuga’s parents state that both 9 had some kind of vaccination at birth but the vaccination records has been lost.
- Looking at the patient’s social environment, Ms.Tracy is a widow and lives with her daughter.
- Kindly provide education to his parents regarding mumps vaccination schedules and recommended vaccines for both children. Encourage them to do his neurological check up. Currently, he is stable and ready for discharge.His address is enclosed along with this.
- In view of the above circumstances, it would be greatly beneficial if you could arrange someone who can help this family. Kindly help her for meeting hygienic needs as she is being affected with loss of bowel and bladder control. Your special attention is brought to the point that you will have to do the needful to assist her in order to improve her mobility.
- If you have further queries,please do not hesitate to contact me.
|To convert the case notes into a referral letter, you need to organize them into the following sections.|
|Whom are you writing to?||
|Who are you referring / transferring / discharging?||
|Patient’s medical history||
|Patient’s diagnosis and treatment.||
|Patient’s social status||
|What is your request?||
|Who are you?||
Royal Perth Nursing Agency
6 Selby Street – West Australia.
15 November 2009
Dear Ms. Kenzy,
Ref: Mrs Catherine Tracy, DOB 14 November, 1963.
I write this letter on behalf of the daughter of the above mentioned patient who needs further care and assistance at home. The patient, Ms Tracey, is being discharged today after a good recovery from a serious spinal cord injury.
Ms. Tracy was presented to the hospital on 19 September 2009. During admission, she was suffering from severe pain and tingling sensation because of the damaged nerve fibres in the spinal cord. Consequently, she developed loss of movement along with bladder and bowel incontinence. Sadly, her body balance and walking ability also impaired.
Presently Ms Tracy is recovering well and she can walk with the help of her daughter. Except for her irregular back-pain, the patient is doing well. Worthy to note, the patient has had diabetes for the past two years and got admitted in the hospital due to high blood pressure in 1992.
Looking at the patient’s social environment, Ms.Tracy is a widow and lives with her daughter.
In view of the above circumstances, it would be greatly beneficial if you could arrange someone who can help this family. Kindly help her for meeting hygienic needs as she is being affected with loss of bowel and bladder control. Your special attention is brought to the point that you will have to do the needful to assist her in order to improve her mobility.
If you have any queries, please do not hesitate to contact me.
Ms Georgine Sharma,
Resident Community Nurse,
Community Retirement Home
103 Light Street, Newtown
|Date||14 June, 2018|
|Salutation||Dear Ms Sharma|
|Subject||RE: Mr Lionel Ramamurthy, aged 63 years|
|Discharge Plan||Mr Ramamurthy will be discharged tomorrow (11/2) from Newtown Public Hospital back into your care following a bout of pneumonia. He was admitted with acute SOB, wheezing, painful coughing, fever, sleeplessness and general aches, and was hospitalised for seven days.|
|You’ll be glad to know that Mr Ramamurthy has made good progress overall and is no longer feverish with his inflammatory markers having normalised. He does, however, still have a dry cough. In addition, his mobility has improved; he can now walk short distances without his walking frame as well as use the shower and toilet independently.|
|Discharge Plan||Please make sure Mr Ramamurthy sits up as much as possible to ensure postural drainage. In addition, he will need to continue his deep breathing and coughing exercises (he may also need paracetamol for his chest and abdominal pain).|
|Discharge Plan||Mr Ramamurthy will also need to be kept warm and encouraged to drink plenty of fluids during his recovery period. His diet will also need to be monitored as he did gain some weight during his stay. If you have any questions, please do not hesitate to contact me.|
An OET Letter should be 99% error-free but that is not very easy. As you know, many of you opt for OET because of its relatively low requirement for English language expertise. However, we cannot hope to go for the exam with an amputated, sleep deprived, ill language proficiency.
Blade-sharp grammar is important in reading, speaking and listening as well. If you don’t know that “little” is equal to zero and “few” is close to “no”, you are bound to err in reading and listening where these words are repeated.
Here are a few grammatical errors that many of the OETians commit in writing letters apart from speaking, listening and reading.
Where to use a comma?
Some of you may ask, “What! for a Comma?” Yes, that’s true.
Now, look at these sentences:
- “I am writing to refer Ms Oven, who is being discharged and sent for continued followup care at your facility.”
- “I am writing to refer Ms Oven, the only survivor of a motor mishap, now being discharged and sent for continued followup care at your facility.”
The comma in the first sentence is completely out of place and that can cost you heavily. The commas in sentence 2 is correct because the part of it between the two commas is an adjective clause. Please be careful about commas.
Many candidates are still confused about the use of “undergo”, a word that most frequently appear in OET letters.
- Ms Roy has undergone cataract surgery (Correct)
- Ms Roy underwent cataract surgery (Correct)
- Ms Roy was undergone cataract surgery (Incorrect)
Similar expressions are elaborated in the Passive Voice Section.
Advise or Advice
Advice is a noun form while advise is verb.
- Ms Roy has been advised to alter her diet immediately.
- Ms Roy has to follow the doctor’s advice to reach an immediate relief.
Greatly or Grately?
Greatly is a word while there is no such word as “grately. However, there is a close match – grateful which means thankful.
- It will be greatly appreciated if you could take over Ms Roy’s care.
- Your involvement in Ms Roy’s case will be greatly appreciated.
Grateful / gratefully
- Your willingness to assist Ms Roy is gratefully considered by the hospital.
OET Tense in Sections
Each segment of an OET Letter is tense specific but we hardly noticed that. Here is what it roughly looks like:
- Starting – Present Tense
- Medical history – Past Perfect & Simple Past
- social history – Present Tense
- Nursing Management – Past, Present and Future Tense.
Introducing the patient
- Simple Present
- Present Perfect
- Present Perfect Continuous
“I write this letter to refer Ms Shallot who has been under our care following multiple surgeries…”
- Simple Past
- Present Perfect
“Ms Shallot was admitted to our care on 12th March, 2018…” Patient’s present condition.
- Simple Present
- Present Perfect
“Post-operatively Ms Sandra has regained a satisfactory health.” Patient’s social circumstances
- Simple Present
Mr John lives with his family – wife and three children, the eldest of which is seventeen years and the youngest 3. Request
- Simple Present
- Simple Future
For the above reasons, you are requested to regularly monitor Ms Reena’s insulin intake
Simple present is mostly used in explaining a patient’s social history.
- Ms Roy lives alone in a two bedroom apartment in the suburbs.
- For the last three years Mr Sam smokes excessively.
Simple present is a safe way of combining past, present and future together.
- A retired nurse, Ms Stallone self injects her medicines. (This sentence suggests that Ms Stallone used to, still does and will continue injecting in the future, too)
Present perfect tense is used to explain the recent tests the patient has undergone, the recent medications the patient has been prescribed, the patient’s medical history that has not ended so far.
- Ms Oven has a family history of osteoarthritis in particular and joint pains in general.
- With regards to his medical and social history, he has been seen by many Physicians and Psychiatrists, yet no noted improvements have been reported.
- Since birth he has been taken care by his attendant Ms Jennifer.
- She has been instructed to use arm slings and is completely restricted from weight lifting is advised for 4 weeks.
- In addition to this, Endocrinologist has advised her to maintain a chart of her blood sugar levels.
In all the above quoted situations, has, has been, have and have been are used. In all those situations, actions are initiated but not completed – at least the effects of the actions are prevailing.
Simple past is commonly used in the introduction, medical history and in the medical management of the letter. Remember, if a particular date is given, never fail to put that in simple past.
- Ms Roy was admitted to our care on 12th December with severe abdominal pain.
Simple Past & Present Perfect
Simple past is used for actions that terminated in the past at a particular time.
- “Ms Ray was admitted on 12th May with complaints of…”
Present Perfect is used for actions that started but not completely ended.
- “He has been advised to undergo this surgery within three weeks.”
In the above sentence, the patient has not yet undergone the surgery although the doctor has advised for surgery.
Take another example.
- “The patient has has undergone surgery and is recuperating well…”
In the above sentence, only surgery is done but has not terminated..
Past Perfect (Had)
Past Perfect or Had + V3 is used mostly in past medical history, that is, to express an action that happened before another action.
- Ms Roy had developed symptoms of uterus cancer before she had got her tests done.
Core Grammar Rules
READ THESE OET RULES BEFORE YOU PROCEED TO CORRECTIONS.
- The following words are followed by a comma:
- In addition to that,
- And the following words are GENERALLY not followed or preceded by comma:
- Who “This is the patient who has requested home visit.”
- Use simple present for Social History
- Ms Alnet lives with her husband and two children.
- Mr Joy is a social worker.
- Use present Perfect for nursing management:
- The patient has commenced ib
- uprofen 20 mg.”
- Ms Patient will have a review appointment with Dr Stenson
Dos and Donts
- Do not begin any sentence with but, and, because, hence. However, you can use their alternate :
- But > However
- And > Besides
- Because – Because of
- Hence – As a result
- Do not end any sentence with
- Do not use the before:
- A group as a whole.
- “Women are very careful in making plans.”
- “Old people are always talkative.”
- A group as a whole.
- Do not use prepositions with:
- Every year, month, everyday
- Use “the” with:
- The poor
- The rich
- The public
- The Nile, the Thames, the Amazon
- The Indian Ocean, the Atlantic
- The Bible, the Quaran
- The Same
- The first, the second, the third, the last…
- The fastest, the sharpest, the cutest, the most important, the most
- Every and Each are singular.
- No need of prepositions before:
- Out of state
Passive voice is very important for OET writing. Let’s see the rules here:
- The doctor diagnosed Ms Stella.
Ms Stella was diagnosed.
- The hospital admitted Ms Stella on 12th May.
On 12th May Ms Stella was admitted to the hospital.
- Her dietitian advised Ms Stella to include low-fat food.
Ms Stella was advised to include low-fat food (by her dietitian) > Better not to mention “by her dietitian)
- She has requested me to provide home care for her son for three weeks.
I have been requested to provide home care for her son for three weeks.
- We cannot convince the patient.
The patient cannot be convinced.
- We have not contacted the patient’s husband.
The patient’s husband has not been contacted.
- The doctor has not diagnosed the patient yet.
The patient has not been diagnosed yet.
- The hospital may not discharge Mr Patient for a week.
Mr Patient may not be discharged for a week.
- The physiotherapist has advised Ms Patient to forego evening meals for a while.
Mr patient has been advised to forego evening meals for a while.
- I request you to take over the care of Ms Patient.
You are requested to take over the care of Ms Patient.
- The doctor is planning to discharge the patient tomorrow.
The patient’s discharge is being planned for tomorrow.
- At the time of admission, we found the patient’s BP very low.
At the time of admission, the patient’s blood pressure was found very low.
- We have advised the patient.
The patient has been advised.
- The patient left a suicide note before committing suicide.
A suicide note was left before committing suicide.
- We have made much attempts to resuscitate the stillborn.
Much attempts have been made to resuscitate the stillborn.
Where to use Verb Forms?
V1 comes after:
- To + V1
- “I like to go abroad.” “She likes to go abroad.” “They liked to go abroad.” “She will go abroad.”
- D + V1
- “Do you live here?”
- “The patient’s relatives do not have any communication with her.”
- “Does he live here?”
- “The patient does not tolerate heavy meals.”
- “Did he live here?”
- “Ms Alnet did not have any problem till Monday.”
- M + V1
- Can “I can do it.” “Many youngsters can get educated.”
- Could “The patient could not stand upright.”
- May “The patient may get discharged today.”
- Might “It was feared that the patient might die.”
- Should .
Vs comes after:
He, she, it + Present Simple
- “Ms Alnet lives in a rented house.”
- “Mr Kapil works as a radiologist.”
- “The patient needs to receive a packet of RBC immediately.
V2 or Simple Past (Completed actions)
With all actions that are completed on a time.
- “Ms Emily drank three ounces of poison yesterday.”
- Last year, the patient suffered from serious burning sensation in the throat.
V3 or Perfect tense:
Present Perfect – Have / has + V3 (Incomplete actions)
- “She has requested to send a nurse to her home.”
Past Perfect – Had + V3
Ving – Continuous Tense
- For “She has come for treating her angina.”
- By “We have managed to stop her bleeding by medicating.”
- Before “The patient needs to undergo MRI before doing surgery.
|The patient was undergone.||The patient has undergone.||Undergoing is an action that one initiates. Undergoing cannot be, therefore, used in passive voice. We don’t say, “Australia was gone by me.”|
|The patient has admitted on 23rd March, 2018.||The patient was admitted on 23rd March, 2018.||In the first sentence, it sounds like the ‘patient has admitted someone else.’ Did she admit the doctor?|
|Your timely involvement will greatly appreciated.||Your timely involvement will be greatly appreciated.||It was just a missing “be.”|
|“I write this letter to refer Mr Yusef who was recovering from a postoperative phantom limb sensation_”||“I am writing this letter to refer Mr Yusef who is recovering from a postoperative phantom limb sensation_”||You should write “am writing” otherwise it sounds like you are not writing at present. Again, who “is” because while writing the letter, the patient is in the process of recovering.|
|Original Letter||After Correction||Why?|
|I write this letter to introduced Ms. Hoyle, who has had fracture 3 days before as heneeds continued care at home from your facility. She is discharged today.||I am writing this letter to introduce Ms Hoyle who has had fracture 3 days ago as she needs continued care at home from your facility. She has been discharged today||Continuous tense is better here. “I write” being simple present tense, it give the impression of a habitual action.|
|Ms Hoyle has been admitted to our hospital on 21 January, 2015 due to a type 1 fracture 1mm above the left elbow and minor displacement with humerus aligned as a result of scooter accident. On examination , she had disorientation, dizziness and nausea. Splint was applied for four weeks.||Ms Hoyle was admitted to our hospital on 21 January, 2015 due to x type 1 fracture 1 mm above the left elbow and minor displacement of humerus alignment as a result of scooter accident. On examination, she was found with disorientation, dizziness and nausea for which she has been made to wear splints.|
|Ms Hoyle has no evidenced medical history . Nevertheless, at present she has the problem with weight loss and poor appetite.||Ms Hoyle has no evidenced medical history. Nevertheless, at present she has the problem with weight loss and poor appetite|
|Ms Hoyle is married and she has a daughter 4-year old who has been hearing problem and has weekly consultation with Speech pathologist. Her husband is not helping for the childcare and housekeeping works and also she has some marriage problems. However, she has been doing home based business in partnership with husband and also she likes to do gardening.||Ms Hoyle is married and she has a 4 year old daughter who has x hearing problem. The child has weekly consultation with a speech pathologist. Sadly enough, her husband is not fond of helping her with childcare and housekeeping works owing to marriage problems. However, she has been doing home based business in partnership with husband.|
|Upon discharge she is stable and she can do independently self care activities. However , she need rest and helps for the child care and lifestyle assistance. Moreover, she needs counselling for the marriage issues.||Upon discharge, Ms Hoyle is stable and she can do self care activities independently. However, she needs rest and help for x childcare and lifestyle assistance. Moreover, she needs counselling for the marriage-related issues.|
|It would be grately appreciated if you can sent home care nurse for helping Ms Hoyle. I request you to please remind the patient regarding appointment. Please do not hesitate to contact me for further queries.||It would be greatly appreciated if you could send a home-care nurse for helping Ms Hoyle. I request you to remind the patient regarding her future appointments. Please do not hesitate to contact me for further queries.|
Your skill to expand notes is very important. At times there are notes as short as two words, like, “being discharged” or two pieces of sentences, like, “Completely dependent. Needs assistance.” In both cases, an OETian should be good at expanding – not too long, not too short. In simple words, if there are five words in the notes, try to expand to 15 or 20 words.
Below you will see a large number of common notes and their expanded form. Learn each line and improve your skill
Expanding little lines and short phrases into perfect, full-fledged sentences is another task that an OETian has to successfully carry out. While expanding notes, you will see a few questions like these arise:
- How much to expand?
- What should be expanded?
- What should not be expanded.
Suppose you are writing to a patient’s family doctor, how much should be told to the doctor? Certainly we do not have to write all the past history of the patient as the doctor is aware of the patient’s medical history.
How to Expand?
- The notes contain a word or two so you have to add all the missing words.
- In most cases, notes come without articles (a, an, the), prepositions (in, on, out, by, from, etc.), connectors (besides, additionally, also, however, but, etc.). You need to add them all, wherever required.
- Be sure you do not use too many connectors and prepositions.
|Admitted with pneumonia.||The patient was admitted to this hospital with definitive symptoms of pneumonia.|
|Acute shortness of breath (SoB).||On examination, it was found out that the patient had acute shortness of breath.|
|Inspiratory and expiratory wheezing.||Further investigations revealed that the patient had wheezing – inspiratory and expiratory.|
|Lives at home with husband, Isaac.||Ms Nimmy lives at her home with her husband.|
|The couple have been married 50 years.||The two have been married for fifty years.|
|Isaac is a decorated soldier who fought in World War II.||This may be noted that Mr. Isaac is a decorated soldier who had fought in the World War II.|
|Isaac attends RSL (Returned Soldiers’ League) meetings and enjoys the camaraderie.||Besides, Mr. Isaac attends RSL (Returned Soldiers’ League) meetings and enjoys the camaraderie|
|Faced cerebrovascular accident (CVA) some 2 years ago.||Mr. Mabel suffered Cerebrovascular Accident (CVA) some 2 years ago.|
|Agile, mentally active, speech slightly slurred.||Although Mr. Mabel is agile and mentally active, his speech has been found slightly slurred.|
|Complaining of severe illness.||Apart from this, he has, on several occasions, complained of severe illness.|
|Walks with limp – impaired balance.||It is important to note that the patient walks with a limp, possibly because of his impaired balance.|
|Fell off the stair – badly injured right knee||Later he fell off the stair from a considerable height and badly injured his right knee.|
|GP requested ‘Your Health Care Agency’ for dressing and assisting in taking shower daily.||Now, the GP has requested the assistance of Your Health Care Agency for dressing and assisting in taking shower daily.|
|Ms Isaac also smoked for 40 years but gave it away in 2004.||Looking at her family history, Ms. Isaac smoked for 40 years. However, she gave it up in 2014.|
|Her mother was overweight with high BP. Mother died of Myocardial infarction at age 75 (20 years ago)||This is also to be noted that her mother was overweight with high BP and died of myocardial infarction at the age of 75.|
|Admitted: 10 days ago for a double by pass. All went well. Has been recuperating.||Ms. Isaac had been admitted 10 days ago for a double bypass surgery and is recuperating post-operatively.|
|Anxiety||The patient is suffering from severe anxiety.|
|Not sure how she is going to cope once discharged from Hospital.||Therefore it cannot be assessed how the client is going to cope with her anxiety after discharge.|
|Worried she will die like her mother.||Probably she fears that she would meet with an unexpected and premature death like her mother.|
|Visibly distressed.||Please note that the patient shows such symptoms that she is visibly distressed.|
|Has outbursts of crying.||It has been noticed that the patient is habitual to frequent outbursts of crying.|
|Regular absence from school dating back to time of father’s death.||He has been regularly absent from school dating back to the time of his father’s death.|
|Year 2 – 3 days||
|Year 5 – 8 Days in first term.||By the time he was in the fifth year, Tom had kept off the school for 8 days in the first term alone.|
|Operation successful.||The operation was greatly successful, especially regarding the postoperative phase.|
|Has been using an oxygen concentrator;||Since then she has been using an oxygen concentrator to avoid any chances of misadventure.|
|To be issued with a rented portable oxygen concentrator on discharge.||The hospital shall issue a rented portable oxygen concentrator for the patient’s use on these fifty days.|
|Prescribed Lipotor Oral, using Ventolin when required;||Apart from Lipotor oral, the doctor has prescribed Ventolin as per requirement.|
|Taught postural drainage position and pursed lip breathing technique.||Apart from the above mentioned awareness programs, the patient has been taught postural drainage position pursed lip breathing techniques.|
|Advised to quit smoking.||In spite of the patient’s refusal, he has been advised to quit smoking during the course of medication.|
|Prescribed Nicobate patches.||Her doctor has prescribed Nicobate patches for improving nocotine level in her body.|
|To be discharged tomorrow.||May I bring to your immediate notice that the patient is due to be discharged tomorrow.|
Read the case notes and complete the writing task which follows:
Wayne Tucker, a 27 year old, was admitted into the hospital of which you are charge nurse.
This letter calls your attention to a little complicated case of Mr Wayne Tucker who was admitted to our care on 4th September, 2016 with severe occipital headache associated with unstable gait and dizziness.
Thank you for accepting the aforementioned bachelor who requires continuity of care from your service . He underwent craniotomy in view of his cystic mass lesion and is recuperating well.
One of his neighbors admitted him into the hospital after he had been complaining of severe headache. The patient was swaying to both sides while walking due to extreme headaches and dizziness/vertigo.
|On his admission assisted by his neighbors, Mr Tucker was found swaying to both sides while walking. It was soon found out that the patient’s irregular movement was caused by headache and dizziness.|
|He has been suffering with the same headache for a year and multiple irregular episodes of vomiting for 5 months respectively. Subsequently, physical examination was performed in which no significant abnormality was found. However, to rule out exact diagnosis, certain diagnostic investigation like MRI and CT of brain were done and they revealed the current diagnosis. Following this, he underwent surgery and his cystic mass has been removed.|
|Mr Tucker’s post-operative phases were satisfactory. Besides, he made a good progress without any complication. Also, a CT was repeated after a month and no lesion was identified in his study. Under the light of the above developments, he is scheduled to be discharged today.|
The condition of the patient was normal at the time of discharge. Recommended to contact Dr. Tiana for further treatment.
|In the light of the above, it would be greatly appreciated if you could examine Mr Tucker and manage his condition as deemed appropriate. All pertinent documents obtained during his confinement is enclosed.|
Lives alone in an apartment (Kiol Apartment, 5/11 Stratfield Square, Sydney NSW 2136, Australia)
Using the information given in the case notes, write a letter to Dr. Tiana, Head of the Department, BrainCenter, Alphon Star Hospital, Reserve Rd, St. Leonards NSW 2065, Australia, who will be responsible for Mr. Wayne Tucker’s continued care.
Head of the Department
BrainCenter, Alphon Star Hospital
Reserve Rd, St. Leonards NSW 2065
In your answer:
NOTES FOR PRACTICE
Convert the following notes into paragraphs.
- Ms Alice Baker. Admitted today. Fall from balcony. Severe bleeding. Under observation. Needs an urgent surgery.
- Mr Parker Coleman. Admission on 13th March. Intermittent pain in lower abdomen.
- Ms Emilie Sharma. 33 years. Doctor advised no conception. She wants a baby (two fetuses got self aborted in 2016 and 2018). Husband Mark undecided.
- X Ray done. Three ribs fractured.
- Pregnant. No labor. Induction failure.
- Mr Joachim. Lives alone. No children. 1st Wife died 13 years ago. Second wife separated.
- Beware, Parents! Drug addiction. Children victims. Elder friends culprits. Keep them away.
- Kindly admit the patient. Will be highly appreciated.
- Thank you in advance. Help the patient with smoking cessation.
Part 4 Passive Voice
You may have noticed that OET writing uses a lot of passive voice. We write “the patient was admitted on 12th December, 2017” or “the patient was treated for three months.” Whatever be the reason, passive voice makes OET Writing impressive.
You may still be confused about the use of present perfect (have been admitted / has been admitted) and simple past (was admitted) in passive voice.
A simple past is used when the action (admitted / injected / treated / scanned) is done and its effect is no more important. “Mr Sam Manjooran was admitted” means that Mr Sam’s admission and treatment are all over while “Ms Monica Washer has been admitted” means Ms Washer is still not treated completely or not yet discharged.
OET letters and passive voice are highly connected. Information such as admission, treatment, tests, prescriptions and advice are mostly written in passive voice. Look at some of the examples:
|The doctor has prescribed tripple dose of paracetamol.||Tripple dose of paracetamol has been prescribed (we know by whom)|
|The patient has requested help of a nurse.||The help of a nurse has been requested by the patient.|
|I am writing this letter to you to refer Mr Tucker for his ongoing care.||This letter is being written to you to refer Mr Tucker for his ongoing care.|
|The hospital admitted him 4 September 2016 with swaying on both sides while walking.||He was admitted to the hospital with swaying on both sides on 4 September 2016.|
Passive Voice Quiz
Passive Voice Correct Use
|Doctor advised Ms Ezee to quit smoking.||Ms Ezee was advised to quit smoking. (We don’t write “by doctor” because it is understood)|
|Nurses fed Mr Sam through tube.||Mr sam was fed through tube. (We don’t write “by nurses” because it is understood.)|
|The hospital admitted Mr Sam Blessen on 12th December, 2015.||
Mr Sam Blessen was admitted on 12th December, 2015.
(We don’t write “by the hospital)
Another important area of an OET Letter is Connectors. Using too many or too less connectors is not advisable. In the long run, when you have written several letters, you tend to feel more comfortable with any number of connectors and there are chances you end up writing so many connectors.
A very important trouble is regarding the placement of connectors. While some can be placed at the start or in the middle, others can be placed only in the middle. There are a few that are placed at the extreme end.
Your knowledge and confidence in English is admired but over dose Connectors will kill the Letter. You may write 1 simple connector (like and, but, because, yet, so, etc) and 1 compound connector (like however, besides, in spite of, for which, etc) in a single sentence. Also, avoid using a compound connector in two adjoining sentences.
Here is an example for overdose Connectors in a sentence:
“I am writing to refer Clara, a 10th grade student who has been presented with peritonitis followed by ruptured appendix for which she underwent appendectomy and is now seeking your home-care based on the availability of which she will be discharged.”
Tilt your Screen for Better View.
In the Middle
At the End
|Additionally||Additionally, you can try uniting the patient’s family, especially his brothers.||No||No|
|Although||Although the patient has no family history of tuberculosis, it is imperative that he undergoes a complete examination.||It is imperative that he undergoes a complete examination although the patient has no family history of tuberculosis.||No|
|Also||Also, kindly monitor his blood-sugar levels daily for a week.||Kindly monitor his blood-sugar levels also daily for a week.||No|
|Apart from this||Apart from this, it is often noticed that the patient remains in seclusion for hours.||Very rarely.||You will have to closely observe the patient’s social behavior apart from this.|
|As a result||As a result, the patient has recently contracted Ebola virus and is now he is undergoing blood transfusion.||Very rarely||No|
|As a result of which||No||The patient was in areas where several cases of Ebola infections were reported as a result which he has recently contracted Ebola virus||No|
|As a result of this||The patient was in areas where several cases of Ebola infections were reported. As a result this he has recently contracted Ebola virus.||No||The patient has recently contracted Ebola virus as a result this.|
As if /
|As if being haunted by his past memories, the patient likes to remain away from everyone.||The patient behaves as if he is being haunted by some spirit.||No|
As well as
(A very confusing connector. When you “connect A and B with as well as in the middle, B doesn’t get equal relevance to A)
|No||The patient as well as his mother and a brother is hypertensive.||For that reason, Ms Roy was given another analgesic, as well.|
|At the same time||At the same time, the patient has been recommended trying warm water bath twice a day.||No||No|
|Because||Because of the extreme pain and swallowing difficulty due to dysphagia, the patient has commenced on an IV fluid therapy since 12th March.||The patient has commenced on IV fluid therapy since 12th March because of the extreme pain and swallowing difficulty due to dysphagia, .||No|
|Because of which||No||The patient has extreme pain and swallowing difficulty due to dysphagia because of which she has commenced on an IV fluid therapy since 12th March.||No|
|Besides, Mr Singh is very depressed about his condition.||She has been on tab paracetamol besides a couple of very expensive analgesics.||No|
|But||No||Thereafter the patient underwent continuous diagnosis but no symptoms were noted objectively.||No|
|Consequently, Ms Roy developed low appetite.||This was followed by a week’s physiotherapy, consequently enabling the patient ambulate without a walker.||No|
|Despite||Despite our attempts to pacify the patient, he remains silent and averse to all the medicines.||The patient remains silent and averse to all the medicines despite our attempts to pacify the patient,||No|
|Due to this||The patient’s car collided with a cyclist and killed a 30 year old man on the spot. Due to this, the patient is experiencing a traumatic depressive state.||No||The patient is experiencing a traumatic depressive state due to this.|
Due to which
|No||The patient has spent two quarters of his life in Siberia due to which he is now homesick.||No|
|For this reason,||For this reason, the patient was advised to consult a psychiatrist.||The patient was advised to consult an optometrist for this reason.|
|Hence||No||Ms Roy experienced cervical dilation but child birth was delayed, hence she had to undergo emergency caesarean section at 6.30.||No|
|However,||However, Ms Tokya has now improved and she can manage her insulin injections.||No||No|
|If||If you think the patient will improve through this smoking cessation, you can encourage him to quit drinking.||You can encourage the patient to quit drinking If you think she will improve through this smoking cessation.||No|
|In addition to (this)||In addition to the above mentioned tests, you are requested to arrange appointment for the patient with Dr Smith on 4th February at 5.00 pm.||You are requested to arrange appointment for the patient with Dr Smith on 4th February at 5.00 pm in addition to the above mentioned tests,.||No|
|In order to||In order to assess the patient’s progress, you may encourage him to actively participate in socializing with his old friends.||You may encourage him to actively participate in socializing with his old friends in order to assess the patient’s progress.||No|
In spite of
|In spite of the continuous monitoring, the patient has have hardly improved over the past one week.||The patient has have hardly improved over the past one week in spite of the continuous monitoring.||No|
|More over||Moreover, Ms Brown has a family history of tinnitus.||No|
Not only X, but Y also.
|Not only is the patient aggressive, (but) she is (also) extremely revengeful at times.||The patient is not only aggressive, but she is also extremely revengeful at times.||The patient is not only aggressive, but she is at times extremely revengeful also.|
|On the other hand||On the other hand, the patient can ambulate freely.||No||(Very rare) The patient can ambulate freely on the other hand.|
|Otherwise||Otherwise it can lead to a prolonged state of comma.||It can otherwise lead to a prolonged state of comma.||The patient or her close relative can administer the insulin injections otherwise.|
|No||You may advise the patient to reduce too much calorie intake so that her body weight will considerably drop.||No|
So that not
|Therefore||Therefore it is evident that the patient will need another three week’s intensive care at your facility.||It is therefore evident that the patient will need another three week’s intensive care at your facility.||No|
|The sooner, the better||The sooner the patient gets accustomed to the hospital environment, the faster will be her recovery.||The sooner the patient gets accustomed to the hospital environment, the faster will be her recovery.||No|
|Too __ to __||No||The patient is too much addicted to drugs to cease from the habit.|
|Unlike||Unlike other members of his family, Mr Kevin has been very active on social media.||No||No|
|While||Rare||Ms Ophir’s right arm is in heavy bandage while her right leg is paralyzed.||No|
Connecting Phrases – Addition
- Besides, the patient is a non smoker and a regular practitioner of yoga.
- Apart fromthe above mentioned medicines, the patient commenced on aspirin and paracetamol 500 mg.
- In addition to this, the patient has been advised to undergo a three week physiotherapy.
- Moreover, the patient has not been on any strict abstinence from alcohol.
- Not only the patient was a widower but also very asocial owing to his abnormalities.
- Also, you can contact the patient’s wife or brother Mr. Biju John on 9810740061.
Connecting Phrases – Contrast
- However, no expected result was found even after three weeks.
- On the other hand, the patient’s health deteriorated on the following days.
- In spite of all the attempts made by the nurses, the patient developed extreme bipolar symptoms.
Connecting Phrases – Reason
- The patient is not accompanied by a relative, hence the need for a nurse to monitor his daily activities.
- Mr Roy has not been able to respond to the analgesics so his doctor has asked him to commence on another course of medicines.
- As well as – As well is not “and.” In the sentence “The patient was advised to take tab paracetamol as well as aspirin,” only paracetamol is in focus. In this case, aspirin is not important.
- Hence is one of the most commonly misused conjunctions. We never begin a sentence with hence. “The patient has repeatedly requested for an early discharge hence this decision from the hospital to discharge her today.”
|His father understands spoken English. He has limited skills in written English.||His father understands spoken English but has limited skills in written English.|
|They are refugees from Greece. For the last five years they have been residing in Australia.||They are refugees from Greece now residing in Australia for the last five years.|
|During the hospitalization, the patient responded well to the treatment. Unfortunately, for the past 28 hours his condition has been unexpectedly unpredictable.||Although the patient responded well to the treatment during hospitalization, for the past 28 hours his condition has been unexpectedly unpredictable.|
|Mr Jenkin’s medical history reveals that he is a known case of hypertension and gout. He is on regular treatment for this.||Mr Jenkin’s medical history reveals that he is a known case of hypertension and gout for which he is on regular treatment.|
There are two kinds of abbreviations in OET:
- Very common abbreviations that you can use in writing, like Dr Mr Ms Ref: ECG, etc.
- Uncommon abbreviations that you cannot use in a letter like ↑ (increasing), ↓ (decreasing), etc.
There are thousands of medical abbreviations but, luckily, you need not learn even 100 of them to understand a case note. Here is a list of those abbreviations most often repeated in your case notes.
|↑||Increase in; Increasing; Elevate|
|↓||Decrease in; Decreasing|
|→||Leads to; Results in; Causes|
|?||Possibility of something|
|ACAT||Aged Care Assessment Team (Australian)|
|BiBA||Brought in by Ambulance|
|EBM||Evidence Based Medicine|
|EBP||Evidence Based Practice|
|MVA||Motor Vehicle Accident|
|NCP||Nursing Care Plan|
|S/B||Seen By (“Seen by Dr. Smith”)|
|SOAP||Subjective Objective Assessment Plan|
|AiN||Assistant in Nursing|
|CNS||Clinical Nurse Specialist|
|DON||Director of Nursing|
|EEN||Endorsed Enrolled Nurse|
|NUM||Nursing Unit Manager|
|PCA||Personal Care Assistant|
The thing is, assessors are fed up with our usual cliche phrases such as “however, even though, should you require further information, …” You will not score much by using these words because 90% OETians use those phrases. Please find some other phrases, like, “I reckon that you will be having further queries about the patient or his past history not furnished in this letter… In that case I will be most obliged to provide you with speedy information…” Such things. I am creating a list of such easy to learn phrases for all of you. Have a nice time. See you tomorrow.
- May I bring to your kind attention the brief case-history and discharge plans of Ms Dona who has been admitted here for her treatment for abdominal pains.
- I am writing this letter to request follow up care for Mr John who is recuperating after a prolonged cardiac instability and two subsequent surgeries. The patient is being discharged in a week’s time.
- It was quite unfortunate that Ms Joseph and her husband had to meet with an accident on a road that has the reputation of zero accidents for a decade.
- Ms Narayan has been on a strict lifestyle to control her addiction to alcohol but for some unknown reasons, she has not been able to make any headway.
- Mr John is an alcoholic and a chain smoker for the last fifteen years after his untimely retirement from the army where he had served as a captain. Mr John was a difficult man in the army and was a nuissance among his peers..
- I look forward to your kindness that would warmly accept Ms Joseph into your reputed palliative care.
- You are most welcome to ring me any time in case at any point of time you require any additional query pertaining to the information of the patient.
- For the above reasons, you are requested to arrange Mr John’s further care as he is moving to home in a week.
- I have all the reasons to believe that you will need to contact me several times to make fresh inquiries about Mr John because this tough man will pop up with new issues for people who are around him. Please feel free to contact me at any time of the night or contact one of our day staff on the number you have recieved in the last mail.
- I reckon that you will be having further queries about the patient or his past history not furnished in this letter… In that case I will be most obliged to provide you with speedy information.
The case notes (question) is not 100% the same. We have changed certain names used in the original not to violate OET terms and conditions.
Ms Amanda Taylor
University of Waikato Health Centre
Hillcrest Road, Waikato
02 February, 2013
Dear Ms Taylor
Subject – Regarding the transfer of John Anderson, 18 years
This letter is being written on behalf of my student, John, who feels anxious regarding the transition to university. He needs your supervision and necessary arrangements as he will be joining your university.
Since the age of 13, John has been suffering from eczema on hands and feet with an unknown cause. Recently his condition has aggravated due to stressful events. Although he was reviewed by a dermatologist, the prescribed medications were, unfortunately, not effective. Additionally, he tried homeopathy medication regime but that could do him no good.
Delving into John’s muddled and complex social background, he has been studying in our boarding school for the past 8 years as his parents work abroad. May I gladly tell you that he is a champion in swimming and a black belt in karate. In spite of his achievements on this side, John has recently been showing symptoms of depression and was was referred to a counselor which he didn’t attend. Additionally, this young man is consuming a moderate amount of alcohol weekly.
John’s anxiety exacerbated during the exam time and he was arranged to sit in a separate classroom. As I have said earlier, he will be joining your institution so it would be appreciated if you could organize similar arrangements for his future exams. Being a stressed patient, John requires your supervision as he is perplexed regarding the transition to university and independent dwelling.
If you will have no objection taking up this case, please do not hesitate to contact me.
St. Lucia Boys’ School
Have a look at the Case Notes below. You will need to join our Telegram Group.
You are the charge nurse at Aster Medicity, Sydney, and Mrs Fabiana Calton has been under your care.
Today’s date : 12 January, 2019.
|Patient’s Name||Mrs Fabiana Calton|
|Diagnosis||Right ankle fracture due to a fall.|
|DOA||1 January, 2019|
Repeated renal dysfunction since 1990.
Stressed after husband’s death in 1998.
|Management and progress||
|Today’s nursing notes||No noticeable progress and cannot move.|
The body of the letter should be approximately 180 – 200 words
Ms Lee Sterner
Ave Well Being
12 January 2019
Ref: Mrs Fabiana Calton, aged 95
I am writing to refer Mrs Fabiana Calton who requires further home management and medication monitoring as she is due to be discharged today after a not remarkable recovery from right ankle fracture following a fall.
Mrs Calton was admitted to the hospital on 1 January 2019 with right ankle fracture. Her X-Ray revealed the presence of fracture and she underwent plaster of Paris over the right ankle. Subsequently during her stay, she was commenced on medications such as warfarin which terminated due to overdose. Following this, she was given apixaban for a while but once again she shifted to warfarin.
Regarding Ms Calton’s social environment, she is a widow and lives alone. She has had repeated renal problems since 1990 and also she became stressed after her husband’s death. Presently, Ms Calton has no remarkable recovery as evidenced by her difficulty in movement. She has been advised to elevate the leg and to continue physiotherapy after the removal of the plastering.
In view of the above circumstances, it would be greatly beneficial if you could assist Ms Calton in taking warfarin medication in the prescribed dose. You are free to medicate her with apixaban in case overdose issues arise. It is important to note that she has to continue her physiotherapy even after POP removal and you are expected to restrict her to walk. Please note that her review for X-Ray will be on 12 February.
Should you require any information regarding this patient, please do not hesitate to contact me.
What isn’t changing
Let’s look at what isn’t changing first of all as the good news is that, in the main part, the subtest is going to remain almost exactly the same. The exam task will remain the same, candidates will have to write a formal letter, usually a referral letter, using a set of case notes, which they will have five minutes to read.
Candidates will then have forty minutes to write their letters. You will still be expected to write full sentences, you will still not be expected to use note form and you will still be expected to use a letter format. The task will neither be more difficult nor easier than it is currently, as it is not actually changing. The skills being tested are the same as before and the recommended strategies for scoring highly in this task remain very similar too. So what exactly is changing, then?
Each of these criteria were graded out of a maximum score of 6 and the score you would get in each criterion would contribute 20% to your overall score in the OET Writing Subtest. All of this will change.
The new grading criteria
There are now six new criteria for OET Writing which are named as follows:
- Conciseness and Clarity
- Genre and Style
- Organisation and Layout
All of the criteria now have a maximum grade of 7, except for Purpose which will be graded out of 3. I will look at each of these criteria in turn to demonstrate the changes in the way the OET Writing Subtest will be graded.
The Purpose criterion is the only part which is completely new, other areas have been repackaged and help to clarify exactly what it is the examiners are looking to see in your letters. This criterion focuses on the way the candidate makes the purpose of their letter immediately apparent and clear. The purpose should be included in the first paragraph of the letter. For example: “I am writing to refer the above mentioned patient who is suffering from worsening osteoarthritis.
Your assessment and management are urgently required.” These two sentences placed at the start of the letter make it extremely clearly to the reader why the letter was written and what action needs to be taken on the part of the reader. It has always been important to include this information but now one of the criteria focuses specifically on doing this.
This criterion focuses on whether you have included all of the necessary information in an accurate manner. It essentially replaces Overall Task Fulfilment and deals with aspects of Comprehension of Stimulus.
To score highly here, you are also required to write a letter of the required length, this will still, usually, be between 180-200 words but the word count itself is just a guide and you will not be penalised directly for writing under or over it. The important thing is to make sure you include everything that is necessary.
Conciseness and Clarity
This area operates alongside the Content criterion. Whereas with the Content criterion you will receive credit for relevant information you include in your letter, for this criterion, you will be marked down for any irrelevant information you include, especially if this irrelevant information makes the purpose of your letter less clear.
Genre and Style
This criterion assesses what was previously covered under Appropriateness of Language. You should continue to write using a formal register and use language which is suitable for your target audience, for example, certain technical abbreviations would be suitable when writing to a doctor which would not be suitable if writing to a parent. Your writing should also be clinical, precise and non-judgement
Organisation and Layout
This has replaced Presentation Features but it has a specific focus on making sure that your letter is organised in such a way that it makes the retrieval of relevant information as easy as possible. This involves including the most relevant information early in the letter and structuring paragraphs so that important information is easily observable and doesn’t become buried in overly-long sentences.
This has replaced Linguistic Features but it now focuses more generally on aspects of vocabulary and grammar. Grammatical accuracy, spelling, cohesion and punctuation will all be graded under this criterion. There is also a special focus on using language which makes the retrieval of relevant information easy to the reader.
So using key words and phrases in sentences such as: “An ECG needs to be conducted as a priority” or “Your urgent assessment is required” helps to focus the reader’s attention on the information which is most important. The range of grammar used in the letter is not directly assessed, only the accuracy.
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