Grammar & Style for Clinical Writing

Which opening sentence is appropriate for a formal referral letter?

• AHi there, I'm sending you Mr Reyes who's got a hernia I think, can you have a look at him when you get a minute and let me know what you think?
• BI am writing to refer Mr Daniel Reyes, a 54-year-old teacher, who requires assessment of a suspected inguinal hernia.✓
• CMr Reyes, 54, teacher, ?inguinal hernia L side, 4/52, reducible, no obstruction, PMH nil, meds nil — please assess and advise re surgery.
• DThis letter is about Mr Reyes. He is 54. He is a teacher. He has a hernia. It is in his groin. It has been there for a month. Please see him.

Answer: A referral letter is formal and written in complete, courteous sentences that state who the patient is and why they are being referred. The informal version, the string of short sentences, and the note-form abbreviations are all inappropriate for the genre.

Which sentence uses tenses correctly to describe a completed hospital stay and a current medicine?

• AShe was admitted on 3 March, underwent a laparoscopic cholecystectomy on 5 March, and is currently taking paracetamol as required.✓
• BShe is admitted on 3 March, undergoes a laparoscopic cholecystectomy on 5 March, and took paracetamol as required.
• CShe has been admitted on 3 March, underwent a laparoscopic cholecystectomy on 5 March, and is taking paracetamol as required currently.
• DShe was admitted on 3 March, has undergone a laparoscopic cholecystectomy on 5 March, and was currently taking paracetamol.

Answer: Completed past events with dates take the simple past ('was admitted', 'underwent'), and a current medicine takes the present continuous ('is currently taking'). The present perfect does not sit with a specific past date, and 'was currently' is contradictory.

Which sentence uses the passive voice appropriately for a clinical letter?

• AWe were performed a chest X-ray, which showed no abnormality.
• BSomebody did a chest X-ray and it didn't show anything.
• CA chest X-ray performed, showing no abnormality it was.
• DA chest X-ray was performed, which showed no abnormality.✓

Answer: The passive ('was performed') is standard in clinical writing when the person acting is unimportant. 'Somebody did a chest X-ray and it didn't show anything' is informal, 'We were performed a chest X-ray' misuses the passive so that 'we' becomes the thing X-rayed, and 'A chest X-ray performed, showing no abnormality it was' is ungrammatical.

Which sentence is correctly punctuated and concise?

• AHer medications are metformin 500 mg twice daily, ramipril 5 mg daily and atorvastatin 20 mg at night.✓
• BHer medications are, metformin 500 mg twice daily ramipril 5 mg daily and atorvastatin 20 mg at night.
• CHer medications are: metformin 500 mg twice daily, ramipril 5 mg daily, and atorvastatin 20 mg, at night.
• DHer medications, are metformin 500 mg twice daily; ramipril 5 mg daily; and atorvastatin 20 mg at night.

Answer: A simple list after 'are' needs commas between items and no colon or comma before the list itself. The alternatives insert a colon or comma where none belongs, omit the separating commas, or break the subject from its verb.

Choose the correct preposition: 'Mr Ahmed was discharged ____ hospital on 12 June and will be reviewed ____ the outpatient clinic in six weeks.'

• Afrom; in✓
• Bout; on
• Cby; to
• Dof; at

Answer: Patients are discharged 'from' hospital and reviewed 'in' (or 'at') a clinic. 'Discharged of', 'discharged out' and 'discharged by hospital' are all wrong in this context.

Which closing is appropriate for a referral letter that opened with 'Dear Dr Patel'?

• AYours faithfully
• BYours sincerely✓
• CBest
• DCheers

Answer: When the recipient is named, the conventional close is 'Yours sincerely'; 'Yours faithfully' pairs with 'Dear Sir or Madam'. 'Cheers' and 'Best' are too informal for a professional letter.

Which sentence avoids unnecessary words while keeping the meaning?

• AIt would be appreciated if a review of the anticoagulation could be undertaken by yourself in view of the instability of the INR.
• BPlease review his anticoagulation, as his INR has been unstable.✓
• CReview needed — INR unstable — anticoag — please.
• DPlease could you possibly find the time to review his anticoagulation, due to the fact that his INR has been somewhat unstable.

Answer: Conciseness and clarity are marked in OET writing: the key sentence makes the request and gives the reason in ten words. The long versions add padding and clumsy constructions, and the note-form version loses the register expected of a letter.

Which sentence correctly reports what the patient said?

• AShe reports the pain that worsens when she is climb stairs.
• BShe reports that the pain worsens when she climbs stairs.✓
• CShe reports that the pain worsens when she climb stairs.
• DShe report that the pain is worsen when she climbs stairs.

Answer: Third-person singular verbs take -s ('reports', 'worsens', 'climbs'), and reported speech here uses a 'that' clause with the present tense for a current symptom. Each alternative breaks subject–verb agreement or the verb form.

Which sentence uses articles correctly in British clinical English?

• AShe was admitted to hospital with a chest infection.✓
• BShe was admitted to the hospital with the chest infection.
• CShe was admitted to a hospital with chest infection.
• DShe was admitted in hospital with an chest infection.

Answer: In British usage a patient is admitted 'to hospital' (no article, like 'to school'), and a condition mentioned for the first time takes 'a'. American English says 'to the hospital' and is accepted, but 'the chest infection' on first mention, 'chest infection' with no article, 'in hospital' after 'admitted' and 'an' before a consonant are all errors.

Which sentence gives advice in a tone appropriate to a letter written to a patient?

• AYou must take the tablets or you will get sick again, so do not forget.
• BIt is important that you take the tablets every morning, even on days when you feel well.✓
• CTablets are to be taken by the patient each morning as prescribed by the clinician at the time of discharge.
• DTake the tablets every single morning without fail — no excuses!

Answer: A letter to a patient should be clear, polite and personal: 'It is important that you…' explains and reassures. The 'You must take the tablets or you will get sick again' version is blunt and threatening, 'Tablets are to be taken by the patient…' is impersonal and written as if to a third party, and 'without fail — no excuses!' is informal and hectoring.

Which sentence correctly describes a medicine started in the past and still being taken?

• AMr Lee takes metformin since 2019.
• BMr Lee has been taking metformin since 2019.✓
• CMr Lee is taking metformin since 2019.
• DMr Lee took metformin since 2019.

Answer: An action that began in the past and continues now takes the present perfect continuous with 'since'. The present simple and present continuous cannot combine with 'since 2019', and the past simple suggests he has stopped.

Which sentence asks the reader of a referral letter to act, in an appropriately formal way?

• APlease you review her medication and arrange follow-up soon.
• BYou should review her medication and arrange follow-up as soon as you can, please.
• CI would be grateful if you could review her medication and arrange follow-up.✓
• DKindly do the needful regarding her medication and follow-up.

Answer: 'I would be grateful if you could…' is the conventional polite request in a professional letter. 'Please you review' is ungrammatical, 'do the needful' is a regional idiom that reads as vague and informal in OET, and 'you should… please' is both directive and awkward.

Which sentence punctuates the relative clause correctly?

• AMrs Khan who lives alone will need support, with her medication.
• BMrs Khan, who lives alone will need support with her medication.
• CMrs Khan, who lives alone, will need support with her medication.✓
• DMrs Khan who lives alone, will need support with her medication.

Answer: 'Who lives alone' adds information about an already identified person, so it is a non-defining clause and needs a comma at both ends. A comma on one side only — before 'who' or after 'alone' but not both — is a common error, and 'will need support, with her medication' puts a comma inside a phrase that belongs to the verb.