Writing

Present Perfect

Present perfect tense is used to describe an event which starts in the past and continues until the
present.
Mastery of this pattern is an essential for writing successful referral letters. Three common ways to form
present perfect when writing referral letters are as follows:

Present Perfect Simple Present Perfect Progressive Present Perfect Passive

Form: have/has+ past participle Form: have/has+been+____ing Form: have/has +been+ past
(present participle) participle
 I have treated Mr. Smith
at this hospital for 3  I have been treating Mr.  Mr. Smith has been
years. Smith at this hospital for treated at this hospital for
3 years. 3 years(..byDr X).
 Dr X has treated Mr.
Smith at this hospital for 3  Dr X has been treating  They have been treated at
years. Mr. Smith at this hospital this hospital for 3
for 3 years. years(..byDr X).

Present perfect is often combined with for/since/over. Compare the usage below and note time markers
used.

For Since Over

For is used to describe a period of Since is used to refer to the start Over uses similar time markers to
time of period of time for but is used to express a
change in condition, or to
 I have been treating the  I have been treating the
describe a repeated event.
patient for 3 years. patient since 2007.
 The patient's condition
 The patient has been on  The patient has been on
has deteriorated over the
this medication for 6 this medication since past 3 months.(change in
months. January. condition)
 I haven’t seen the patient  I haven’t seen this patient  The patient has presented
for 1 year. since December 2009. several times over the last
  The patient has been in  The patient has been in year. (repeated event)
pain for 5 hours. pain since 10am.
 The patient's back pain
 The patient has been  The patient has been has worsened over the
waiting for 15 minutes. waiting since 11.45am. last week.(change in
condition)
 He has been complaining  He has been complaining
of back pain for a week. of back pain since last  He has tried to quit
week. smoking several times
 He has not had bowel over the past 25 years.
motions for 3 days.  He has not had bowel (repeated event)
motions since Saturday.
 He has been a smoker for  The patient has
a period of 25 years.  He has been a smoker experienced seizures on 3
since 1985. occasions over the past
year.(repeated event)

Handy Tip
When using time markers such as ...for the past 20 years, ...forthe last 3months, ...for the next 3 months
or .... for the previous 3 months always use the definite article "the" as it its function is to specify a
particular period of time.

Common Errors

Incorrect Correct

 The patient was diagnosed hypothyroidism  The patient has had hypothyroidism since
since 2007 2007. (present perfect)

Explanation: Past tense cannot be used with for or  The patient was diagnosed with
since hypothyroidism in 2007. (simple past)

 She has been problems with arthritis in her  She has been having problems with
hands. arthritis in her hands since 2007. (present
perfect progressive)
Explanation: Problems in this sentence is a noun so
you can not use “been” with a noun. You must use  She has had problems with arthritis in her
have or has + noun or been+ ___ing verb. You can hands since 2007.(present perfect simple)
also use been + adjective
 She has been arthritic since 2007. (present
 perfect simple +adjective)

 She has had arthritis since 2007. (present

perfect simple +noun)

 He is smoking 2 packs of cigarettes a day  He has been smoking two packs of

for the past 25 – 30 years. cigarettes a day for the past 25-30 years.
(present perfect progressive)
 Over the past week she remains free from
severe pain and has been able to tolerate a  Over the past week she has remained free
fluid diet. from severe pain and has been able to
tolerate a fluid diet.(present perfect
 Also, there is an ulcer on the right lower simple)
lateral border of the tongue which is
present for more than one year.  Also, there is an ulcer on the right lower
lateral border of the tongue, which has
 Mr. Diamond is a patient of mine since been present for more than one year.
2000 (present perfect passive)
 Mr. Eddy is a known smoker for 25-30  Mr Diamond has been a patient of mine
years. since 2000.(present perfect simple)
Explanation: The verbs in these sentences are in  Mr. Eddy has been a smoker for 25 years.
simple present tense. Present perfect needs to be (present perfect simple)
used because you are referring to a time period
which started in the past and has continued to the
present.

 Mrs. Brown has been presenting to me on  Mrs. Brown has presented to me on several
several occasions over the past few occasions over the past few months.
months.

Explanation: Progressive form not required.

Articles Usage with Countable & Uncountable Nouns

Whether an article is required or not depends on the noun that follows. For this purpose nouns can be
classified into two types: countable & uncountable nouns. The difference is based on whether the noun
can be counted or not. For example complaint is a countable noun as it can be counted. Therefore it is
possible to say 1 complaint or 2 complaints. Advice on the other hand cannot be counted so it is not
possible to say 1 advice or 2 advices , The correct expression is some/any advice or the expression a
piece of advice.

Countable nouns
These nouns have a singular form and plural form.

Singular
In the singular form an article is usually used before the noun. Example: The doctor received a complaint
from her patient.
NB. Exceptions: The article can be left out if it is replaced with another determiner such as his/her or this
/that or any/each/every. E.g. The doctor listened to each complaint. Her complaint was recorded.

Plural
In the plural form the article is usually not used before the noun. Example: The doctor received
complaints from her patients.

Remember: Always use articles when referring a particular job such as:
doctor/dentist/nurse/pharmacist/physiotherapist/teacher etc etc.

Countable nouns Singular form Plural form

Note the use of an article before Note the absence of the indefinite
each noun in singular form, either articles a/an before each noun in
as a/an/the singular form, but the definite
article

abscess The patient had an abscess on her The patient had 3 abscesses on
gum. her gum.

ache The patient reported a dull ache The patient suffered from aches
in her abdomen. and pains.

accountant Mr. Hagen is an accountant. Mr. & Mrs. Hagen are both
accountants.

appointment A follow-up appointment was The patient did not attend her
scheduled. follow-up appointments.

cavity The cavity was exposed. The cavities were exposed.

check up The patient attended for a check- Regular check-ups will keep you
up. healthy.

complaint If you have a complaint, tell your If you have any complaints, tell
doctor. your doctor.

condition You have a condition known as There are 3 conditions which can
tuberculosis. indicate the presence of cancer.

deposit A carious deposit was evident on Carious deposits were evident on

tooth 32. teeth 32 & 33.

doctor The patient has not seen a doctor Three doctors were involved in
for several years. the treatment of the patient.

episode The patient had an episode of The patient reported 3 episodes

heart flutter. of heart flutter.

examination An examination is necessary to Blood urine examinations

rule out cancer. revealed no abnormalities.

gum The gum surrounding tooth 23 The gums were infected.

was inflamed.

increase There was an increase in the size The patient presented with
of the swelling. numerous swellings.

interpreter An interpreter is required. Interpreters will be required.

investigation An investigation is required to Investigations are required to rule

rule out bowel cancer. out bowel cancer.

limp The patient walked with a limp. All the patients had limps.

parasite The threadworm is a parasite. Threadworms are parasites.

lip The patient had a swollen lip. The patient had swollen lips.
(one lip) (both lips)

smoker She is a smoker. They are smokers.

operation An operation is necessary. Two operations are necessary.

painkiller The patient requested a Painkillers are not necessary with

painkiller. this procedure.
physiotherapist An appointment needs to be a Two physiotherapists work at this
arranged with a physiotherapist. rehabilitation centre.

result The patient hoped for a positive The results were positive.
result.

review A review was scheduled after 2 The nurse received positive

weeks. reviews from her patients.

sensation The patient reported a tingling The patient experience tingling

sensation in his fingers. sensations in his fingers.

social worker A social worker has been Two social workers have been
arranged to offer ongoing care. arranged to offer ongoing care.

teacher Steve is a teacher. Steve and Chris are teachers.

test A blood test was ordered. Blood and urine tests were
ordered.

visit Please organise a visit by a social Regular visits by a social worker

worker. are required.

Uncountable nouns
These nouns cannot take a plural form such as: cancer, anaesthesia and information. For these words no
article is required. However, the definite article the as well as quantifiers such as some and any can be
used before the noun.

Uncountable nouns Indefinite articles cannot be used with

uncountable nouns. However definite article “the”
as well as quantifiers such as some and any can be
used.

accommodation The patient lives in rental accommodation.

advice Advice on diet is requested.

assistance The patient will require assistance upon discharge.

attention The patient requires urgent attention.

behaviour On examination, the patient's behaviour was

abnormal.

cancer The patient has cancer.

caries Deep caries were present on several teeth.

concentration The patient has poor concentration.

damage The scan confirmed damage to the medial cartilage.

discomfort If you experience discomfort, please consult your

doctor.

information Should you require further information, please do

not hesitate to contact me.

pain The patient experienced pain on palpation.

progress The patient has made good progress.

tissue She has healthy, soft tissue.

treatment The condition did not respond to treatment.

research Further research is required.

surgery The patient chose not to have surgery.

Common mistakes

Incorrect Correct

Wound on her left knee has been stitched. A wound on her left hand has been stitched.

I am writing to refer Marvin, 7 year old boy who I am writing to refer Marvin, a 7 year old boy who
was admitted to hospital on 21/11/10. was admitted to hospital on 21/11/09.

Mr Brown has been patient of mine for 7 years. Mr Brown has been a patient of mine for 7 years.

Please note, the patient has had prosthetic heart Please note, the patient has had a prosthetic heart
valve for year. valve for a year.

Examination revealed abscess on her gum. Examination revealed an abscess on her gum.

Apart from bruises to her body, X-rays reveal that Apart from bruises to her body, X-rays reveal that
she has fracture of the right ankle. she has a fracture of the right ankle.

Mr Jones had a heart surgery in 2009. Mr Jones had heart surgery in 2009.
The patient has a cancer. The patient has cancer.

She had a healthy soft tissue. She had healthy soft tissue.

He had lacerated lip and swollen gum. He had a lacerated lip and swollen gums.

The patient has pollen allergy. The patient has a pollen allergy.

The patient has tender right elbow joint. The patient has a tender right elbow joint.

The patient presented for regular check-up on The patient presented for a regular check-up on
12/2/10. 12/2/10.

Referring to Something Specific

The definite article is used when referring to something specific. It is very important to include this
article to signify the information is specific.

Note: These articles are usually omitted in the case notes. This is because the case notes are in short note
form and standard grammar rules do not apply. However for referral letters it is necessary to apply and
adhere to standard grammar rules.

Incorrect Correct

 She was on Microgynon 30 for previous 5  She was on Microgynon 30 for the previous
years. 5 years

 He has been a smoker for last 12 years.  He has been a smoker for the last 12 years.

 Mr. Roberts has been a resident at our  Mr. Roberts has been a resident at our
 nursing home for past 2 years. nursing home for the past 2 years.

 This medication needs to be taken twice a  This medication needs to be taken twice a
day for next 3 days. day for the next 3 days.

Explanation: All the expressions above are referring

to a specific period of time so a definite article is
required.

 MrsSangean is currently on following  MrsSangean is currently on the following

medication: karvea 150mg daily, oroxinen medication: karvea 150mg daily, oroxinen
0.1 daily. 0.1 daily

Explanation:In this case, the writer is referring to

specific medication. i.e that which follows.

 The patient reported pain in left ankle.  The patient reported pain in the left ankle.

Explanation: Here the writer is referring to a

specific side, i.e not the right side but the left side.

 Patient complained of chest pain.  The patient complained of chest pain.

Explanation: Patient requires an article to indicate

which patient the writer is referring to.

 Examination revealed a slightly swollen  Examination revealed a slightly swollen

joint and a tender spot on medial aspect of joint and a tender spot on the medial
it. aspect of it.

Explanation: Here the writer is referring to a

specific region, i.e not the anterior aspect but the
medial aspect.

 Based on above information, I believe the  Based on the above information, I believe
patient needs urgent admission to hospital. the patient needs urgent admission to
hospital.
Explanation: Here the writer is referring to a
specific information, i.e not the information on the
medical chart but the information written above.

 Thank you for seeing this patient who  Thank you for seeing this patient who
presented at my surgery regarding tooth 54 presented at my surgery regarding tooth 54
which has been temporary filled by school which has been temporary filled by the
dental service. school dental service.
Explanation: Here the writer is referring to a
specific dental service, i.e not the community
dental service but the school dental service.

Special Usage of Articles

There are some situations where you should always use the definite article and there are some
situations where the indefinite article is required. Understanding these rules can greatly reduce the
number of "minor" errors in your writing so please study these rules carefully.

Handy Hint!
Articles are usually omitted in the case notes. This is because the case notes are in short note form and
standard grammar rules do not apply. However for referral letters it is necessary to apply and adhere to
standard grammar rules including article usage.

Body Parts

The definite article "the" should be used when referring to parts of the body.

Incorrect Correct
  Pain in left groin.  Pain in the left groin.

 Pain in stomach.  Pain in the stomach.

 I suspect it to be adenoma of parotid gland.  I suspect it to be adenoma of the parotid

gland.
 Mr. Smith had an operation on a left knee.
 Mr. Smith had an operation on the left
knee.

Names of Diseases

Do not use an article for names of diseases or conditions.

Incorrect Correct

 The patient is suffering from the high blood  The patient is suffering from high blood
pressure. pressure.

 Recently, the patient has complained of the  Recently, the patient has complained of
headache. headache.

 The patient was diagnosed with the  The patient was diagnosed with arthritis.
arthritis.
 The patient has had influenza for three
 The patient has had the influenza for three days.
days.

Same

Always use the definite article with this word.

Incorrect Correct

 She has a family history of same disease  She has a family history of the same
that had been controlled by Risperidone. disease that had been controlled by
Risperidone.
 The children were treated by same dentist.
 The children were treated by the same
 The medication is same as last time. dentist.
  The medication is the same as last time.

Articles with Gerunds

A gerund is the …ing form of a verb which takes on the grammatical function of a noun. It can be the
subject or object in a sentence. Usually no article is required with gerunds.

Incorrect Correct

 On review today, Mr Walker has reduced  On review today, Mr Walker has reduced
the smoking from 20 to 10 cigarettes per smoking from 20 to 10 cigarettes per day.
day.
 The patient was advised to stop drinking.
 The patient was advised to stop the
drinking.

Articles and Nominalisation

Nominalisation is a process where verbs can be turned into a "noun phrase". For example:The patient
sucked his thumb until he was five becomes The patient had a habit of thumb sucking until the age of
five.

Often in medical English, it is necessary to use nominalisation such as: The excessive drinking of alcohol
will adversely affect your health. The reduction of weight has led to improved health. It is common in
these cases to use an article before the nominalised expression.

The other benefit of using the style of writing is that it creates a formal tone and allows you to
summarise details from the case notes.

Incorrect Correct

 The patient is complaining of discomfort  The patient is complaining of discomfort

during passing of urine. during the passing of urine.

Capitalisation
Correct use of capitals is an important area to master when writing referral letters. Study the rules of
usage below to ensure you meet the standard conventions.

Rules of Usage

1. Medications and Diseases

o Capitals are required for proper nouns. Proper nouns include the brand name of a drug
or registered trademark of the manufacturer.

 Ritalin

 Voltaren

 Zocor

o The chemical constituent should be written in lower case.

 penicillin

 amoxicillin

o Names of diseases should always be lower case.

 bowel cancer

 high blood pressure

 diabetes

 epilepsy

o Eponyms: Some medical conditions are named after the person who discovered it. In
this case the first word should be capitalised.

 Parkinson’s disease

 Bell’s palsy

o Names of medical procedures do not require capitals.

 orthopantomogram

 x-ray

 caesarian section

o Body parts should always be lower case

  heart

 adrenal gland

 knee

2. Proper Nouns: Proper nouns name something specific as in the examples below. These words must
always be capitalised.

o Job titles

 The Lactation Consultant, Mater Hospital

 The Veterinary Eye Specialist, University of Queensland

o Institutions

 Mary Jones was admitted to Spirit Hospital.

 Dr. Bloomfield works at Weller Point Medical Centre.

o Places including addresses

 168 Wickham Terrace, Spring Hill

 12 Logan Road, Mt Gravatt

 36 Barmore Street, Holland Park

o Titles when they precede the name of a person

 The patient was seen by Doctor Smith.

 Nurse Jones is in charge of the patient's care.

3. Common Nouns: Common nouns do not name any specific institution, place, person or profession.
These words do not need to be capitalised.

o The patient was admitted to hospital.

o The patient does not have a family doctor.

o Steve is a teacher.

o Yoshiro is a doctor.

o Reza is a dentist.

4. Holidays, months, days of the week all need to be capitalised. However seasons do not.
 o The baby was born on Christmas Day.

o The patient was admitted to hospital on January 12.

o Please come and see me on Wednesday.

o The vaccination will be available in spring.

5. The pronoun "I" must always be capitalised.

o It was I who treated the patient.

6. Capitalise the first word of a salutation and the first word of a complimentary close.

o Dear Dr. Jameson:

o Yours sincerely,

Common Errors

Incorrect Correct

 His medical history shows that he is  His medical history shows that he is
Epileptic. epileptic.

 Also, I have given Dycal base on 1.1 and  Also, I have givendycal base on 1.1 and
dressed it with Glass Ionomer Cement. dressed it with glass ionomer cement.

 The patient was diagnosed with Type 2  The patient was diagnosed with type 2
Diabetes. diabetes.

 Mrs. Marsh has a history of  Mrs. Marsh has a history of

Hyperthyroidism, Hypertension and hyperthyroidism, hypertension and
Glaucoma. glaucoma.

 The patient is allergic to Penicillin.  The patient is allergic to penicillin.

 The patient suffered from severe  The patient suffered from severe
Abdominal pain. abdominal pain.

Refer to rule 1 above.

 Mr. duanethomson presented at my clinic  Mr. Duane Thomson presented at my clinic

today with the complaint of a broken today with the complaint of a broken
posterior tooth. posterior tooth.
  The director of nursing  The Director of Nursing

 emergency department  Emergency Department

 Mater hospital  Mater Hospital

 84 Monash road  84 MonashRoad

 The patient was seen by doctor Jones.  The patient was seen by Doctor Jones.

The above words are all proper nouns. Refer to rule

2 above.

 As per the General Practitioner’s order, we  As per the general practitioner’s order, we
are doing daily home visits and wound are doing daily home visits and wound
dressing and also assisting him with his dressing and also assisting him with his
showers. showers.

 Please see your Pharmacist for advice.  Please see your pharmacist for advice.

 Ms. Gatsby is a University student.  Ms. Gatsby is a university student.

The above words are all common nouns. Refer to

rule 3 above.

 The patient first visited my surgery in  The patient first visited my surgery in
march, 2008. March, 2008.

 Mrs. Green will be discharged from hospital  Mrs. Green will be discharged from hospital
on wednesday. on Wednesday.

 Symptoms of hay fever are worse in Spring.  Symptoms of hay fever are worse in spring.

Refer to rule 4 above.

 The patient requested that i prescribe  The patient requested that I prescribe
antibiotics for the virus. antibiotics for the virus.

Refer to rule 5 above.

 dear Dr. Roberts:  Dear Dr. Roberts:

 yours sincerely,  Yours sincerely,

Refer to rule 6 above.

Common Mistakes Regarding Physical Description

Incorrect Correct

Advice was given to reduce her weight. 1. Advice was given to reduce weight.

After the verb reduce it is not necessary to follow 2. The patient was advised to reduce weight.
with a pronoun. So youis not required. Simply
3. A reduction of weight was advised.
say:

I advised him to reduce weight, or, you need to

reduce weight.

In addition, she had lost her weight. 1. In addition, she had lost weight.

After the verb lose it is not correct to follow with 2. In addition, she has lost a further 11 kg of
a pronoun. weight over the past 2 months.

3. In addition, the patient’s weight has

significantly reduced from 61 kg to 50 kg
over the past 2 months.

He is now obese with a 99kilos weight and a 1.     He is now obese with a weight of 99 kg and a
170cm height. height of 170cm. (noun form)

The use of the correct verb & noun form and 2.     He weighs 99 kg and is 170cm tall. (verb form)
associated grammar is difficult. Refer opposite for
correct usage. 3.     He weighs 99kg and is 170cm in height. (verb
   form)

1.     Today’s examination revealed multiple 1.     Today’s examination revealed multiple missing
missing teeth, various carious lesions and a teeth, various carious lesions and a periodontal
periodontal pocket of depth 4-9mm. pocket depth of 4-9mm.

2.     There are several periodental pockets with 2.     There are several periodontal pockets which
about 4-9 mm in depth. are about 4’9 mm in depth or

Correct word order is: 3.     There are several periodontal pockets with a
depth of about 4-9 mm.
Depth of 4-9mm
4.     His height is 173cm.
Height of 173cm

Length of 20 m

Weight of 78kg

3.     His height was 173cm. Weight can change

but height can not so don’t use past tense.

1.     He was overweight 85 Kg with respect to his 1.     He was overweight at 85 kg with respect to his
height 173 cm. height of 173 cm.

This sentence is a shortened version similar to

the case notes. It is important to write in full
sentences.

Difficult Words

The English language is governed by rules. However, there are also many exceptions to these rules and
words which do not follow the normal or expected pattern are those which often cause problems. Study
this list carefully so that you can improve your grammatical accuracy and knowledge.

Complain Vs Complaint

Complain is a verb

 The patient complained of severe abdominal pain.

Complaint is a noun

 The patient presented with a complaint of severe abdominal pain.

Note 1: Complaint is a countable noun. so it can be used in the plural form or singular with an article.
Note 2: The two main prepositions used with complain are: complain of & complain about.

 Mr. Cochrane presented with complaints of nausea, headache and fever. (plural)

 Mr. Cochrane presented with a complaint of nausea. (singular with article)

Incorrect Correct

 The patient complaints of chest pain and  The patient complains of chest pain and her
her blood pressure is high. blood pressure is high.(verb)

 The patient presented with a complain of  The patient presented with a complaint
chest pain. ofchest pain.(noun)

 The patient presented with complaint of  The patient presented with a complaint of
chest pain. chest pain. (article required)

 He presented to my office on 23/03/2008  He presented to my office on 23/03/2008

complaining on severe pain associated with complaining of severe pain associated with
the lower left first molar. the lower left first molar.

Suggest & Recommend VsAdvise

Suggest, recommend and advise are all words commonly used in referral letters to report information
were given to the patient. However their rules of use differ and result in errors. Here are some examples
of their correct and incorrect usage.

Incorrect Correct

 I have suggested him to see you next week.  I suggested (that) he see you next week.

 I suggested her to return in morning as she  I advised him to see you next week
required further blood test and
 I suggested (that) she return in morning as
assessment.
she required further blood test and
 I recommended him to rest for 3 days. assessment.

Explanation:The words suggest & recommend  I advised her to return in morning as she
cannot be followed by an object pronoun such as required further blood test and
him/her whereas advise can.
 assessment.

 I recommended (that) he rest for 3 days.

Explain Vs Tell

Explain and tell also have different rules which cause confusion

Incorrect Correct

 I explained them that unsuccessful  I explained to them that unsuccessful

conception was not unusual in their case. conception was not unusual in their case.

 I have already explained the couple the  I told them that unsuccessful conception
basic advice regarding conception. was not unusual in their case.

Explanation: The word explain cannot be followed  I have already explained to the couple basic
by a pronoun or noun without the preposition to advice regarding conception.
whereas tell can.
 I have already told the couple basic advice
regarding conception.

Advise Vs Advice

Advise is a verb

 We advise patients on how to take their medication.

Advice is a noun

 We give advice or provide advice to patients on how to take their medication.

Note 1: The noun advice is uncountable so it can not be used in plural form. i.e. advices is incorrect as is
an advice.

 I gave some advice to the patient regarding her medication.

Note 2: The pronunciation is different: adviseadvice

Incorrect Correct

 It would be greatly appreciated if you could  It would be greatly appreciated if you could
make a visit to this family and advice his make a visit to this family and advise his
parents regarding the recommended parents regarding the recommended
 vaccines for both children. vaccines for both children. (verb)

 I am writing to refer this patient to you for  I am writing to refer this patient to you for
an advice regarding the management of his advice regarding the management of his
bilateral inguinal hernia. bilateral inguinal hernia(noun)

 I gave an advice to the patient regarding  I gave some advice to the patient regarding
her medication. her medication.(noun)

 I gave advices to the patient regarding her  I gave advice to the patient regarding her
medication. medication.(noun)

 Please advice the patient on how and when  Please advise the patient on how and when
to take their medication. to take their medication. (verb)

Request

Request can be both a verb and noun.

Request as a verb

 The patient requested painkillers. (verb form)

Request as a noun

 The patient made a request for painkillers. (noun form: request+for)

Incorrect Correct

 The patient requested for new dentures.  The patient requested new dentures. (verb)

 Ms. Green requested about IVF treatment.  The patient made a request for new
dentures. (noun)
Explanation: The common mistake is to use the
verb form plus preposition which incorrect.  Ms. Green requested IVF treatment.(verb)

 Ms.Greenmade a request for IVF

treatment. (noun)

Affect Vs Effect

Affect is a verb
  The patient has not been affected by the treatment.

Effect is a noun

 The treatment has had no effect.

Note: The pronunciation is the same.

Incorrect Correct

 She has also been effected by glaucoma for  She has also been affected by glaucoma for
the past 4 years. the past 4 years. (verb)

 The side affects of this medication are  The side effects of this medication are
unknown. unknown. (noun)

Widow or Widower

 Widow (noun) refers to a woman whose husband has died and who has not remarried.

 Widower (noun) refers to a man whose wife has died and who has not remarried.

 Widowed (adjective) refers either a man or woman whose spouse has died and has not
remarried.

Incorrect Correct

 I am writing to refer Mrs. Saunders, a 58-  I am writing to refer Mrs. Saunders, a 58-
year-old widowed who admitted with pain, year-old widow who admitted with pain,
dehydration and nausea. dehydration and nausea.(noun)

 I am writing to refer Mr. Saunders, a 60-  I am writing to refer this patient a 58-year-
year-old widow who complained of pain in old widowed woman who admitted with
his upper right second molar. pain, dehydration and nausea.(adjective)

 I am writing to refer Mr. Saunders, a 60-

year-old widower who complained of pain
in his upper right second molar.(noun)

History

History is always present, never past because you can’t erase it! Therefore you need to use simple
present tense not past tense when using this expression.
Incorrect Correct

 Mrs. McGowan had a history of heart  Mrs. McGowan has a history of heart
palpitation of 3 day duration. palpitation of 3 day duration.

Allergy Vs Allergic

Allergy is a countable noun

 Michael has no known allergies.(plural)

 Michael has a peanut allergy. (singular)

Allergic is an adjective

 Michael is allergic to peanuts.

Incorrect Correct

 In addition, he is known allergic to nuts for  In addition, he has a known allergy to nuts
which he was admitted to hospital with for which he was admitted to hospital with
anaphylaxis 2 years ago. anaphylaxis 2 years ago.(noun)

 Regarding his medical history he is allergy  In addition, he is known to be allergic to

to sulphur containing drugs. nuts for which he had been admitted in the
hospital with anaphylaxis 2 years ago.
(adjective)

 Regarding his medical history he has an

allergy tosulphur containing drugs.(noun)

 Regarding his medical history he is allergic

tosulphur containing drugs.(adjective)

Confident Vs Confidence

Confident is an adjective

 The patient is not confident in her ability as a mother.

Confidence is a noun

 The patient lacks confidence in her ability as a mother.

Incorrect Correct

 The patient has not confident social  The patient has no confidence in social
situations. situations. (noun form)

 The patient is not confidence in social  The patient is not confident in social
situations. situations. (adjective form)

a few/few & a little/little

Few and a few is used with plural nouns, and little and a little is used with uncountable nouns. Little and
few have negative connotations and are similar in many to not much/ not many. A little and a few have
positive connotations and are similar in meaning to some. Mixing up these words therefore will
completely change the meaning of the sentence.

Incorrect Correct

 The patient has reduced speech output and  The patient has reduced speech output and
a little eye contact. little eye contact.(negative connotation
required here)
 There are few ways to help identify the
possibility of threadworms such as  There are a few ways to help identify the
checking the anus of your children at night possibility of threadworms such as checking
and frequent scratching. the anus of your children at night and
frequent scratching.(positive connotation
required)

during/while

During is followed by a noun

 During hospitalisation the patient made a full recovery.

 The patient had many visitors during his stay in hospital.

While is followed by a phrase or gerund: ____ing

 While in hospital, the patient made a full recovery.

 The patient had many visitors while recovering in hospital.

Incorrect Correct
  He twisted his ankle during playing squash  He twisted his ankle during a game of
3 months ago. squash 3 months ago.

 He twisted his ankle while playing squash 3

months ago.

following/followed by

Incorrect Correct

 She was admitted to our hospital followed  She was admitted to our hospital following
by a collapse at home with a collapse at home with
dehydration,nausea and severe pain. dehydration,nausea and severe pain.

Incorrect as it means the patient was admitted to Correct as it means the collapse occurred before
hospital first, then collapsed. being admitted to hospital.

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Introductions
There are a variety of ways to write introductions and with practice you can develop a formula that works for you.
For the purpose of this document, the opening salutation and subject will be included as part of the introduction.
Salutation: If the name of the person is included in the case notes then it should be used. This can be followed by
either a comma or full colon.

o Dear Dr. Wilson,

o Dear Dr. Wilson:

If the name of person is not mentioned then you can begin with Sir/Madam

o Dear Sir/Madam,

Subject: The subject is a place where information such as the name & age of the patient can be included. This can
save you words in the body of the letter, but be careful not include too much information here, and definitely no
phrases or sentences. Both Re & RE are acceptable.

o Re: Dylan Charles D.O.B. 04/12/2009

o RE: Dylan Charles D.O.B. 04/12/2009

Handy Tip 1
You can save on word length by added some detail after Re, such as the patient name and age. However, take care
not to write too much here, and always use note form i.e nouns only (no articles, verbs, adjectives)

Basically, the introductory sentence of the letter can contain the following:

1. Background information such as name, age, occupation, marital status and gender of the patient if relevant
and not mentioned in the subject line
2. A brief summary of the chief complaint, purpose of writing or your main concern

It will usually be only 1 or 2 sentences long and detailed information about the patient's history and condition should
go in the main body of the letter.

Important Grammar Rules

The important patterns to learn are as follows:
Example 1
Relative Clauses: A relative clause is a useful sentence structure to use in the introduction. It allows the write to
demonstrate the ability to write a complex sentence, which is a basic necessity to get B grade of higher.

1. I am writing to refer this patient. He is due to be discharged today. He has made a full recovery.
2. I am writing to refer this patient who is due to be discharged today after making a full recovery.

Example 2
Appositives: This is a noun or a noun phrase that is placed after another noun to explain or identify it, and a comma
is required to separate these nouns. It has a very important use in the introductory sentence of referral letters as in
the example below.

1. I am writing to refer Mr. Barry Booth. He is 68 years old. He is a pensioner. He is a widower. He requires
dietary advice after undergoing heart surgery.
2. I am writing to refer Mr. Barry Booth, a 68-year-old widowed pensionerwhorequires dietary advice after
undergoing heart surgery.
Example 3
Age: There are specific rules regarding how to refer to a patient's age. The first is that it must be hyphenated when
used before a noun such as man/woman, and the second is that an article is required. For more details refer to Year
Vs Years in the Grammar and Vocabulary Clinic.
Incorrect Correct
 I am writing to refer this patient, a 63 • I am writing to refer this patient, a 63-year-old
years old man who lives alone. man who lives alone.
 I am writing to refer this patient, 63 • I am writing to refer this patient who is 63
years old man who lives alone. years old and lives alone.

Handy Tip 2
Mastery of the patterns above will ensure that you start your letter on a positive note.

Sample Introductions
Introduction Analysis
Dear Ms. Attard,  Does not include patient name as this is clearly
stated in the subject line
Re: Ms. Robyn Harwood
DOB: 04/02/1948
 Uses relative clause and appositive sentence
structures which demonstrate ability to use
complex sentences
I am writing to request daily home visits by the Blue
Nurses to provide care and support for this patient, a 61-  States purpose of writing clearly
year-old widow who lives on her own.
Dear Sir/Madam,  Includes shorter for a patient name as full name
stated in the subject line
Re: Mr. Henry O’Keefe
 Uses appositive and relative clause sentence
structure which demonstrates ability to use
I am writing to request aged care assistance for Mr.
complex sentences
O’Keefe, an 83-year-old man who is recovering from a
malignant melanoma in his left shoulder.  States both purpose of writing and chief
complaint

Dear Sir/Madam,  Includes shorter for a patient name as full name

stated in the subject line
Re: Mr. Bill O’ Riley
 Uses appositive and relative clause sentence
structure which demonstrates ability to use
I am writing with regard to Mr. O’Riley, a 53-year-old
complex sentences
man who was admitted the hospital on the 2nd of
September and diagnosed with obstructive coronary  Summarises chief complaint and treatment
artery disease. He underwent a coronary artery bypass
graft on the 4th of September.
Dear Sir/Madam,  Does not include patient name as this is clearly
stated in the subject line
Re: Mrs. Carol Bradley
 Includes relevant biographical detail: age,
marital status, mother
I am writing to request a respite admission for this
patient, a 41-year-old married mother of two who has  Uses relative clause and appositive sentence
been receiving personal care from our organisation over structures which demonstrate ability to use
the last two months. complex sentences
  States purpose of writing clearly and
summarises recent history

Dear Parents:  Purpose of writing stated clearly in the subject

line
Re: Outbreak of headlice
 Informs parents of main problem
I am writing to inform you of a recent outbreak of  Summarises symptoms and treatment briefly
headlice at Mt Gravatt Primary School. Although
headlice spread easily and cause several symptoms of
itchiness and discomfort, they are easy to diagnose and
treat.
Dear Mrs. MacDonald,  Does not include patient name or age as this is
clearly stated in the subject line
Re: Nasser Ali
DOB: 04/02/62
 States purpose of writing clearly and
summarises recent history
I am writing to refer this patient who was admitted to our  Summarises chief complaint and treatment and
Coronary Care Unit ten days ago with the diagnosis of current condition
myocardial infarction. A cardiac artery bypass graft was  Uses relative clause structure which demonstrate
done, followed by post- operative treatment and ability to use complex sentences
physiotherapy. Mr. Ali’s condition has now stabilized
and he is being discharged today.
Dear Dr. Thompson,  Does not include patient name or age as this is
clearly stated in the subject line
Re: Ms. Amber Watson
DOB: 25/03/1991
 States purpose of writing clearly
 Uses relative clause and appositive structures
I am writing to request further testing and contraceptive which demonstrate ability to use complex
advice for this patient, an 18-year-old single woman who sentences
presented to our clinic for a Pap test on 16th May.

Common Errors
Incorrect Correct
Dear Ms. Jones, Dear Ms. Jones,

Re: Mr. Adrian Lamp Re: Mr. Adrian Lamp

DOB: 10/10/1949 DOB: 10/10/1949

I am writing to refer Mr Adrian Lamp to you, an 61-year- I am writing to refer this patient to you, a 61-year-old
old widower. He is due to be discharged today. He has widower who is due to be discharged today after making
made a full recovery from chest congestion. a full recovery from chest congestion.
Explanation: No grammatical errors, but it lacks
sophistication in the use of simple sentences. Also, it
repeats the patient name in full which is not necessary
and repetitive since it was written directly above in the
subject line.
Dear Sir/Madam, Dear Sir/Madam,

Re: Beryl Saunders Re: Beryl Saunders

Thank you for admitting Mrs. Saunders, an 80-year-old Thank you for admitting Mrs. Saunders, an 80-year-old
dementia patient,requires respite care for a period of two dementia patient who requires respite care for a period of
months. two months.
Explanation: Relative pronoun required.
Dear Mrs. Smith, Dear Mrs. Smith,

I am writing in regards of Annette MacNamara , single, I am writing in regards of Annette MacNamara , a single
age pensioner, requesting your assistance when she age pensioner who will require your assistance when she
discharged from this hospital today. discharges from hospital today.
Explanation: Several errors in terms of sentence or
structure and grammar. I am writing to request assistance for Annette
MacNamara , a single age pensioner who is due to be
discharged from this hospital today.
Dear Doctor, Dear Sir/Madam,

Re: Mrs Diana Atherton Re: Mrs Diana Atherton

I am writing to refer Mrs Atherton, an 77 year old woman I am writing to refer Mrs Atherton, a 77-year-old woman
who is a resident at the Sandy Beach Retirement Village, who is a resident at the Sandy Beach Retirement Village.
who needs urgent admission to your hospital due to chest She needs urgent admission to your hospital due to chest
pain. pain.
Explanation: Incorrect sentence structure with two or
relative clauses. I am writing to refer Mrs Atherton, a 77-year-old female
resident at the Sandy Beach Retirement Village who
needs urgent admission to your hospital due to chest pain.
Dear Sir/Madam, Dear Sir/Madam,

Re: Aiden Cooper Re: Aiden Cooper

I am writing to refer Cooper a 12-year-old boy, who is a I am writing to refer Aiden, a 12-year-old boy who is a
year 6 student at Wellers Hill State School. year 6 student at Wellers Hill State School.
Explanation: Two errors 1. Use first name when
referring to a child. Click here for more details. 2.
Incorrect comma placement

Study Strategy
When writing introductions, find a style which you like and use it for all tasks. However, take care to understand the
basic grammar rules and always remember to include the chief complaint, purpose of writing or your main concern.
Practice writing introductions using the sample case notes provided in your course.

Most referral letters will contain 2 or 3 body paragraphs located between the introduction and the conclusion. Each
of the paragraphs should have a main idea which the writer needs to convey to the reader. All the sentences with the
paragraphs must relate to this main idea. The length of the paragraphs will vary, but an approximate guideline to
meet the required word length of 180~200 words in OET is as follows:
  Introduction: 25 words
 Body paragraph 1: 40 words
 Body Paragraph 2: 40 words
 Body Paragraph 3: 70 words
 Conclusion: 25 words

Paragraph Structure
A good paragraph will contain 3 main elements

1. A Topic Sentence which introduces the reader to the main idea of the paragraph. In many cases it will
identify and/or summarise an area of concern regarding the patient. Quite often it is written in original
words rather than from words in the case notes.
2. Supporting sentences which may contain the detail regarding patient history, descriptions of symptoms,
significant aspects from the treatment record, causes and effects, trends and so on. Quite often this
information can be taken directly from the case notes, and written as full sentences. However, you will
need to paraphrase the information into your own words. This includes:
o Changing verbs to nouns: complain=complaint
o Changing adjectives to nouns: lethargic=lethargy
o Using synonyms
o For more details on how to paraphrase, follow this link: Paraphrase
3. Signal words link sentences together so that the information flows smoothly and is easy to read.

Common signal words which can help you present information clearly and logically include:

o Time: At that time, On review today, On consultation today, Recently, Over the past 3 weeks....,
Two weeks later, On her next visit, During, Since that time, Initial examination..., On 19/08/10...
o Location: During hospitalisation, Initial examination at my clinic revealed...,On examination....
o More information: In addition, Moreover, Also, Apart from this..
o Contrast: However, Despite, Although
o Result: Therefore, Consequently, As a result, For this reason...
o Emphasis: Please note, May I remind you, My main concern is...., What concerns me most is.....
o Sympathy: Unfortunately, Regrettably, Fortunately,
o Subject: In terms of her social history..., With regard to her medication....,Based on the blood test
results....., Regarding her medical history....., Her dental history shows..., The risk factors
include....., Treatment to date includes...
o Advice: It is important to..., I recommend that you....., Please ensure that....
o Chronology: Firstly, Secondly, Finally

Example 1
Case Notes Paragraphs Analysis
Diagnosis Ms. Harwood was admitted to our  Topic sentence is introduced with
Right partial rotator cuff tear hospital on the 30th of October the phrase: Ms. Harwood was
Presented to Mater hospital with with a diagnosis of right rotator admitted to our hospital on....
pain and weakness in the right cuff tear following a fall while
shoulder, especially when lifting descending stairs. Therefore,
 Supporting sentences transform
case notes into complete sentences
arm overhead. surgery has been
Descending stairs at home and suggested,however, she prefers  Signal words express cause and
slipped, falling onto outstretched non-surgical treatment. She has effect and express contrast
arm. received ibuprofen and cortisone o Therefore,
Xray and MRI showed a partial as prescribed and also daily visits o However
rotator cuff tear. by a physiotherapist.
Orthopaedic surgeon discussed
surgery. Patient prefers to try non-
surgical treatment.
Date of admission: 30-10-2008
Date of discharge: 01-11-2008

Treatment
Ibuprofen orally QID
Cortisone injections
Daily physiotherapy
Medical History In terms of her medical history,  Topic sentence is introduced with
Diabetes Mellitus Type 2 she suffers from type 2 diabetes the phrase: In terms of medical
Metformin 500mg mane mellitus for which she is taking history,
metformine 500mg. However,
Nursing Care Needs following her discharge, she will
 Supporting sentences transform
case notes into complete sentences
Needs blood glucose level need a regular monitoring on the
monitoring 4 hourly blood glucose level which may  Signal words connect ideas and
May be elevated because of become elevated due to express contrast
cortisone administration of cortisone during o However,
Needs assistance with shower and hospitalisation. She will also o due to
housework require assistance in showering o also
Orthopaedic review on 19th and home help. As well as this, she o As well as this,
November needs to review her condition with
an orthopaedic surgeon on the
19th of November.
Social Background Ms. Harwood lives alone and has  There is no topic sentence, but the
Marital status: Widow. No no children. Her next of kin is her main idea of social history is clear
children. Lives alone niece, Megan Mack who lives in
Next of kin: Megan Mack (Niece) Sydney. Regrettably, she has no
 Supporting sentences expand the
case notes into complete
Niece lives with husband in relatives or friends to support her.
sentences, note the use of verbs,
Sydney who works as software
articles and conjunctions (and)
engineer for Google Australia.
Sister died recently. No other  Signal word shows empathy
relatives. o Regrettably,

Example 2
Case Notes Paragraphs Analysis
Birth History The patient was born via vaginal  The topic sentence is begins with
Normal vaginal birth at term birth at term with a birth weight of the baby's birth.
Birth weight: 3400gm 3400 grams. During a heatwave at
Apgar score at 5min: 9 Christmas, the baby became
 Supporting sentences transform
case notes into complete sentences
No antenatal or postnatal unsettled, due to lack of fluids.
complications When the mother became sick for  Displays understanding of the long
a few days, her mother-in-law case notes by summarising the
Feeding visited to help out but has advised main idea. Explains conflicting
Breast fed for first three weeks her to change to formula feeds and views of mother and mother-in-
after birth. to put more powder in the bottle to law.
improve weight gain. However,  Signal words express a time line,
Baby became unsettled during the mother believes that breast contrast and cause and effect.
heatwave at Christmas. Mother got milk is the best for her baby and o During a heatwave
sick and had a fever for a few would like to breast feed full-time o When...
days. Mother-in-law came to visit but is worried that she doesn’t o However,....
and advised changing baby to have enough breast milk for the
formula feeds. Mother-in-law baby. Therefore, she has been o Therefore,....
advised extra powder in formula giving extra formula feeds to the
feeds to improve weight gain. baby.
Mother-in-law says her son (Ray
Charles) also had feeding problems
and difficulty gaining weight as a
baby.

Mother says she is worried she

does not have enough breast milk
and now gives extra formula feeds
as well as breast feeding. She
wishes she could breast feed
properly as she believes it would
be the best thing for her son. He
hasn’t taken to the bottle.

15/01/10 At the 6 week check-up, the baby’s  Topic sentence is introduced with
weight is 4200 grams and his vital the phrase: At the 6 week check up,
Subjective signs are in normal limits.
Mother and baby attended for However, the baby is suffering
 Focuses on objective information
and final assessment.Omits less
routine 6 week check-up. Mother from mild constipation,
relevant detail.
says she is concerned about dehydration and lethargy.
constipation: once every three  Summarises objective details
days, hard stool. Mother is asking concisely into "vital signs in
about stool softener or prune juice normal limits"
for baby.  Paraphrases adjectives into nouns
i.e lethargic=lethargy
Objective
Reflexes normal
Lethargic
No abdominal tenderness
Heart Rate: 174
Respirations: 56
Temperature: 37.1
Weight: 4200gms
3 wet nappies in last 24 hours.
Urine dark.

Assessment
Mild constipation and dehydration
Plan Could you please support and  Topic sentence is a request of
Increase breast feeds. Refer to advise the mother regarding support
breast feeding support service. breastfeeding and correct
Check formula is correctly preparation of formula feeds if
 Supporting sentences expand case
notes into formal sentences
prepared. If continuing formula required. In addition, advice on
feeds, advise to supplement with how to keep the baby cool in hot  Signal words add cohesion
water (boiled and cooled). Advise weather is necessary. Please note, o In addition,
on keeping baby cool in hot the patient is due for review on o Please note,
weather. Return for review in 48 17/01/2010.
hours.
 

Conclusions
The conclusion or final paragraph in the letter should be fairly standard in structure. It should be based on the task
question which is found at the end of case notes. It may contain one or two of the following points:

 a polite request of action required

 a thank you for ongoing support
 an offer of future assistance if required (this can be useful if you choose to omit some details from the case
notes)

It is useful to be familiar with some standard patterns so that you are able to conclude your letter confidently,
quickly and most importantly, accurately. However, some degree of originality will impress the assessors.
Therefore, where possible try to ensure that your conclusion is related to your task and not simply a memorised
ending.

Important Grammar Rules

Modal Verbs : Some modal verbs & the verb hope are used to convey politeness and commonly used for polite
requests in the conclusion of formal letters. Compare the patterns below.
Informal Polite More polite
 Can you examine and treat  Please examine and treat the  Could you please examine
the patient as you feel patient as you feel and treat the patient as you
appropriate appropriate. feel appropriate
 I will be pleased if you can  Please examine, diagnose  I would be grateful if you
examine, diagnose and treat and treat the patient as you could examine, diagnose and
the patient as you feel feel appropriate. treat the patient as you feel
appropriate.  Please arrange someone to appropriate. (active)
 Can you arrange someone to help this family and provide  I would appreciate it if you
help this family and provide proper medical support. could examine, diagnose and
proper medical support. treat the patient as you feel
appropriate. (active)
 It would be greatly
appreciated if you could
examine, diagnose and treat
the patient as you feel
appropriate. (passive and
most polite)
Explanation: These sentences are Explanation: These sentences are  I hope you can arrange
fine in spoken English, but not acceptable in written English, but can someone to help this family
suitable for formal writing. Can and sound quite direct. and provide proper medical
will are considered less polite than support.
could and would.
Explanation: These sentences are the
 most suitable for concluding requests
in formal letters.

Conditional Sentences: These sentences are also frequently used in the conclusion of a referral letter and the rules
are as follows:
Use a comma when the if clause is at the beginning of Don’t use a comma when the if clause is at the end of
the sentence. the sentence.
 If you could take over her on going care,it  It would be greatly appreciated if you could take
would be greatly appreciated. over her ongoing care.
 If you have any further questions regarding this  Please don’t hesitate to call me if you have any
patient, please don’t hesitate to call me. further questions regarding this patient.

 If you require any more information, please  Please don't hesitate to contact me if you require
don't hesitate to contact me.(active) any more information.(active)
 If any more information is required, please don't  Please don't hesitate to contact me if any more
hesitate to contact me.(passive) information is required.(passive)

 Should you have any further queries, please  Please don't hesitate to contact me should you
don't hesitate to contact me. have any further queries.

Note: Sometimes if is omitted from a conditional

sentence. In full the sentence means:
If you should have any further questions regarding this
patient, please don’t hesitate to call me.

Closer and signature

Leave a space between the last line of the conclusion and the closer. The closer should be followed by a comma.
Then write your signature below the closer, and if you have time, print your name below your signature.

Sample Conclusions
Case Notes Conclusion Analysis
Writing Task In order to maintain a good health  Uses information from the
MrO’Riley has requested advice on condition, Mr. O’Riley has requested writing task to formulate
low fat dietary guidelines and healthy advice on low fat dietary guidelines conclusion
simple recipes. Write a letter to the and healthy simple recipes. It would
Community Information Section of be greatly appreciated if you could
 Contains a polite request
the Heart Foundation, Gregory send the above mentioned  Maintains polite tone
Terrace, Brisbane on the patient's information to Mr. O’Riley at his through the use of modal
behalf. Use the relevant case notes to home address, 9476 Old Dam Road, verbs would and could
explain MrO’Riley’s situation and the Goondiwindi, QLD, 4390.  Contains information
information he needs. Include specific to the task
Medical History, Body Mass Index Yours sincerely,
and lifestyle. Information should be
sent to his home address. Lee Wong Charge Nurse
Writing Task I hope you will be able to arrange  Uses information from the
Using the information in the case someone who can help this family writing task to formulate
notes, write a letter to The Director, and provide proper medical support. conclusion
Community Child Health Service, 15 Please do not hesitate to contact me
Pauline Street, Kuraby, requesting if you require any further information
 Contains a request using the
polite expression: I hope you
follow-up of this family. about this family.
 will be able to..
Yours sincerely,  Contains information
specific to the task
Nurse
 Offers future assistance

Writing Task I would appreciate your assessment  Uses information from the
Write a letter for the admitting doctor and emergency management of this writing task to formulate
of the Medivale Hospital Emergency patient’s condition. conclusion
Department. Give the recent history
of events and also the patient’s past Yours sincerely,
 Maintains polite tone
through the use of modal
medical history and condition.
verb would
Night Nurse
Sandy Beach Retirement Village  Maintains level of urgency
appropriate to the situation

Writing Task It would be greatly appreciated if you  Contains a very polite

Write a referral letter to the Dr Jane could assess the patient's condition request using conditional "if"
Thompson, Medical Practitioner at and treat as you feel appropriate. plus passive form
the North Fitzroy General Practice,
requesting assessment of your patient' Yours sincerely,
 Polite tone through the use of
modal verbs would & could
condition. Give the recent history of
events and also the patient’s past Charge Nurse  Note, sometimes a brief
medical history and condition. conclusion is all that is
required,.... or all that you
will have time for! Although
it is a memorised phrase, it is
grammatically correct,
concise and direct.

Discharge Plan It would be greatly appreciated if you  This is a long conclusion, but
Organise social worker and Meals on could do daily home visits and incorporates discharge plan
Wheels. (niece will visit at weekend provide support and reassurance for into the conclusion which is
to help with housework and shopping) Mrs. Butler. In addition, please an effective strategy
Stitches to be removed and situation organize Meals on Wheels and a
to be reviewed at Out Patient social worker for home help. Please
 Emphasises a future
appointment
Department appointment - 10.30 am note, the patient has an appointment
31-05-09 at the Out Patient Department at  Maintains polite tone
Writing Task 10.30 am 31-05-09 for the removal of through the use of modal
Using the information in the case stitches .Thank you for your ongoing verb would & could
notes, write a letter to the Director, care.  Contains a polite thank you
Blue Nursing Service, 207 Sydney
Street, West End. Yours sincerely,

Charge Nurse

Common Errors
Incorrect Correct
  I would very much appreciated your attention  I would very much appreciate your attention
regarding further management of Mr. regarding further management of Mr.
Henderson. Henderson.(active)
 Your attention regarding further management of
Explanation: Incorrect grammar, see above Mr. Henderson would be very much
appreciated.(passive)

 If you have any query, please do not hesitate to  If you have any queries, please do not hesitate to
contact me. contact me.

Explanation: Use plural form of query

 I will appreciate your further assessment and  I would appreciate your further assessment and
management management.

Explanation: Polite form "would" required

 Kindly investigate this child and do the needful.  I would appreciate it if you could investigate
If you need any more information regarding her this child’s condition and do the necessary
situation, please try to contact me without any management. If you require anymore
hesitation. information, please do not hesitate to contact
me.
Explanation: Several errors here. Basically it is
important that the standard patterns and style conventions
are followed in conclusions.
 Thanks to review and arrange a home visit for  I would appreciate it if you could review and
this patient, if you have any further questions, arrange a home visit for this patient. If you have
please be free to ask me. any further questions, please do not hesitate to
contact me.
Explanation: As above, several errors here. The style is  It would be appreciated if you could review and
casual and therefore an inappropriate way to conclude a arrange a home visit for this patient. Please do
letter not hesitate to contact me if you have any
further questions.

I would be appreciated if you could take over the care of  It would be appreciated if you could take over
this patient. the care of this patient. (passive verb)
Explanation: Incorrect grammar
 I would be appreciative if you could take over
the care of this patient.(be + adjective)
 I would appreciate it if you could take over the
care of this patient. (active verb)


Handy Tip
As with introductions, when writing conclusions, find a style and pattern which you are confident with and
use it. However, take care to understand the basic grammar rules and always remember to respond to the
task question. Practice writing conclusions using the sample case notes provided in your course.
 
Dos & Don’ts
 Below are a list of simple points to remember on the day of your exam.
Do Don’t
Summarise all the information from the Follow a strict chronological order as
case notes into sections such as: your letter may become too long,
treatment given and obvious trends, difficult to read and will not focus on the
medication, medical history. This will be main problem and related factors.
both easier to write and read as well as
avoiding repition
Try to write somewhere between 180 and Write over 220 words as it will effect
200 words for the body of the letter. This your overall result. You being tested on
is the requirement of OET and the your ability to write a clear concise
assessors are quite strict in this area. letter, not a long letter.
Don’t write under 160 words as there
may not be sufficient language to get a B
grade.
Omit information which is not directly Try to put all the information from the
relevant to your task. This is a big trap for case notes into the letter. Your letter
many candidates in that they try to write will be too long and also poorly organised
down all the information from the task and difficult to read
sheet. This does not reflect reality.
Expand on all acronyms. For example OPG Overuse acronyms. You are being tested
should be written as orthopantamogram, on you ability to expand on case notes so
BP as blood pressure and PR as pulse rate make sure you do.
&hx as history
Provide a simple clear summary of the Use too much medical jargon. Remember
condition so that a lay person could it is a test of English not Latin!
understand
Spend time reading the case notes and Start writing without planning your
grouping information which are related letter. You should allow 15 minutes
such as medication, persistant high blood reading case notes and planning the
pressure etcetc letter.

 
Use synonyms so that you can express the Copy directly from the case notes
information from the case notes in without any changes. You are expected
different ways to put the information into your own
words.
Allow 5 minutes at the end of the test to Submit the letter without checking for
proof read your work and fix up any basic mistakes such as grammar/spelling.
mistakes