DR - Marwa OET Notes
DR - Marwa OET Notes
DR - Marwa OET Notes
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.
Note the use of an article before each noun Note the absence of the indefinite articles
in singular form, either as a/an/the a/an before each noun in singular form, but
the definite article
abscess The patient had an abscess on her gum. The patient had 3 abscesses on her gum.
ache The patient reported a dull ache in her The patient suffered from aches and pains.
abdomen.
accountant Mr. Hagen is an accountant. Mr. & Mrs. Hagen are both accountants.
appointment A follow-up appointment was scheduled. The patient did not attend her follow-up
appointments.
check up The patient attended for a check-up. Regular check-ups will keep you healthy.
complaint If you have a complaint, tell your doctor. If you have any complaints, tell your doctor.
condition You have a condition known as tuberculosis. There are 3 conditions which can indicate
the presence of cancer.
deposit A carious deposit was evident on tooth 32. Carious deposits were evident on teeth 32 &
33.
doctor The patient has not seen a doctor for several Three doctors were involved in the
years. treatment of the patient.
episode The patient had an episode of heart flutter. The patient reported 3 episodes of heart
flutter.
gum The gum surrounding tooth 23 was inflamed. The gums were infected.
increase There was an increase in the size of the The patient presented with numerous
swelling. swellings.
investigation An investigation is required to rule out bowel Investigations are required to rule out bowel
cancer. cancer.
limp The patient walked with a limp. All the patients had limps.
lip The patient had a swollen lip. (one lip) The patient had swollen lips. (both lips)
painkiller The patient requested a painkiller. Painkillers are not necessary with this
procedure.
result The patient hoped for a positive result. The results were positive.
review A review was scheduled after 2 weeks. The nurse received positive reviews from her
patients.
sensation The patient reported a tingling sensation in The patient experience tingling sensations in
his fingers. his fingers.
social worker A social worker has been arranged to offer Two social workers have been arranged to
ongoing care. offer ongoing care.
test A blood test was ordered. Blood and urine tests were ordered.
visit Please organise a visit by a social worker. Regular visits by a social 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.
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 was admitted to I am writing to refer Marvin, a 7-year- old boy who was admitted to
hospital on 21/11/16. hospital on 21/11/16.
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 valve for year. Please note, the patient has had a prosthetic heart 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 she has fracture of Apart from bruises to her body, X-rays reveal that she has a fracture
the right ankle. of the right ankle.
Mr Jones had a heart surgery in 2015. Mr Jones had heart surgery in 2015.
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 12/2/16. The patient presented for a regular check-up on 12/2/16.
Indefinite Article: A or An
When you mention something for the first time the indefinite article a/an is required. This signifies to the reader that it
hasn’t been mentioned before.
Definite Article: The
When you mention something for the second and subsequent times that we mention it the definite article the is required
because we are referring a something which has been mentioned before.
Example: Initially, she came to me on 03/07/06 for a blood test. The results of the blood test were negative.
Correct application of this rule creates cohesion in your letter as you are able to connect ideas, as in the example above,
where the reader knows which blood test is being referred. Conversely, incorrect use can confuse the reader.
Example: Initially, she came to me on 03/07/06 for the blood test. The results of a blood test were negative.
In the example above the ideas are not connected and the reader will be confused.
Incorrect Correct
The patient has the family history of diabetes. The patient has a family history of diabetes.
Explanation: If it is the first time to give this information then the
indefinite article is required for countable nouns.
In addition, the pain in the right knee joint has appeared In addition, pain in the right knee joint has appeared over
over the last 2 days. the last 2 days.
Thank you for seeing, Mr and Mrs Conway, who have Thank you for seeing, Mr and Mrs Conway, who have
presented to me for the fertility advice. presented to me for fertility advice.
Explanation: If it is the first time to give this information and the
word is an uncountable noun, such as pain or advice, then no
article is required. Note, this error has a big effect on
meaning: the in this case implies that this subject has been
mentioned previously, which of course it hasn't.
For more details on countable & uncountable nouns click here
Thank you for seeing this patient, an eight year old girl who Thank you for seeing this patient ,an eight year old girl who
presented today with the broken left arm following the presented today with a broken left arm
accident at her school play ground.It has been forty minutes following an accident at her school play ground.It has been
since a accident. forty minutes since the accident.
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 years. She was on Microgynon 30 for the previous 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 nursing home for Mr. Roberts has been a resident at our nursing home
past 2 years. for the past 2 years.
This medication needs to be taken twice a day for next 3 This medication needs to be taken twice a day forthe next 3
days. 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 medication: karvea MrsSangean is currently on the following medication:
150mg daily, oroxinen 0.1 daily. karvea 150mg daily, oroxinen 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.
Based on above information, I believe the patient needs Based on the above information, I believe the patient needs
urgent admission to hospital. 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 presented at my Thank you for seeing this patient who presented at my
surgery regarding tooth 54 which has been temporary filled surgery regarding tooth 54 which has been temporary filled
by school dental service. by the 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.
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
Names of Diseases
Incorrect Correct
The patient is suffering from the high blood pressure. The patient is suffering from high blood pressure.
Recently, the patient has complained of the headache. Recently, the patient has complained of headache.
The patient was diagnosed with the arthritis. The patient was diagnosed with arthritis.
The patient has had the influenza for three days. The patient has had influenza for three days.
Same
Incorrect Correct
She has a family history of same disease that had She has a family history of the same disease that
been controlled by Risperidone. had been controlled by Risperidone.
The children were treated by same dentist. The children were treated by the same dentist.
The medication is same as last time. The medication is the same as last time.
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 the On review today, Mr Walker has reduced smoking
smoking from 20 to 10 cigarettes per day. from 20 to 10 cigarettes per day.
The patient was advised to stop the drinking. The patient was advised to stop drinking.
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
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
Job titles
The Lactation Consultant, Mater Hospital
The Veterinary Eye Specialist, University of Queensland
Institutions
Mary Jones was admitted to Spirit Hospital.
Dr. Bloomfield works at Weller Point Medical Centre.
Places including addresses
168 Wickham Terrace, Spring Hill
12 Logan Road, Mt Gravatt
36 Barmore Street, Holland Park
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.
Common Errors
Incorrect Correct
His medical history shows that he is Epileptic. His medical history shows that he is epileptic.
Also, I have given Dycal base on 1.1 and dressed it with Also, I have given dycal base on 1.1 and dressed it
Glass Ionomer Cement. with glass ionomer cement.
The patient was diagnosed with Type 2 Diabetes. The patient was diagnosed with type 2 diabetes.
Mrs. Marsh has a history of Hyperthyroidism, Hypertension Mrs. Marsh has a history
and Glaucoma. of hyperthyroidism,hypertension and glaucoma.
The patient is allergic to Penicillin. The patient is allergic to penicillin.
The patient suffered from severe Abdominal pain. The patient suffered from severe abdominal pain.
Refer to rule 1 above.
Mr. duane thomson presented at my clinic today with the Mr. Duane Thomson presented at my clinic today with the
complaint of a broken posterior tooth. complaint of a broken posterior tooth.
The director of nursing The Director of Nursing
emergency department Emergency Department
Mater hospital Mater Hospital
84 Monash road 84 Monash Road
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 are doing daily As per the general practitioner’s order, we are doing daily
home visits and wound dressing and also assisting him with home visits and wound dressing and also assisting him with
his showers. his 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 march, 2008. The patient first visited my surgery in March, 2008.
Mrs. Green will be discharged from hospital on wednesday. Mrs. Green will be discharged from hospital onWednesday.
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 antibiotics for the The patient requested that I prescribe antibiotics for the
virus. virus.
Refer to rule 5 above.
Present perfect is often combined with for/since/over. Compare the usage below and note time markers used.
Handy Tip
When using time markers such as ...for the past 20 years, ...for the 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 2012 2012. (present perfect)
Explanation: Past tense cannot be used with for or The patient was diagnosed with
since hypothyroidism in 2012. (simple past)
He is smoking 2 packs of cigarettes a day for He has been smoking two packs of cigarettes a day for
the past 25 – 30 years. the past 25-30 years. (present perfect progressive)
Over the past week she remains free from Over the past week she has remained free from severe
severe pain and has been able to tolerate a pain and has been able to tolerate a fluid diet.
fluid diet. (present perfect simple)
Also, there is an ulcer on the right lower There is also an ulcer on the right lower lateral border
lateral border of the tongue which is present of the tongue, which has been present for more than
for more than one year. one year.(present perfect)
Mr. Diamond is a patient of mine since 2005 Mr Diamond has been a patient of mine since
Mr. Eddy is a known smoker for 25-30 years. 2005.(present perfect simple)
Explanation: The verbs in these sentences are in Mr. Eddy has been a smoker for 25 years. (present
simple present tense. Present perfect needs to be perfect simple)
used because you are
There is often confusion of whether to use simple past or present perfect tense. The basic rule to remember is if you are
referring a particular time in the past then you must use simple past tense. If you are referring to a period of time that
starts in the past and continues up to now use present perfect tense.
There are some common time markers used with simple past and present perfect. It is important to study, learn and use
these tenses correctly when writing referral letters as you must refer to both past events and periods of time leading to
the present.
Time Markers with Simple Past Time markers with Present Perfect
Common Errors
Incorrect Correct
She has underwent triple coronary bypass surgery She underwent triple coronary bypass surgery on
on 10/08/15 10/08/15
Active and Passive Verb Formation
When writing a referral letter, it is necessary to use a variety of verb forms including both active and
passive verbs. Using active verbs is good when you wish to create a personal tone or impart subjective
information. However, passive verbs and sentence structures enable the writer to be more objective and
focus attention on what is most important in a sentence such as the patient, procedures and treatment
rather than on health professional.
Compare
1. I advised her to do bed exercises to prevent further complications such as deep vein thrombosis.
2. Bed exercises were advised to prevent further complications such as deep vein thrombosis.(focus on
the treatment)
1. You need to take Flucloxacillin capsules twice a day for a duration of 2 weeks.
2. Flucloxacillin capsules need to be taken twice a day for a duration of 2 weeks.(focus on the
medication)
To form the passive, use the be verb (be, is/ are; was/were; has been/have been) + past participle as
described in the table below.
Active Passive
The patient was taking aspirin daily. Aspirin was being taken daily.
Present perfect
Present perfect
Aspirin has been taken daily for a period of one
The patient has taken aspirin daily for a period of year.
one year. Aspirin, noten and normison have been taken for
The patient has taken aspirin, noten and normison a period of one year.
for a period of one year.
The patient had taken aspirin daily for a period of Aspirin had been taken daily for a period of one
one year. year.
Aspirin, noten and normison had been taken for
The patient had taken aspirin, noten and normison a period of one year.
for a period of one year.
Future Future
The patient will take aspirin in the evening Aspirin will be taken in the evening.
The patient should have taken aspirin in the evening. Aspirin should have been taken in the evening.
Incorrect Correct
She had done colonoscopy 3 years ago. A colonoscopy was done 3 years ago.
This sentence indicates the patient did the She had a colonoscopy done 3 years ago.
procedure! In these sentences it is unimportant who performed the colonoscopy
so passive voice is used.
Initially, she came to me on Initially, she came to me on 14/01/2006 for a general check
14/01/2012 for a general check up and up and her blood pressure was found to be 160/90.
was found her blood pressure 160/90. After the conjunction "and" a subject is required.
Noten 50mg 1/2 tablet daily prescribed Noten 50mg 1/2 tablet daily was prescribed while Zocor and
while Zocor and Calcium Caltrate Calcium Caltrate were continued.
Add the "be verb"
continued.
Today at my surgery attended Mr. Today, Mr. Attard attended my clinic complaining of pain in
Attard complaining of pain in his upper his upper left molar.
left molar. Use active form here as you need to focus on your patient, not your
surgery
Past Perfect
Past Perfect is an important tense in referral letters. The main functions of this tense are:
When used with simple past it allows the writer to distinguish the order of events:
She had not been able to conceive over the previous four months and as a result she was
suffering from depression. This means: first she could not conceive, then she became
depressed.
When used in reported speech. The case notes may describe the patient's condition at a time in the
past, i.epatient found blood in toilet bowl 2 times. This can be written in the referral letter as
follows:
At today’s consultation, Ms. Leon reported that there had been blood in the toilet bowl on 2
occasions.
So the main benefit of using past perfect is that it allows the writer to express the order in which certain
health events occurred logically and clearly.
Handy Hint 1
Do not use past perfect when describing one past event as it is not necessary.
Compare
The patient had been feeling unwell last week.(incorrect if 1 past event described)
The patient was feeling unwell last week. (correct)
The patient had been feeling unwell last week and was admitted to hospital for observation. (correct
as 2 past events need to be distinguished)
Handy Hint 2
Past perfect is often used with the word previous instead of ago to demonstrate that you are referring to a
time before a particular date in the past, not the date you are writing the letter. See below for examples.
Incorrect Correct
She presented to me yesterday evening with abdominal She presented to me yesterday evening
pain, mostly on the left iliac fossa, and was since 24 with abdominal pain, mostly on the left
hours. iliac fossa, which had been occurring for
the previous 24 hours.
Note that in the correct version 3 different times
need to be considered
Subject-Verb Agreement
Subject verb agreement is an area where accuracy is important. Below are some important rules which you
should remember.
Common Errors
Incorrect Correct
Alison’s school medical record reveals that her Alison’s school medical record reveals that her
attendance have been declining in recent past. attendance hasbeen declining in recent past.
I am writing to refer this patient who I suspect I am writing to refer this patient who I suspect is
is suffering from rheumatic fever and need suffering from rheumatic fever and needs urgent
urgent admission. admission.
I believe that the teeth 65 and 54 needs to be I believe that the teeth 65 and 54 need to be
extracted followed by space maintainer. extracted followed by space maintainer.
Example Words
Casual Formal Casual Formal Casual Formal Casual Formal Casual Formal Casual Formal
asks requests think believe get become so very but however kids children
for
say state get receive got became about regarding really greatly sad depressed
said stated got received So Therefore a bit slightly kid child till until
like include like such as don't do not Thanks Thank- kids children lots a lot of
you
Example Sentences
She refuses to eat solids and prefers fluids only She refuses to eat solids and prefers fluids such
like apple juice and lemonade. as apple juice and lemonade.
There are several measures which can be taken There are several measures which can be taken
to reduce the risk of infection like taking a to reduce the risk of infection including taking a
shower in morning, using separate towel for shower in morning, using separate towel for
everyone, changing underwear and bed sheets everyone, changing underwear and bed sheets
regularly, vacuuming carpets, keeping the nails regularly, vacuuming carpets, keeping the nails
short and washing hand thoroughly. short and washing hand thoroughly.
She was given general advise for softening her She was given her general advise for softening
stool, like changing her dietary habit but she her stool such as changing her dietary habit but
was non compliant. she was non compliant.
Thanks for seeing Mr. Brown. Thank you for seeing Mr. Brown.
Thanks for arranging a home visit for this Thank you for arranging a home visit for this
patient. If you have any further questions, patient. If you have any further questions,
please feel free to ask me. please be free to ask me.
In view of the above signs and symptoms I In view of the above signs and symptoms
think she is suffering from schizophrenia. I believeshe is suffering from schizophrenia
The patient's family is thinking about a The patient's family is considering a reduction
reduction in her medication. in her medication.
About his dietary habits, he eats a large amount Regarding his dietary habits, he eats a large
of oily and sweet food. amount of oily and sweet food.
If you require any other information about her If you require any other
condition, please do not hesitate to contact me. information regarding her condition, please do
not hesitate to contact me.
Explanation: About is a casual expression, regarding is
more suitable. Lots of is also casual. “A large amount
of” is more formal.
There was nothing significant in his social There were no significant findings in his social
history. history.
Explanation: Nothing is more commonly a spoken
expression which is not suitable for writing.
Please do not hesitate to contact me if u need Please do not hesitate to contact me if you need
additional information. additional information.
She has got maternal postpartum haemorrhage She has had maternal postpartum haemorrhage
of 800mls. of 800ml.
Mr O’ Riley got an appointment for a follow up Mr O’ Riley has an appointment for a follow up
visit with his general practitioner, Dr. Avril visit with his general practitioner, Dr. Avril
Jensen. Jensen.
The mother got sick for a few days. The mother became sick for a few days
Should you have any concerns regarding them, Should you have any concerns regarding Mary
please do not hesitate to contact me. and her child, please do not hesitate to contact
Explanation: The pronoun them sounds casual here. It me.
is much better to use the patient’s name, especially in
the final sentence of the letter.
At the moment, she is weak and disorientated At the moment, she is weak and disorientated at
sometimes but severe pain has been alleviated. times but severe pain has been alleviated.
Explanation: Sometimes is a casual expression. More
formal expressions include: at times or on occasions At the moment, she is weak and
disorientated on occasions but severe pain has
been alleviated.
This pain was exaggerated to cold and hot This pain was exaggerated to hot and
things coldstimuli.
Explanation: Things is a casual expression and should
be avoided
A repeat vaginal examination revealed a very A repeat vaginal examination revealed a very
tender right vaginal fornix. But her blood tender right vaginal fornix. However, her blood
pressure pulse is within normal range. pressure pulse is within normal range.
Explanation: It is not good English to begin a sentence
with the conjunction but In this case use However, as
it is more formal
Her temperature and blood pressure were Her temperature and blood pressure were
normal while pulse was elevated at 88. So I normal while pulse was elevated at
recommended that she return today for a blood 88. Therefore, I recommended that she return
test and reassessment. today for a blood test and reassessment.
Explanation: So is a casual word, you can use it
within a sentence, but not to start a sentence in
formal writing. Replace with: Therefore,
There was evidence of poor oral hygiene, There was evidence of poor oral hygiene,
carious lesions and active periodontal disease carious lesions and active periodontal disease as
too. well.
Explanation: too is informal, a more more formal
expression is as well.
Her husband was upset because, she was not Her husband was upset because, she was not
showing interest towards the kids. showing interest towards the children.
Mark's dad also suffers from this condition. Mark's father also suffers from this condition.
The teacher spoke to her mum regarding the The teacher spoke to her mother regarding the
regular absences from school. regular absences from school.
She had had termination of pregnancy 10 She had had termination of pregnancy 10
yearsback. yearsago.
He is a regular smoker and drinker with the only He is a regular smoker and drinker with the only
relevant past history of left inguinal hernia relevant past history of left inguinal hernia
operation 2 years back. operation 2 years previously.
He had a habit of thumb sucking till the age of He had a habit of thumb sucking until the age of
5. 5.
Explanation: Till is casual, until is formal
I am writing to request a follow-up for this I am writing to request a follow-up visit for this
patient. patient.
Examination revealed that his vitals were stable Examination revealed that his vital signs were
and left knee was swollen without effusion. stable and left knee was swollen without
Examination revealed normal vitals. effusion.
Examination revealed that his vital signs were
Explanation: Vitals and follow up are incomplete normal.
expressions, commonly used in spoken English, but
not suitable for formal writing.
Mrs. Jones is a widow who complained of Mrs. Jones is a widow who complained of
persistent chest pain at roughly 1.45pm. persistent chest pain at approximately 1.45pm.
Miss Roberts started smoking around 6 months Miss Roberts started smoking approximately 6
ago. months ago.
Roughly and around are casual or vague expressions.
I recommend some investigations to rule out I recommend further investigations to rule out
cancer. cancer.
I requested some blood tests. I requested additional blood tests.
Explanation: Some is vague and does not sound
professional.
Her BMI was 28 and all the rest of the Her BMI was 28 and the remainder of the
examinations were normal. examinations were normal.
Explanation: all the rest of sounds informal.
Abdominal examination revealed a small right Abdominal examination revealed a small right
groin swelling that’s consistent with inguinal groin swelling that is consistent with inguinal
hernia. hernia.
Thank you for your expert care and please don't Thank you for your expert care and please do
hesitate to contact us if you require further nothesitate to contact us if you require further
information. information.
In addition, she is just able to tolerate fluids. In addition, she is only able to tolerate fluids.
Medical Terminology
The medical case notes for the OET exam often contain abbreviations, medical acronyms and technical
language. The task for the writer is to expand these into full words and sentences. There are 3 reasons why
this is important.
1. As the OET is a test of English, you need to demonstrate your ability to transfer technical language in
the case notes into standard English.
2. For some letters you are may have to write to someone who is not a health professional such as a
social worker or family member.
3. A referral letter is not a report so the standard conventions of letter writing require a formal style
which includes using complete words and sentences.
Handy Hint: It is a test of English not Latin, so where possible avoid the use of Latin based acronyms
and words.
L left + positive
Exceptions to this rule include abbreviations of measurement. Therefore it is acceptable to use the
following in short form:
cm centimeter ml millilitre
g gram mg milligram
Common Errors
Incorrect Correct
Her current medications include sid Metformin Her current medications include a daily dose of
500 mg. mane and nocte, Glycosamine 5mg.mane Metformin 500 mg. in the morning and at night,
and Candesartan 10mg. nocte. Glycosamine 5mg.in the morning and Candesartan
10mg. at night.
After discharge from hospital, Mrs.Jones has been After discharge from hospital, Mrs.Jones has been
told to take Aperients (PRN) and Aldomet (250 mg told to take Aperients when required and
bid). Aldomettwice a day.
I treated Claudia with prednisolone5mg 1t/sid for I treated Claudia with prednisolone 5mg tablet
seven days. once a day for seven days.
On examination, there was tenderness and rebound On examination, there was tenderness and rebound
tenderness over the R. iliac fossa. tenderness over the right
iliac fossa.
I am writing to refer Mrs. Wilson, a 45yr old I am writing to refer Mrs. Wilson, a 45-year-old
woman who is suffering from signs and symptoms woman who is suffering from signs and symptoms
suggestive of advanced English. suggestive of advanced English.
She presented to me yesterday evening with She presented to me yesterday evening with
abdominal pain mostly in the left iliac fossa which abdominal pain mostly in the left iliac fossa which
had been present for the last 24 hrs. had been present for the last 24 hours.
On examination she was found to have PR 88/min On examination she was found to have a pulse rate
of 88 beats per minute.
On examination she was found to have a pulse of
88.
Mr Duane Eddy 57/m is an a urgent referral Mr Duane Eddy, a 57 year old male is an a urgent
regarding an ulcer in R. lateral border of tongue. referral regarding an ulcer in the right lateral
border of tongue
I would appreciate if you could inform me about I would appreciate if you could inform me about
her treatment & progress over the next few days. her treatment and progress over the next few days.
The patient was discharged on Dec. 30 2009. The patient was discharged on December 30 2009.
The patient was discharged on 30/12/09.
Lab work and review was planned for the next Laboratory work and review was planned for the
morning. next morning.
Referring to a Patient
There are certain conventions which need to be followed when referring to a patient in a formal letter. This
worksheet will explain what you need to know so that you can conform to these conventions.
Handy Tip 1: Definitely do not use titles with first names only, i.eMr Thomas or Mrs. Carol as this is not
acceptable. See below for correct usage.
These titles can be used in the following ways
I am writing to refer Mr. Thomas Hacker (very formal, usually used above the address or after Re: but
not on the body of the letter.)
I am writing to refer this patient (commonly used in the opening sentence if patient's name has been
mentioned above as in Re: Mr. Thomas Hacker)
Question: When and how often should I use the patient's name in the letter?
Answer: The standard way is to write the patient's name in full below the opening saluation. Then, use the
patient's name once per paragraph as illustrated below ,after which you can use pronouns. It is also
important to be consistent with how you refer to the patient. Do not mix up your use of first names and
surnames in the letter as this will only confuse the reader.
Handy Tip 2: There is no need to write the patient's name out in full in the introduction if you have
stated it below the salutation i.e Re: Mrs. Carol Brady as it is very clear who you are writing about. In such
cases use "this patient" or title and surname "Mrs. Brady". If you do this you will be following standard
conventions.
Example Letter
31 July 2016
The Director
Redeemer Palliative Care Hospital
32 Nelson Drive
St Lucia
Queensland, 4050
Dear Sir/Madam,
I am writing to request palliative respite admission for this patient, a 42-year-old woman who has recently
been diagnosed with terminal cancer.
Mrs. Brady was admitted to Spirit Hospital on 20/10/16 due to severe stomach pain. During hospitalisation,
a laparoscopy was performed and she was diagnosed with stage 4 ovarian cancer on 22/10/16.
Unfortunately, the cancer has metastasized to her liver and left lung with a limited life expectancy. She has
also been experiencing increased pain for which she takes Oxycontin and Panadol as required. She is feeling
depressed and has not been eating well. Chemotherapy was offered but she refused the treatment and
wished to return home to her family.
Mrs. Brady lives with her husband and has two children aged 10 and 12. Mr. Brady has reduced his work
hours in order to care for his wife and the children who can be difficult to manage. Mr. Brady is finding it
difficult to cope emotionally and feels isolated with limited family support. Due to the difficulty of the
current situation, he has agreed to palliative respire admission for his wife.
It would be greatly appreciated if you could accept Mrs. Brady into your care and provide a complete
reassessment ofher pain medication to ensure maximum effectiveness.
Yours sincerely,
Community Nurse
Common Mistakes
Thank you for seeing my patient, Master Alfie Thank you for seeing my patient, Alfie, a 7-year-
Langer, a 7 year old boy. old boy.
Explanation: Master is somewhat old fashioned and
does not sound "familiar" if used in the body of the
letter.
Mr. Peter, a 23 year old young man, presented at Mr Holmes, a 23-year-old young man, presented at
my surgery today complaining of painful wisdom my surgery today complaining of painful wisdom
teeth. teeth.
Explanation: You can not use titles with first names
only.
I am writing to refer Miss. Green for surgical I am writing to refer Miss Green for surgical
assessment. assessment.
Explanation: Miss is not an abbreviation so no
punctuation required.
One of the criteria used to assess your writing in the OET exam is Control of Presentation Features. This
criterion assesses the overall presentation of the letter and includes a lot of the features outside the body
of the letter including
Letter format
Punctuation
Capital letters
Spelling
This worksheet will describe the characteristics of formal medical correspondence. To do this, the letter has
been broken up into 6 parts.
1. Date: The date should be placed at either the top left or top right of the letter and can be either written
in full or as numbers as follows:
21/07/16
July 21, 2016
21st July, 2016
2. Address: The address gives the name and address of the person or facility to whom you are writing.
There are some basic conventions which need to be followed including:
Capital letters for job titles, names & street names
3.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.
If the name of person is not mentioned and they are a non-medical person, then you can begin
with Sir/Madam as used in business correspondence or if they are a medical professional you can use their
job title Doctor/Nurse/Dentist etc
Dear Sir/Madam,
Dear Doctor
Dear Nurse
4.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.
5.Body: The information in the body of the letter should be divided into paragraphs, with the standard
format for a referral letter being as follows:
Introduction which includes background information & purpose of writing or chief complaint in
summary form.
6.Closer: The closer is the final part of the letter and should be written one space below the last line of the
body. Only the first word in the closer should be capitalised and a comma should following the last word.
Yours sincerely,(standard)
Sincerely yours,
Sincerely,
Yours truly, (American style, but gaining popularity in Australia)
Note: Yours faithfully, is often recommended as a closer when you don't know the name of the person to
whom you are writing. However, in formal medical correspondence it is not advised as it puts you in a
subservient position.
Thank you for taking over the care of Peter, a 16-year-old student who has a
history of cystic fibrosis (CF).
Peter was diagnosed with CF when he was born and he needs frequent admissions due
to recurrent lung infections. He lives with his parents and an elder brother.
Peter currently takes Pancrease, omeprazole and oral hypoglycaemics. His self-
management program includes active cycle breathing (ACB), positive expiratory
pressure (PEP), flutter and posture drainage (PD). Peter’s fitness is maintained
by biking to school.
Peter’s condition has improved and he started gym sessions today. I have arranged
for an appointment with Peter to check the effect of car fumes when he is biking.
I will consider a mask to keep his airway moisturised if the car fumes impact on
his breathing.
Peter will be discharged in 3 days from the medical ward and will require on
going care.
Yours sincerely,
Tania Robinson
Physiotherapist
Common Errors
Incorrect Correct
Explanation:
1. To not required.
Re: Julie Crosby, 25 yr receptionist, single Re: Julie Crosby, 25 years of age
Explanation: Too much information. Best practice is too Re: Julie Crosby, D.O.B 21/07/90
include name and age of patient only. Other information
such as gender, profession, marital status and so forth can
be included in the opening sentence.
Rules of Usage
1. The Adverbial Phrase: The adverbial phrase can be used in referral letters to provide information such
as a time, place, context, emphasis or mood in the sentence which is to follow and it is commonly separated
by a comma
Contrast: The patient's condition has improved. However, a follow up visit is required.
Sentence Structure
Comma preferred Regarding her she has been suffering asthma for which
medical history, from she uses a ventolin
inhaler.
Handy Hint: Do not put a comma between a subject and a verb or a verb and an object.
2. Appositives: This is a noun or a noun phrase that is placed after another noun to explain or identify it. It
has a very important use in the introductory sentence of referral letters as follows.
Mr Smith, an 80 year old widow, was admitted to hospital with complaints of heart
palpitations.
Thank you for seeing Jordan, a 10 year old boy who presented at my clinic today with a main
concern of pain in tooth 54.
I am writing to refer Mrs. Bradley, a 42 year old married woman who is suffering from cancer.
3. Conditional Sentences: These sentences are frequently used in the conclusion of a referral letter and
the rules are as follows:
If you have any further questions regarding this patient, please don’t hesitate to call
me.
Don’t use a comma if the dependent clause is at the end of the sentence.
Please consult your doctor in case of irritation, redness or swelling.
I will forward the results to you when they become available.
The patient was admitted to hospital because of her deteriorating condition.
5. Comma Splices: A comma splice is two sentences joined together with a comma, but no conjunction.
This is an error as the information must be either joined with a coordinating conjunction such
as and/but/or or a new sentence must be started.
He does not have any dental experience, he is worried about the pain.(incorrect)
He does not have any dental experience and he is worried about the pain.(correct)
He does not have any dental experience. Therefore, he is worried about the pain.(correct)
6. Noun Clauses beginning with that should not be separated by a comma.
It is also important to know, that a re-check is organised for the 31.5.2009 at 10:30 in order to
remove the suture. (incorrect)
It is also important to know that a re-check is organised for the 31.5.2009 at 10:30 in order to
remove the suture.(correct)
7. Use commas to separate three or more words, phrases, or clauses written in a series.The final word
does not require a comma and it should be separated by a conjunction such as and or or
Mrs. Olsen has a history of hypertension, hypothyroidism, glaucoma for which she is on regular
medication. (incorrect)
Mrs. Olsen has a history of hypertension, hypothyroidism and glaucoma which is on regular
medication. (correct)
Common Errors
Incorrect Correct
1. On review today Mr Walker has reduced 1. On review today, Mr Walker has reduced
smoking from 20 to 10 cigarettes per day. smoking from 20 to 10 cigarettes per day.
2. On examination today there was a soft 2. On examination today, there was a soft
fluctuant swelling palpable on the left cheek fluctuant swelling palpable on the left cheek
3. Regrettably she has problems with breast 3. Regrettably, she has problems with breast
feeding and caring for the baby. feeding and caring for the baby.
4. Please note he has a prosthetic heart valve. 4. Please note, he has a prosthetic heart valve.
Comma preferred for adverbial phrases. Refer to
rule 1 above.
1. I am writing to refer Mr. Jones a 57 year old 1. I am writing to refer Mr. Jones, a 57 year old
man who was admitted to hospital on the man who was admitted to hospital on the
18th of July, diagnosed with myasthenia 18th of July, diagnosed with myasthenia
gravis. gravis.
2. Mr Jones, a 57 year old man was admitted to 2. Mr Jones, a 57 year old man, was admitted to
hospital on the 18th of July, diagnosed with hospital on the 18th of July, diagnosed with
myasthenia gravis. myasthenia gravis.
Comma required for appositives. Refer to rule 2
above.
Please note that, Daniel has an allergy to Please note that Daniel has an allergy to
peanuts. peanuts.
Apply the comma rule for comma splices. Refer to
rule 5 above.
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
Job titles
The Lactation Consultant, Mater Hospital
The Veterinary Eye Specialist, University of Queensland
Institutions
Mary Jones was admitted to Spirit Hospital.
Dr. Bloomfield works at Weller Point Medical Centre.
Places including addresses
168 Wickham Terrace, Spring Hill
12 Logan Road, Mt Gravatt
36 Barmore Street, Holland Park
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.
His medical history shows that he is Epileptic. His medical history shows that he is epileptic.
Also, I have given Dycal base on 1.1 and dressed it with Also, I have given dycal base on 1.1 and dressed it
Glass Ionomer Cement. with glass ionomer cement.
The patient was diagnosed with Type 2 Diabetes. The patient was diagnosed with type 2 diabetes.
Mrs. Marsh has a history of Hyperthyroidism, Hypertension Mrs. Marsh has a history
and Glaucoma. of hyperthyroidism,hypertension and glaucoma.
The patient is allergic to Penicillin. The patient is allergic to penicillin.
The patient suffered from severe Abdominal pain. The patient suffered from severe abdominal pain.
Refer to rule 1 above.
Mr. duanethomson presented at my clinic today with the Mr. Duane Thomson presented at my clinic today with the
complaint of a broken posterior tooth. complaint of a broken posterior tooth.
The director of nursing The Director of Nursing
emergency department Emergency Department
Mater hospital Mater Hospital
84 Monash road 84 Monash Road
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 are doing daily As per the general practitioner’s order, we are doing daily
home visits and wound dressing and also assisting him with home visits and wound dressing and also assisting him with
his showers. his 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 march, 2008. The patient first visited my surgery in March, 2008.
Mrs. Green will be discharged from hospital on wednesday. Mrs. Green will be discharged from hospital onWednesday.
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 antibiotics for the The patient requested that I prescribe antibiotics for the
virus. virus.
Refer to rule 5 above.
1. Today’s examination revealed multiple missing 1. Today’s examination revealed multiple missing
teeth, various carious lesions and a periodontal teeth, various carious lesions and a periodontal
pocket of depth 4-9mm. pocket depth of 4-9mm.
2. There are several periodental pockets with about 4- 2. There are several periodontal pockets which are
9 mm in depth. about 4’9 mm in depth or
Correct word order is: 3. There are several periodontal pockets with a depth
Depth of 4-9mm of about 4-9 mm.
Height of 173cm 4. His height is 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.
Submission status
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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
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 her blood pressure The patient complains of chest pain and her blood pressure
is high. is high.(verb)
The patient presented with a complain of chest pain. The patient presented with a complaint of chest pain.(noun)
The patient presented with complaint of chest pain. The patient presented with a complaint of chest pain.
He presented to my office on 23/03/2008 complaining on (article required)
severe pain associated with the lower left first molar. He presented to my office on 23/03/2008
complaining of severe pain associated with the lower left
first molar.
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 required further I advised him to see you next week
blood test and assessment. I suggested (that) she return in morning as she required
I recommended him to rest for 3 days. further blood test and assessment.
Explanation:The words suggest & recommend cannot be followed I advised her to return in morning as she required further
by an object pronoun such as him/her whereas advise can. blood test and 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 conception was not I explained to them that unsuccessful conception was not
unusual in their case. unusual in their case.
I have already explained the couple the basic advice I told them that unsuccessful conception was not unusual in
regarding conception. their case.
Explanation: The word explain cannot be followed by a pronoun or I have already explained to the couple basic advice
noun without the preposition to whereas tell can. regarding conception.
I have already told the couple basic advice regarding
conception.
Advise Vs Advice
Advise is a verb
It would be greatly appreciated if you could make It would be greatly appreciated if you could make a
a visit to this family and advice his parents visit to this family and advise his parents regarding
regarding the recommended vaccines for both the recommended vaccines for both children. (verb)
children. I am writing to refer this patient to you
I am writing to refer this patient to you for an advice for adviceregarding the management of his bilateral
regarding the management of his bilateral inguinal inguinal hernia(noun)
hernia. I gave some advice to the patient regarding her
I gave an advice to the patient regarding her medication. medication.(noun)
I gave advices to the patient regarding her medication. I gave advice to the patient regarding her medication.(noun)
Please advice the patient on how and when to take their Please advise the patient on how and when to take their
medication. medication. (verb)
Request
Request can be both a verb and noun.
Request as a verb
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 Ms. Green requested IVF treatment.(verb)
preposition which incorrect. Ms.Green made a request for IVF treatment. (noun)
Affect Vs Effect
Affect is a verb
Incorrect Correct
She has also been effected by glaucoma for the past 4 She has also been affected by glaucoma for the past 4 years.
years. (verb)
The side affects of this medication are unknown. The side effects of this medication are 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-year-old widowed I am writing to refer Mrs. Saunders, a 58-year-
who admitted with pain, dehydration and nausea. oldwidow who admitted with pain, dehydration and
I am writing to refer Mr. Saunders, a 60-year-old widow nausea.(noun)
who complained of pain in his upper right second molar. I am writing to refer this patient a 58-year-oldwidowed
woman who admitted with 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 palpitation of 3 day Mrs. McGowan has a history of heart palpitation of 3 day
duration. duration.
Allergy Vs Allergic
Allergy is a countable noun
In addition, he is known allergic to nuts for which he was In addition, he has a known allergy to nuts for which he
admitted to hospital with anaphylaxis 2 years ago. was admitted to hospital with anaphylaxis 2 years
Regarding his medical history he is allergy to sulphur ago.(noun)
containing drugs. In addition, he is known to be allergic to 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 has not confident social situations. The patient has no confidence in social situations. (noun
The patient is not confidence in social situations. form)
The patient is not confident in social situations. (adjective
form)
Incorrect Correct
The patient has reduced speech output and a little eye The patient has reduced speech output and littleeye
contact. contact.(negative connotation required here)
There are few ways to help identify the possibility of There are a few ways to help identify the possibility of
threadworms such as checking the anus of your children at threadworms such as checking the anus of your children at
night and frequent scratching. night and frequent scratching.(positive connotation
required)
during/while
During is followed by a noun
He twisted his ankle during playing squash 3 months ago. He twisted his ankle during a game of 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 by a collapse at She was admitted to our hospital following a collapse at
home with dehydration,nausea and severe pain. home with dehydration, nausea and severe pain.
Incorrect as it means the patient was admitted to hospital first, then Correct as it means the collapse occurred before being admitted to
collapsed. hospital.
Years Vs Year
Incorrect Correct
I am writing to refer this patient,63 years old man who lives 1. I am writing to refer this patient, a 63- year- old
alone. man, who lives alone.
In this sentence there are two mistakes: 2. There are two 63-year-old men in the waiting room.
1. the expression is a phrase and therefore requires an
article “a “ to precede the phrase a 63-year-old
man. An article is required because the noun man is
singular. Compare with: There are two 63-year-old
men in the waiting room.
2. Years is an adjective in this sentence (it describes
the age of the man) and adjectives are uncountable.
This patient is 63 year old. This patient is 63 years old.
In this sentence the word years is a noun preceding an
adjective old. Nouns can be countable so in this case you
must make it plural.
Her father died at 50 year old of bowel cancer 1. Her father died at 50 years of age of bowel cancer
In this case at is a preposition and needs to be followed by 2. Her father died at the age of 50 of bowel cancer
a noun or noun phrase, rather than the adjective” old”. See 3. Her father died when he was 50 years old of bowel
column on the right for possible correct choices. Year is a cancer.
noun in this case so it should be written in plural form.
Other examples
1. In addition, he had a habit of thumb sucking until 1. In addition, he had a habit of thumb sucking until the
age of five years. age of five.
2. In addition he had a habit of thumb sucking until he 2. In addition, he had a habit of thumb sucking until he
was five years age. was five years of age.
3. Regarding the medical history, Alfie has a history of 3. In addition, he had a habit of thumb sucking until he
thumb sucking until the age of 5 years, was five years old.
1. In addition she has fillings, crowns, good dental 1. In addition she has fillings, crowns, good dental
hygiene and a 13 years old chrome /cobalt hygiene and a 13 year old chrome /cobalt removable
removable partial denture. partial denture.
Years is an adjective in this sentence (it describes the
age of the denture) and adjectives are uncountable.
A to Z of Phrasal Verbs and Useful Vocabulary
Letter Expression Example sentence
1. admitted to The patient was admitted to our hospital in March 2008 for the first time.
associated with
advised to
Mr. Booth first came to see me on 12/08/08 complaining of shortness of
advice on
breath which was worse when he was lying down. It was associated with a
allergies
tightness in the chest and coughing.
allergic to
She was advised to return the next day for a blood test and follow up
arrived at
consultation. (verb)
arrived in For both children advice on recommended vaccines will be necessary. (noun)
confidence in
She lacks confidence in caring her baby in terms of breast feeding and
bathing.
4. discharge on He will be discharged on the 12th of August.
deteriorate Since 28th of July her condition has deteriorated with occasional
deny disorientation.
difficulty in She denied vomiting and she was vague reporting about laxatives.
diagnosed with Mr. MacIntosh presented to me with the complaint of difficulty inpassing
diagnosis of urine.
I am writing to refer my patient, Fletcher, a nine year old Labrador cross dog
who is diagnosed with high grade lymhoma. (verb)
Histological results confirmed the diagnosis of high grade lymphoma.(noun)
5. evidence of Examination findings revealed evidence of an enlarged prostate.
enclosed I have enclosed the radiograph for your convenience.
6. to follow The patient was advised to follow a low fat diet.
8. history The patient first attended me yesterday evening with a one day history
of lower abdominal pain
Mr. Abrahim has a positive family history of prostate cancer
9. indicate The family has indicated that they need an interpreter who speaks Farsi or
Arabic during follow-up visits with this family.
indicative of However, there was slight swelling in the right groin indicative ofinguinal
hernia
inconspicuous His family and social history is inconspicious.
11. known She is a known asthmatic since childhood and is on Budesonide inhaler for
the same.
13. to make an I have made an appointment for her through your receptionist.
appointment
14. on examination On examination, her blood pressure was 180/90 mm Hg with a regular
pulse of 70 beats per minute.
15. occasions Today she presented very anxious and depressed as she had noted some
blood in her motions on two separate occasions.
16. provisional Provisional diagnosis suggests prostate cancer.
present at Mr Gates presented at my clinic yesterday at 7pm with a complaint oflower
present to back pain.
Today, he presented to me complaining of a regular dull ache in the groin.
17. queries If you have any further queries, please do not hesitate to contact me.
18. reveal Examination today revealed a significantly increased right groin swelling.
risk factors His risk factors include: smoking 20 cigarettes per day, lack of exercise and a
a routine recovery strong family history of hypertension.
reluctant to He has made a routine recovery and his wounds appear to be healing well.
rule out He is reluctant to seek treatment.
remarkable
findings I believe she needs an urgent assessment to rule out bipolar disorder
19. suggestive of Miss Jones is suffering from the signs and symptoms suggestive ofectopic
suspicious of pregnancy.
I am writing to refer this patient, a 60-year-old women,with
suffering from symptoms suspicious of bowel malignancy
signs and Ms.Tylor has been suffering from diabetes and she is administering insulin
symptoms injection by herself.
He is a 40-year-old man who is suffering from signs and symptomssuggestive
of peritonitis with perforated gastric ulcer.
20. treated with He also has been suffering from hypertension which has been treated
tentative with Atenolol 50 mg daily.
My tentative diagnosis is dental fluorosis.
21. underlying I would appreciate your assessment of this girl to find out whether he has
under control any underlying psychological problems.
uneventful Currently, her pain is under control with medication and she is tolerating
urgent fluids.
unremarkable Her second pregnancy and delivery were uneventful.
to undergo I would appreciate if you could give urgent attention to Mrs. Woods' problem.
treatment/surgery Cardiovascular examination was unremarkable and her electrocardiogram
/an operation was normal.
She underwent colonoscopy three years ago which was normal. (simple past)
During hospitalization, the patient has undergone an electromyogram and X-
ray. (present perfect)
22. vital signs Her vital signs were normal, but she was overweight (85 kg). Thereforeshe
was advised to reduce weight and do exercise.
23. with a complaint Mr Gates presented at my clinic yesterday at 7pm with a complaint oflower
of back pain.
Prepositions
Prepositions are a difficult area of language to fully master as their usage is not governed by strict rules. The best way to learn prepositions is by
regular reading so that you can slowly absorb and become comfortable with their correct use. However, it is possible to memorise the correct use
of a selection of prepositions in order to use them accurately in writing the referral letter.
Prepositions of Time
In: In is used for longer On: On is used for days and At: At is used for the time of Some words require no
periods of time dates and some time day and for some expressions preposition
expressions
Prepositions of Place
In: In is used for inside of something On: is used for the surface area of At: At is used for a place of activity
something
Common Errors
Incorrect Correct
His father died of cancer during the age of 50. His father died of cancer at the age of 50.
In examination today, the patient was anxious and On examination today, the patient was anxious and
distressed. distressed.
Initial examination on today revealed inflammed gums. Initial examination today revealed inflammed gums.
On December 2006, the patient had his wisdom teeth In December 2006, the patient had his wisdom teeth
removed. removed.
The patient's family arrived at Australia in last year. The patient's family arrived in Australia last year.
Useful signal markers
Letter Signal Marker Example Sentence
1. ______as well She suffers from oedema as well as bladder incontinence and only
as______ tolerates fluids.
as a result of This child was admitted with Acute Meningoencephalitis as a result of a
complication following Mumps.
as a result Let me inform you that that the patient has proven to be uncooperative
during his dental treatments. As a result, I would recommend the
treatments be carried out with a general anaesthetic.
along with On vaginal examination cervical excitation was noted along
withtenderness in the right fornix.
apart from this She looked very anxious and was having trouble sleeping. Apart from
at that time this, no abnormalities were found on rectal, cardiovascular and
respiratory examinations.
Initially, I saw the patient six months ago when she complained of
constipation. At that time, her physical examination was normal.
2. besides that The patient has smoked 40 cigarettes a day for 25-30 years. Besides
because of this that he has type 2 diabetes.
based on He smokes 20 cigarettes and drinks 2 beers every day. Because of this, he
has been told to cease smoking and to reduce alcohol.
Furthermore, a fine needle aspiration was taken and was
investigated. Based on that, I suggest the dog has developed lymphoma.
3. consequently The depth of periodontal pocket was 3.4mm.Consequently, he has
undergone extensive treatment for carious lesions and oral hygiene
maintenance.
4. during_________ During hospitalization, his vital signs have been monitored and he has
been assisted with his showers.
duration On 15/2/08, she presented complaining of lower abdominal pain of 1 day
duration.
despite
Despite various dental treatments and regular dental cleaning, his
general gum condition is only fair.
6. for this reason Mr. Fox's blood pressure was elevated and he was overweight. For this
reason the patient was advised to do exercise and follow a healthy diet.
8. hence The carious lesions on 65 are reasonably deep and hence the tooth has to
however be extracted.
The patient regularly visits the dentist and her oral hygiene status is
good. However, her gums are inflamed.
9. in terms of ___ In terms of her medical history, she has mild hypertension and a 12 year
history of diverticulitis.
I have prescribed agleam in order to reduced anxiety.
in order to
in addition Regarding the medical history, Alfie had a history of thumb sucking until
the age of 5. In addition, he is epileptic and uses dylantin to control the
in the meantime
attacks.
I have planned to review him in two months to monitor his blood pressure
in case of and smoking reduction. In the meantime, I believe he needs urological
assessment.
In case of any irritation, redness or swelling of the skin, discontinue the
treatment and consult your doctor immediately
13. may I remind you May I remind you that both the teeth will require root canal treatment
that…. and crown.
my main concern My main concern is that the patient is reluctant to breastfeed and
is that……. confident in caring for her baby.
14. It should be It should be noted that they may have a problem with communicating in
noted English as they understand limited English.
15. over…… Over the past week, she has remained free from severe pain and has
been tolerating a fluid diet.
She first presented to me on 3.7.06 with several episodes of heart
on review today, flutter over the previous few weeks.
On review today, the patient has reduced smoking to 10 cigarettes a day,
attended gym twice a week and lost 7kg so far.
16. please note Please note, he has an allergic reaction to nuts.
18. regarding Regarding his medical history, Jordan suffers from eczema and asthma
for which he receives treatment twice a year.
Regrettably, she complains of mild constipation and weakness.
regrettably
Recently, she has been prescribed Karvea 150mg and Oroxine 0.1mg per
recently day, Timoptol Eye Drops 0.5% twice a day and Normison 10mg as
required.
19. since then His urinalysis and examination were normal except obesity and
borderline hypertension. Since then, he has been doing regular exercise
and has managed to lose 8kg of weight
20. therefore Her vital signs were normal, but she was overweight (85
the reason for kg). Therefore she was advised to reduce weight and do exercise.
The reason for the referral is to consider a possible prostate biopsy
regarding the patient’s condition.
21. up until now, Up until now, Mr. Hutton has leaded a very unhealthy life.
unfortunately Unfortunately, she is not expected to survive more than 3 months.
23. with regard to I am writing with regard to this patient, a 57 year-old married man who
is under our care with the diagnosis of myasthenia gravis
Dentists
Initial examination on 20/ 02/ 2008 revealed that 54 has a temporary filling with a cavity
extending through the furcation. Based on the bitewing radiological findings, I advised
both 54 and 65 be extracted along with the construction of a space maintainer. Moreover I
advised the filling of carious 55 and fissure sealant for all 6’s. In my view, general
anesthesia is the proper sedation as the patient is known to be uncooperative in a dentist
chair.
Nurses
When admitted to this hospital, Mr. Jagger complained of haemetemesis, anorexia,
dizziness associated with weight loss and anaemia. He also was suffering from severe
epigastric pain after meals. Therefore, his stool was examined and an endoscopy has been
performed.
Compound Sentences and Coordinating Conjunctions
When writing referral letters it is necessary to take information from the case notes and write it in
complete sentences. The most basic way to do this is as a simple sentence. Simple sentences commonly
contain a subject, verb and object and are known as independent clauses.
This method is suitable for information which is not connected to other information in the case notes.
However, it is more common to group information which is related into compound sentences. In the
sentence below ,two ideas are joined by the conjunction and. Note that the subject for each clause is
different and each clause can function as a complete sentence
Example: I prescribed Panadol for his hand pain and he was advised to reduce weight and do exercise.
Compound sentences are joined by conjunctions and they show the relationship between the ideas. The
most common conjunctions are:
Example: She does not smoke but (she) is a heavy alcohol drinker.
Example: She does not smoke or drink alcohol so her health is good.
One important decision for the writer to make is whether to include a subject in the second clause.
Basically, the rule is you need to add a subject after a conjunction if the subject of the second clause is
different to that of the first clause.Or if the sentence is very long.
I prescribed Panadol for his hand pain and he was advised to reduce weight and do exercise. (In this
case you must add a subject after and as the subject is different in the second clause)
I prescribed Panadol for his hand pain and advised for weight reduction and exercise. (in this case you
can omit the subject I as it is the same as the subject for the first part of the sentence)
I prescribed Panadol for his hand pain and I advised for weight reduction and exercise. (this is
grammatically correct, but in terms of style not very good as it is clear the subject remains the same,
so need to repeat it)
Common Mistakes
Incorrect Correct
Nicole is a non-smoker and no drink alcohol or other Nicole is a non-smoker and (she) doesn’t drink
drugs. alcohol or take drugs.
The parents say that immunisations were given at The parents say that immunisations were given at
birth to both their children, but no record to prove birth to both their children, but they have no records
that. to prove that.
Explanation: No subject or verb after the conjunctionbut The parents say that immunisations were given at
birth to both their children, but there are no records
The wound has healed and free of infection to prove that.
Explanation: Omission of subject and verb The wound has healed and (it) is free of infection
Mr. Smith’s activities were restricted since last year Mr. Smith’s activities have been restricted since last
by grinding pain in the left hip and had difficulty in year by grinding pain in the left hip and he had
climbing and descending stairs. difficulty in climbing and descending stairs.
Explanation: No subject after the conjunction and, and note Her blood pressure was 175/95 and she took Normison
the subject for each clause is different. In the first clause the
subject is Mr Smith’s activities and in the second clause the 1 tablet and 2 panadol at 10 pm
subject is Mr Smith (not his activities)
She is a widow and a resident at Golden Pond She is a widow and a resident at Golden Pond
Retirement Village, has a son in Warwick. Retirement Village and (she) has a son in Warwick.
Mr. Jones has been a patient of mine since 1999 and Mr. Jones has been a patient of mine since 1999 and
attending my clinic on a regular basis for scaling and (he) has been attending my clinic on a regular basis
cleaning. for scaling and cleaning.
The information in the case notes is usually written in note form, and therefore does not follow conventional grammatical
rules. However, when this information is organised into complete sentences in the referral letter it is necessary to follow
standard conventions of grammar and sentence structure. This worksheet explains how to group information using parallel
structures to ensure that the sentences you write are grammatically balanced. This can be achieved by making sure that
verbs, adjectives, nouns, prepositions, phrases and clauses are parallel. Parallel structures within a sentence are joined
with coordinating conjunctions such as and/or as well as with commas. Here are some examples:
With active verbs
He is now worried about his condition because he is overweight, lacks exercise and smokes regularly
With passive verbs
During hospitalization, IV fluids were commenced and a transdermal patch was used for her pain.
With nouns & noun phrases
He is now worried about his condition because of his increased weight, lack of exercise and his habit of smoking.
He will require information about how and when to take his medication, how to stop smoking and the necessity of
doing regular exercise.
With gerunds
In order to handle the above mentioned effects be cautious when driving a car, operating machinery
or performing any hazardous activities especially after taking your regular dose.
With prepositions
Threadworms resemble pieces of 1.5 cm cotton thread which is normally detectable at the surface of the feces
or around the anus at night.
With verbs in the conclusion
I am worried about Miss Jones and would appreciate your urgent assessment and treatment as you think
appropriate.
The important point to remember is that the structures must be balanced.
Common Mistakes
Incorrect Correct
Sally initially presented alone to my clinic on Sally initially presented alone to my clinic on 27/12/07 with
27/12/07 with a 3-month-history of constipation a 3-month-history of constipationand associated use of
and associated using laxatives laxatives
Explanation: The sentence is not balanced as noun phrases
He has a family history of stroke and diabetic. He has a family history of stroke and diabetes
Explanation: This sentence is not balanced as stroke is a noun and
diabetic is a adjective
Good hygiene should be maintained by taking a Good hygiene should be maintained by taking a
morning shower, using individual towels, washing morning shower, using individual
clothes daily and to vacuum regularly. towels, washing clothes daily
Explanation: the final verb is out of balance and vacuumming regularly.
I am writing to refer this patient, a 26 year old I am writing to refer this patient, a 26 year old
computer programmer, who is displaying sign and computer programmer, who is
symptoms consistent with subdural haematoma. displaying signs and symptoms consistent with
Explanation: Both nouns should be in plural form subdural haematoma.
His height is 170cm and weighing 99kg. His height is 170cm and weight is 99kg.
Explanation: unbalanced word form, height is a noun, weight is a
gerund
On subsequent visits, impressions for full upper and On subsequent visits, impressions for full upper and
lower dentures were made, bite registered and lower dentures were made, bite registration was
complete upper and lower dentures were delivered taken and complete upper and lower dentures were
. delivered
Explanation: Passive form required for all verbs
She diagnosed with hyperthyroidism in 1997, She was diagnosed with hyperthyroidism in 1997,
hypertension in 2003 and Glaucoma since 2004. hypertension in 2003 and Glaucoma in 2004.
Explanation: Time markers need to be balanced. She has had hyperthyroidism since 1997,
hypertension since 2003 and Glaucoma since 2004.
During hospitalization, IV fluids were commenced During hospitalization, IV fluids were commencedand a
and used a transdermal patch for her pain. transdermal patch was used for her pain.
Explanation: Passive form required for all verbs
Further examination revealed dry mouth, dentures Further examination revealed dry mouth. In addition,
were worn out on occlusal surfaces and a heavy her dentures were worn out on occlusal surfaces and a
calculus deposit was seen on the dentures. heavy calculus deposit was seen on the dentures.
Explanation: In example 1, by adding in addition, you can change Further examination revealed dry mouth, worn out
the structure and keep the sentence balanced. In example 2 the dentures on occlusal surfaces and heavy calculus
sentence is balanced as the verbs have been replaced with noun deposits on the dentures.
phrases.
She is feeling loneliness and isolated due to losing She is suffering from loneliness and isolation due to
her social contacts losing her social contacts. (nouns)
Explanation: Loneliness is a noun whereas isolated in an adjective She is feeling lonely and isolated due to losing her
so the word forms are not balanced. social contacts. (adjectives)
Relative Clauses
In the introduction of a referral letter it is common practice to introduce the patient and provide some
relevant details relating to their situation or condition. The relative clause allows writers to do this in a
clear and concise manner.
Definition: A relative clause is the part of the sentence which provides information about the patient.They
can be divided into two types, defining and non-defining. Defining clauses provide details about the noun
being referred to. Commas are not required.
Non-defining clauses provide extra information about the noun being referred to but do not define
it.Commas are required.
Defining Non-defining
I am writing to refer this patient who is due I am writing to refer this patient,who is due
to be discharged today. to be discharged today, for ongoing
physiotherapy treatment.
Explanation: The relative clause defines the object
of the main clause i.e Which patient? The patient Explanation: The relative clause provides extra
who is being discharged. information (patient is due to be discharged) about
theobject of the main clause but does not define
it. It could be removed from the sentence and the
meaning would still be clear: I am writing to refer
this patient for ongoing physiotherapy treatment.
I am writing to refer Mrs. Patterson, a 36- Mrs. Patterson, who is a 36-year-old married
year-old married woman who is suffering woman, is suffering from mild depression.
from mild depression.
Explanation: The relative clause provides extra
Explanation: The relative clause defines the object information (Mrs. Patterson is a 36 year old
of the main clause i.e Who? Mrs. Patterson, a 36- woman) about the subject of the main clause but
year-old woman. does not define it. It could be removed from the
n.b. In this sentence, the first comma allows extra sentence and the meaning would still be clear: Mrs
information to be added about Mrs. Patterson. Patterson is suffering from mild depression.
Handy Tip
No name=no comma
In example 1 below, no comma is required as the relative clause is defining the person being referred to. In
example 2, the relative clause does not define the person being referred to because it is already known.
Therefore, If you include the patient's name, commas are required.
Mr. Holmes who lives with his wife in a Mr. Holmes, who lives with his wife in a
government flat, is an aged care pensioner. government flat, is an aged care pensioner.
Explanation: Commas required as it is a non- Mr. Holmes lives with his wife in a
defining relative clause. You can also express this government flatand is an aged care
information in a compound sentence. pensioner.
Mr. O'Riley, who lives alone in his own home, Mr. O'Riley, who lives alone in his own
and works as a fencing contractor and has home, worksas a fencing contractor and has
only one brother. only one brother.
Explanation: After the second comma a verb is
required. i.eMrO'Riley works..
Mrs. Peterson who recently moved to our Mrs. Peterson recently moved to our
retirement village following her husband's retirement village following her husband's
death. death.
Explanation: No relative pronoun needed here as it Mrs. Peterson, who recently moved to our
is a simple sentence. retirement village following her husband's
death, has a history of hypertension.
Mr. Brown presented at my clinic today with Mr. Brown presented at my clinic today with
a complaint of fractured front teeth in a a complaint of fractured front
traumatic car accident. teeth which occurred in a traumatic car
Explanation: A relative clause is required to define accident.
how the teeth were fractured. Alternatively it can Mr. Brown presented at my clinic today with
be written as two separate sentences. a complaint of fractured front teeth. This
occurred in a traumatic car accident.
I am writing regarding Mr. Jones, a 35-year- I am writing regarding Mr. Jones, a 35-year-
old male, who was recently diagnosed with old male who was recently diagnosed with
with tuberculosis. with tuberculosis.
Explanation: Second comma not required as it is a
defining relative clause, i.e it defines Mr. Jones
I am writing to refer Mrs. Margaret Green, a I am writing to refer Mrs. Margaret Green, a
66-year-old widow with three children, with 66-year-old widow with three children who is
complaints of chest pain. complaining of chest pain.
Explanation: Relative clause required here as two
prepositional phrases is confusing.
I am writing to refer, Ms. Abbot, a 58-year- I am writing to refer Ms. Abbot, a 58-year-old
old widow admitted with pain, dehydration widow who was admitted with pain,
and nausea. dehydration and nausea.
Explanation: Incorrect comma placement and
relative clause required.
Mr. Fisher was admitted to hospital with the Mr. Fisher was admitted to hospital with the
diagnosis of obstructive artery disease and diagnosis of obstructive artery disease which
end with quadruple artery bi-pass grafts. required quadruple artery bi-pass grafts.
Explanation: A relative clause is required to define
the treatment.
I am writing to refer this 14-year-old boy to I am writing to refer this 14-year-old boy who
you who came to me complaining of a came to me complaining of a sprained ankle.
sprained ankle.
Explanation: The relative pronoun must follow the
noun it is referring to.
I am writing to refer this patient, a 39-year- I am writing to refer this patient, a 39-year-
old widowed woman, who is under our care old widowed woman who is under our care
after being injured in a car accident. after being injured in a car accident.
Explanation: No comma required as it is a defining
relative clause.
Mr. Roberts who is a 72-year-old retired Mr. Roberts, who is a 72-year-old retired
gentleman was admitted to hospital for gentleman, was admitted to hospital for
acute cerebral infarction on 08/03/10. acute cerebral infarction on 08/03/10.
Explanation: Commas required as it is a non-
defining relative clause and provides extra
information about Mr. Roberts.
I am writing to explain Mr. Clarke's current I am writing to explain Mr. Clarke's current
situation, who has been a patient of mine for situation. He has been a patient of mine for a
a long time. long time.
Explanation: The relative pronoun must be added I am writing to refer Mr. Clarke, who has
directly after the person you are referring to. been a patient of mine for a long
time. Currently, he is suffering from........
Clauses of Contrast
Contrast can be expressed by joining two clauses with the following linking words: although/but/despite/despite the fact
that/even though/however/in spite of/on the other hand/whereas/while. A comma is used to separate the two clauses as
illustrated below.
Although her condition has improved, she is still very weak.
Her condition has improved, but she is still very weak.
Despite an improvement in her condition, she is still very weak.
Despite the fact that there has been an improvement in her condition, she is still very weak.
Even though her condition has improved, she is still very weak.
Her condition has improved. However, she is still very weak.
Inspite of an improvement in her condition, she is still very weak
While her condition has improved, she is still very weak.
Common Mistakes
Incorrect Correct
Inspite of providing with exercises and compensatory Inspite of our provision of exercises and compensatory
techniques she was unable to cope with training due techniques, she was unable to cope with training due to an
to an increase in pain. increase in pain.
Explanation: providing is incorrect, as it was the patient who was Inspite of being provided with exercises and compensatory
provided excercise, in such cases you have 2 choices techniques, she was unable to cope with training due to an
1. Use a noun phrase In spite of our provision of increase in pain.
exercises
2. Use passive voice In spite of being provided with
excercise
Although she has improved, but she is still very weak Although she has improved, she is still very weak.
Explanation: This sentence has two linking words so one must be She has improved, but she is still very weak.
omitted.
Despite of regular follow up, plaque and tartar were Despite regular follow up, plaque and tartar were
detected over cervical and bucal surfaces of the detected over cervical and bucal surfaces of the
denture teeth. denture teeth.
Explanation: There is no linking expression “despite of” Inspite of regular follow up, plaque and tartar were
detected over cervical and bucal surfaces of the
denture teeth.
Despite of this advice, he regularly drinks 2~4 glasses Despite this advice, he regularly drinks 2~4 glasses of
of wine every night as well as 1~2 glasses of scotch wine every night as well as 1~2 glasses of scotch at
at weekends. weekends.
Explanation: As above Inspite of this advice, he regularly drinks 2~4 glasses
of wine every night as well as 1~2 glasses of scotch at
weekends.
Clauses of Purpose
Purpose clauses allow the writer to express why a certain action was taken in the past or why a certain action needs to be
taken in the future. It can be expressed by joining two clauses with the following linking words: in order to; so that. A
comma is required when the subordinate clause comes before the independent clause.
In order to reduce weight, a low fat diet has been recommended.(quite formal and suitable for referral letters)
A low fat diet has been recommended in order to lose weight.
A low fat diet has been recommended so that the patient can lose weight. (casual expression and used more in
informal writing or spoken English)
Rules
in order to + infinitive: Further investigation is required in order to rule out bowel cancer.
so that + past reference: A general anaesthetic was given so that the patient would not feel pain.
so that+ future reference: A general anaesthetic needs to be given so that the patient will not feel any pain.
Handy Tip: in order to rule out + disease name is a useful phrase for introductions or conclusions.
In order to rule out ectopic pregnancy, I would appreciate your urgent assessment.
The patient wants to have a scan for nuchal translucency in order to rule out Down's Syndrome.
Incorrect Correct
In order for alleviation of pain, the patient was In order to alleviate of pain, the patient was
prescribed paracetamol. prescribed paracetamol.
Explanation: In order must be followed by to + infinitive
verb, not for + noun
Clauses of Reason
In referral letters it is often necessary to state why a certain action was taken and clauses of reason allow the writer to
do this in a clear manner. It can be expressed by joining two clauses with the following linking words: due to/due to the
fact that; for this reason; because/ because of.
Examples
Due to failure to progress and fetal stress, an emergency caesarean section was performed.
Due to the fact that there was failure to progress and fetal stress, an emergency caesarean section was performed.
(formal)
There was evidence of poor progress and fetal stress. For this reason, an emergency caesarean section was
performed.
Because there was evidence of poor progress and fetal stress, an emergency caesarean section was performed.
Because of failure to progress and fetal stress, an emergency caesarean section was performed.
Rules
due to/because of + noun (underlined below)
Example: Due to a low fat diet, the patient's health improved.
The patient's health improved due to a low fat diet.
Because of a low fat diet, the patient's health improved.
The patient's health improved because of a low fat diet.
because + clause
Example: Mrs Healy's health improved because she was on a low fat diet.
Because she was on a low fat diet, Mrs Healy's health improved .
Handy Tip: due to + ing form allows the writer to express meaning clearly and concisely so it is useful in referral
letters.
Comma placement
A comma is required when the subordinate clause comes before the independent clause. However, if the
independent clause comes first, no comma is required.
Incorrect Correct
The patient is feeling lonely and isolated due to lose her The patient is feeling lonely and isolated due to losing her
usual social contacts. social contacts. (clear and concise)
The patient is feeling lonely and isolated due to the fact
Explanation: Incorrect word form and sentence structure after due that she lost her social contacts. (formal and a bit wordy)
to
His mother had difficulty in caring for both her son's illness His mother had difficulty in caring for both her son's illness
and looking after two other small children due to sick. and looking after two other small children due to her
Explanation: Incorrect word form and sentence structure after due sickness.
to His mother had difficulty in caring for both her son's illness
and looking after two other small children due
to being sick.
Recently, the Mr Hutton stopped playing sport because Recently, Mr Hutton stopped playing sport because
muscle soreness. of muscle soreness.
Explanation: Incorrect word form and sentence structure after Recently, Mr Hutton stopped playing sport because he had
because of muscle soreness.
Clauses of Time
A very important part of referral letters is summarising the patient history and order of events in the case notes. The use
of time conjunctions help the writer express these relationships clearly. Commonly used conjunctions include: ago,
during, when, while, since,first, on the next visit, at that time,after, later, in .......... time etc. etc.
Example sentences
The patient first saw me three months ago complaining of painful wisdom teeth.
During hospitalisation, the patient had surgery to remove a suspicious lesion on his lip.
When Mr. Matthews is discharged, he will need assistance with showering and general household chores.
While you are on this medication, please do not drive or consume alcohol.
Since being admitted 3 weeks ago, the patient has steadily improved and is due to be discharged today.
The patient first attended me yesterday evening
On the next visit, Peter's condition had worsened and he was very anxious.
Mr. Hauritz initially presented at my clinic on 20/11/09. At that time, examination revealed carious lesions on
several teeth along with poor dental hygiene.
On review after three months, she had made good progress with her weight reduction.
The patient was advised to reduce alcohol consumption, avoid heavy lifting and review in three months time.
A review consultation was scheduled for one month later.
Example paragraph
Six months ago, Mr. Roberts twisted his right ankle while playing golf. During the following months, the patient
experience intermittent attacks of pain which hindered his ability to work effectively. On review after three months, the
right ankle joint was x-rayed and the result appeared to be satisfactory. However, when the swelling, pain and impaired
improvement persisted, an MRI was ordered which revealed a detached cartilage.Currently, Mr. Roberts does not have
full mobility, and is no longer capable of full-time employment on which, financially, his family depends.
Rules
Comma Placement
A comma is required when the time clause comes before the independent clause.
Handy Tip
Correct verb tense is an important point to consider when writing time clauses. The important points to remember are as
follows:
When the verb of the time clause is in present form, the verb in the main clause must also be present or future
form.
Example: While you display symptoms of fever and rash, you are still infectious.
When the verb of the time clause is in past form, the verb in the main clause must also be in past form.
Example: When the patient received his results, he fainted.
When the verb in the main clause is in present perfect form,the verb of the time clause must be in present perfect
form.
Example: While the patient has been in hospital, his condition has steadily improved.
Incorrect Correct
Today, the couple presented at my clinic. Mrs. Conway When the couple presented at my clinic today, Mrs.
informed me that her home ovulation prediction test Conway informed me that her home ovulation prediction
showed positive. test showed positive.
Explanation: To demonstrate a higher level of English proficiency Today, when the couple presented at my clinic, Mrs.
this information should be expressed in a complex sentence rather Conway informed me that her home ovulation prediction
than two simple sentences. test showed positive.
The patient has had placement of a prosthetic heart valve 12 The patient had placement of a prosthetic heart valve 12
months ago. months ago.
Explanation: has had is present perfect, but simple past is required
with the time marker ago.
I first saw Mrs. Smythe at my clinic last week , she urgently When I first saw Mrs. Smythe at my clinic last week , she
needed a new partial denture. urgently needed a new partial denture. (best choice)
Explanation: An adverb of time such as when required to connect I first saw Mrs. Smythe at my clinic last week andshe
these two independent clauses urgently needed a new partial denture.