The OETWorkshops Essential Grammar for Health Professionals

By Marg Tolliday, OET Tutor / IELTS Trained Examiner May 2010

Getting B, B, B, B (or even higher) in the OET or Band 7 in IELTS Academic requires . . . correct grammar correct spelling appropriate words more sophisticated vocabulary correct punctuation verbal and written fluency quick comprehension skills

If you are a skilled health professional or a high achiever needing Band 7 in IELTS to gain entry into a prestigious University course, then 1. You will know how much hard work is involved in stepping up to a higher level 2. You read widely not just literature to do with your chosen discipline but general everyday matters 3. You use English when involved in everyday conversations as you go about your daily life 4. You know what this or means 5. If you do all of the above and you recognise symbols instantly and they mean something to you then you are well on your way to mastering English at a high level. 6. Think about this: English letters/characters are also symbols, which need to be instantly recognisable, and the quicker you can do this the better.

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THIS LITTLE BOOKLET INTRODUCES YOU TO THE FINER POINTS OF USING LOTS OF USEFUL STUFF AT http://owl.english.purdue.edu/exercises/2/
1. What makes an English sentence, a sentence ? ? ? 2. Adjectives and Adverbs 3. Articles ( a, an, the - or nothing at all! ) 4. Apostrophes 5. Joining words (however, yet, and, but, consequently, therefore) 6. Making up complex sentences joining 2 sentences together 7. Prepositions 8. Punctuation ( ; : - , ) 9. Tricky words (advise/advice loose/lose since/ago ) 10. Verb tenses 11. Appositives 12. Tricky had / has had / had had

1. What is a sentence?
An English sentence consists of a subject, a verb and an object. If you dont have a subject, a verb and an object in a sentence then you have what is called a fragment and you will never get a high score by writing fragments. See http://owl.english.purdue.edu/exercises/5/18 (Avoiding fragments) Dr Jones was held up in traffic so he called the Clinic to reorganise his day. Can you see a subject ? a verb word ? and an object ? (the reason for writing this sentence in the first place?) What about Temperature was very high at 39oC. Can you see a subject: a verb word ? an object ? You can? Amazing because I cant !! His/The temperature was very high at 39oC. Much better!

Sometimes we use it to refer back to a particular subject - be careful make sure you are using it clearly - that there is no doubt what or whom you are referring to. The cat being chased by the dog jumped over a high fence. It was an amazing sight. What was amazing? The dog chasing the cat? The cat jumping up and over a very high fence? Perhaps it was the amazingly high fence? It is not clear.

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2. Adjectives and adverbs

See http://owl.english.purdue.edu/exercises/2/2 Adverbs describe the verb, the doing word : how fast / how much / to what degree of speed or skill did someone run, teach, grow old, spend money, recover from illness and so on. And adverbs nearly always have l y at the end. The patient is recovering slowly. The doctor carefully explained the surgical procedure. Adjectives describe a noun. A car - a black car.

The elderly patient is recovering slowly. The Sri Lankan doctor carefully explained the surgical procedure.

3. Articles a an the - or nothing at all

See http://owl.english.purdue.edu/exercises/2/1 (for exercises on Articles) In English, most objects in a sentence require an article in front of them. But not always !!! Articles are NOT used before medical conditions / diseases* a and an are both indefinite articles . The only difference being, an is used when the next letter is a, e, I, o, u. However - the word x ray, for example, starts with an x - yet we would say The patient had an xray. Why? Because xray sounds like ex ray which begins with an e - so use an. Another example: If you use a University-publication, make sure you put it back. Why not an before the u in University? Because it sounds like You-ni-versity and y does not need an. Confused? Keep going! Note the use of articles in these examples: The patient had an appendectomy in 2001. The operation was a success. The patient was walking on Day 2 after the hip replacement. Mrs Jones first had cancer in 2002. As a child she had measles and mumps.*

4. Apostrophes
APOSTROPHES are little marks, like a comma but written above the line, which have three uses:

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Use No.1

To show a letter has been left out. Ive done it. Instead of: I have done it! To show something belongs to someone (singular possessive). The apostrophe goes before the s The nurses mask was a blue colour. To show things belonged to more than one (plural possessive). The apostrophe goes after the s The nurses masks were blue.

Use No.2

Use No.3

DO YOU NEED TO KNOW ABOUT THE APOSTROPHE ? Yes! Because your patients name [singular possessive] might be Mr Blackmore. You might want to write: Mr Blackmores vital signs had changed for the worse. Now what about a patient whose name is, say, Mrs Jones her name ends in an s. Mrs Jones vital signs had changed for the worse. Although Mrs Jones is only one person the vital signs belong to her and strictly speaking you could write Mrs Joness vital signs however, for the past few decades this convention has changed and now singular possessive apostrophes for names ending in s adopt the apostrophe after the s.

EXERCISES ON USING APOSTROPHES Do the following sentences require an apostrophe? 1. The patients behaviour was very strange. 2. Its OK to miss one tablet, but not two. 3. Mrs Stromess headaches were getting worse. 4. The doctors performing the surgery were all specialists. 5. The patients in the Waiting Room were becoming impatient and noisy

5. Joining words (however, yet, and, but; consequently, therefore; furthermore, in addition, moreover; )
The following is copied from http://owl.english.purdue.edu/engagement/index.php?category_id=3&sub_category_id=4&article_id =76

The definitions of these words can overlap, so you want to be careful about how and when you use them.
ANSWERS TO APOSTROPHE EXERCISES ABOVE 1. patients behaviour 2. Its OK to miss 3. Mrs Stromess headaches were 4. no need for an apostrophe doctors is the plural form of doctor 5. same as above no need for an apostrophe Essential Grammar Ver.2 Compiled by Marg Tolliday of the OETWorkshop May 2010 www.oetworkshop.com page 4 of 11

5. Joining words (however, yet, and, but; consequently, therefore; furthermore, in addition, moreover; ) continued
consequently, therefore: Something happened or something is true because of something preceding it. Example: Jonathan read the company website and articles about the company before his interview. He was able to ask very good questions during his interview. Revision: Jonathan read the company website and articles about the company before his interview; therefore, he was able to ask very good questions during his interview. furthermore, in addition, moreover: Similar to the word and, but with more of a relationship to the first part of the sentence. Example: Soo-yeon checked the grammar in her college application essay twice. She asked her neighbor to check the grammar one more time. Revision: Soo-yeon checked the grammar in her college application essay twice; in addition, she asked her neighbor to check the grammar one more time. however: Just like the word but, only for longer sentences. Example: Miguels car didnt start this morning. He got a jump start from his neighbor and was able to make it to his appointment on time. Revision: Miguels car didnt start this morning; however, he got a jump start from his neighbor and was able to make it to his appointment on time. indeed, in fact: Similar to the word and, but there is a closer relationship to the first part of the sentence, and it extends the information in the first part of the sentence. Example: Priya seems to be a workaholic. She spent the holiday in her office finishing the report. Revision: Priya seems to be a workaholic; in fact, she spent the holiday in her office finishing the report. nevertheless: Very similar to the word but, but the truth of what comes before nevertheless is emphasized. Example: All his friends have been praising the high quality of service in the new coffee shop for months. When he went there, the server was quite rude. Revision: All his friends have been praising the high quality of service in the new coffee shop for months; nevertheless, when he went there, the server was quite rude. then: Something happening in sequence, after a previous event. Example: Wenyu carefully reviewed the credit cards offers she had received this month. She chose the one with the best terms and completed the application. Revision: Wenyu carefully reviewed the credit cards offers she had received this month; then, she chose the one with the best terms and completed the application.
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And is a simple joining word be careful you use it only once in a sentence - and try to think up a different joining word the next time you join two connected ideas together! Consider this sentence: Tom never attended lectures and somehow passed his exams and then he went on to be a doctor in Guatemala and he has been living there for six years now and has married and has two children and I think he likes his life. [AND it is boring, repetitive, uninspiring, poor English]. How do you make the above long sentence better? By making it into two sentences! Tom never attended lectures. Somehow he passed his exams and went on to be a doctor in Guatemala where he has lived for six years, married, with two children: I think he likes his life. However is a word that carries a connotation of something else, an alternative. Tom never attended lectures, however passed his exams. He went on to be a doctor in Guatemala. He has, however, been living there for six years and has married and had two children. [There is a subtle difference can you spot it?]

6. Making up complex sentences joining 2 sentences together See http://owl.english.purdue.edu/owl/resource/573/02/

If you are writing something like: The patient presented with a severe headache. One hour later the patient suffered an episode of vomiting and diarrhoea. The above 2 sentences are all about the same thing: the patient and his (or her) problems. The above 2 sentences are also both independent clauses - both of them are sentences in their own right. If you join them together two independent clauses into one long sentence it will become better English, more concise. They will become a compound sentence. The patient first presented with a severe headache which was followed one hour later with vomiting and diarrhoea. Another example: The globalization of commerce is underpinned by smart technology. One problem is, however, ever increasing cyber attacks by computer hackers who penetrate databases and password protected files.
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These 2 sentences are both stand alone sentences in their own right but the second one is dependent on the first one - there is no need for the second clause unless you wrote the first one. Joining these two together (an independent and a dependent clause) will make this a complex sentence. Better: Globalized commerce, underpinned by smart technology, has the rising problem of computer hacking unauthorised access to our private data. Handy words to use when joining two sentences together: and so / consequently / however / therefore / but / and / as well as / which was followed by / which first arose / in addition to / but, unfortunately /

7. Prepositions
Prepositions over, under, beside, behind: To make these prepositions highly relevant to your letter writing, consider the following examples and graphics.

The scars will reduce over time.

2001 2002 2003 2004 2005

The nurse reached over the bed to get the patients chart. His slippers were under the bed. The consultant sat down on the chair beside the bed. The name on the chart behind the bed was incorrectly spelt

The interns are beside one another.

Two nurses, one behind the other.

For more on prepositions, have a look at http://owl.english.purdue.edu/exercises/2/14

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8. Punctuation
For an excellent overview of punctuation see http://owl.english.purdue.edu/owl/resource/566/01 The ones discussed here are the colon : and the semi colon ; the dash and the comma , The semi-colon ; and the colon : Colons indicate the start of a horizontal list. Semi-colons separate the items in a list with each item itself having several bits of information and all bits are equally important (the first mentioned is as important as the last mentioned) Test yourself: Should the following sentences have a colon, semi-colons, commas or a mixture of all three? 1. The patient has been attending this Clinic for the past two years complaining of dyspepsia GORD hypertension and insomnia. 2. The patient has been suffering for the past week with a number of complaints a runny nose bilateral headaches dizzy spells and nausea. 3. The patient has been suffering for the past week from a runny nose bilateral headaches dizzy spells and nausea. 4. Mr Jones has been coming to this Clinic for the past five years during which time he has had a number of problems addressed chronic rhinitis (2004), GORD (2005), hypertension (2007) insomnia (2008) and most recently (June 2009) irregular blood pressure. the elipsis . . .

ANSWERS: 1. The patient has been attending this Clinic for the past two years complaining of dyspepsia, GORD, hypertension and insomnia. 2. The patient has been suffering for the past week with a number of complaints: a runny nose, bilateral headaches, dizzy spells and nausea. 3. The patient has been suffering for the past week from a runny nose, bilateral headaches, dizzy spells and nausea. 4. Mr Jones has been coming to this Clinic for the past five years during which time he has had a number of problems addressed: chronic rhinitis, (2004); GORD (2005) ; hypertension, (2007); insomnia (2008) and, most recently (June 2009), irregular blood pressure.

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The ellipsis

(3 little dots)

. . .

The ellipsis is very useful for all those academics out there writing long dissertations. It is used when you are quoting something but are omitting some of the quotable text. Example: According to Jones (2004) without which it would not have been possible. The main thrust of what you are quoting is that Jones, back in 2004, did some kind of research and concluded that the result would not have been possible unless abc or xyz had been used / consulted. The bit left out could be several hundred words a couple of sentences or just the first clause of the sentence. It is up to you. But if you are quoting, word for word, then put in a citation and three little dots for the bits you are omitting. Dashes If used with care, a dash can be a very useful bit of punctuation. They are particularly useful in an appositive phrase - setting off the main pieces of information. For example: I am referring the above patient - forty three, divorced, has suffered a cardiac arrest thirty minutes ago - for admission and urgent attention. This could have been written: I am referring the above patient, a forty three year old, divorced, who has suffered a cardiac arrest thirty minutes ago, for admission and urgent attention. Note the differences.

The comma

Commas divide up sentences into different (but related) parts. If you regard the comma as a way of indicating to the reader that this is the place where you would pause briefly and take a breath that is probably spot on. Strictly speaking, a comma joins two independent (stand alone) clauses followed by and, but, or, for, nor, so. Say the following (no pauses) : Good morning my name is Dr Singh and I am on the Ward today I have just called by to see how you are going Did you have a good sleep last night? I would just like to check your temperature and look at the surgical wound Would that be OK? [Then you pause, to take a breath]. Goodness!! No .. you would probably say: Good morning, my name is Dr Singh and I am on the Ward today. I have just called by to see how you are going. Did you have a good
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sleep last night? I would just like to check your temperature, and look at the surgical wound. Would that be OK? [Ah! Much better!}

For more information on using dashes, semi colons, colons, commas and other kinds of punctuation, go to http://owl.english.purdue.edu/owl/resource/566/01/

9. Tricky words (advise/advice loose/lose since/ago )

Advise is the verb form the doing word. Advice is the noun form the thing you are giving you are not giving a card you are giving advice. Loose is the opposite to tight Lose is when you have lost something Since a particular time and event something has happened Ago refers to things that happened some time ago. Examples: I advise you to brush more regularly. If you want my advice, your problem is really bad oral hygiene. The splint is too loose. If you lose the splint, it will cost another $350 to replace so look after it. Since attending this Clinic, the patient has had a lot of respiratory problems. The patient has had a lot of respiratory problems since 2001. Nine years ago, when the patient first started attending this Clinic, he has had breathing problems.

10. Verb tenses

The basic rule is to stick to the same tense if the action took place during the same time (the same morning, same day, everything happened before the operation, everything happened after the operation, everything is planned to take place after the patient is discharged). Example: Yesterday * the patient was suffering from diarrhoea and was advised to maintain his fluid intake to avoid dehydration. Today ** he is much better and is recovering. * = straight away, you are using past tense ** = now you are using present tense Both these sentences are in the same paragraph as they should be, as they are both referring to the patients physical condition. For a comprehensive overview of verb tenses, go to http://owl.english.purdue.edu/owl/resource/601/08/
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11. Appositives
Appositives are modifying phrases or nouns, between two commas, adding more information or detail. Here is an example of an appositive (the noun is in teal, the appositive is in red). The chief surgeon, an expert in organ-transplant procedures, took her nephew on a hospital tour. Note: If you eliminated [took out] the appositive you would end up with the nutsand-bolts of the sentence: The chief surgeon took her nephew on a hospital tour. [The appositive just gives us more information about the surgeon]. You can put appositives to good use in the opening paragraph of your Letter of Referral. I am referring the above patient, a 45 year old divorced male, who is suffering from suspected colon cancer, for further investigation and ongoing management. Eliminate the appositive and what have you got? I am referring the above patient for further investigation and ongoing management. AND THAT IS WHY YOU MUST PUT A COMMA before and after the appositive to set it out clearly because if you dont put a comma before and after the appositive, it will not be a grammatically correct sentence!

12. Had / Has had / Had had

Had is used for recent past tense: I had a coffee with my breakfast this morning. Had had is used for long time ago past events - which will not recur: The patient had had an appendectomy in 1995. Has had is used for long time ago past events which MAY recur: The patient has had asthma in 2001 and 2004. When you use has had in a sentence it infers the patient has had asthma in the past and may get it again in the future: the problem is still occurring or might occur in the future. But! When you use had had in a sentence - it infers the patient had asthma in the past and has made lifestyle changes - bringing about a cure and the patient is not expected to ever get asthma again. He/She is now completely cured of asthma.

Any queries, please email

[email protected]
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Essential Grammar Ver.2 Compiled by Marg Tolliday of the OETWorkshop May 2010