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
• nerves of steel

If you are a skilled health professional - a high achiever, then …

You will know how much hard work is involved in stepping “up” to a
higher level
You read widely – not just literature to do with your discipline – but
general everyday matters
You use English when involved in everyday conversations as you go
about your daily life

You know what this or means -

If you do all of the above – as well as recognising symbols instantly – then

you are well on your way to mastering English at a high level.
Remember, letters/characters – are also symbols, which need to be
instantly recognisable, and the quicker you can do this – the better.

THIS LITTLE BOOKLET INTRODUCES YOU TO THE FINER

POINTS OF USING LOTS OF USEFUL STUFF WHICH ARE
ELABORATED ON AT THE ONLINE WRITING LAB WEBSITE
(LOCATED AT PURDUE UNIVERSITY IN THE U.S.A.) It also
provides you with many useful self-testing exercising with
a health-professional flavour – and the answers are all located in the
back of the book - so you can check yourself !

Table of Contents

1. What makes an English sentence, a sentence ? ​ ​ ​3

 1. What makes an English sentence, a sentence ? ​ ​ ​3
2. Adjectives and
Adverbs ​4
3. Articles ( a, an, the - or nothing at all! ) ​ ​5
4. Apostrophes ​6
5. Joining words (however, yet, and, but, consequently, therefore) ​7
6. Making up complex sentences – joining 2 sentences together ​9
7. Prepositions ​10
8. Punctuation ( ; : ) ​ ​ ​11
9. Punctuation ( , . . . - ) ​13
10. Tricky words (advise/advice loose/lose since/ago/before
affect/effect “it” /him or her
) ​ ​14
11. Verb tenses ​16
12. Appositives ​17
13. More tricky stuff: had / has had / had had
(a.k.a. “past participles”)
​ ​18

Answers to exercises ​20

1. What exactly is a sentence?

An English sentence consists of a Subject, a Verb and an Object.

If you don’t have a subject, a verb and an object in a sentence – then you don’t have an
English sentence - what you do have is a “fragment” - and you will never get a high
score by writing fragments.

Dr Jones was held up in traffic so he called the Clinic to reorganise his day.
(S) (V) (V) - - - (O)---
-

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 39 C. o

(V) - - (O) - -
 ​His/The temperature was very high at 39 C. o
Much better!
- (S) - (V) - - (O) - -

Exercise: Is it a sentence, or not?

(Circle “Y” for yes; “N” for no. Answers are given at the end of the book)

1.1 ​She rushed at him with the scalpel in her hands. ​Yes / No
1.2 ​Surgery had finished; lights were turned off. ​Yes / No
1.3 ​BP was 160/90 – very high. ​Yes / No
1.4 ​Make sure you fast before your Barium Meal. ​Yes / No
1.5 ​Before a Barium Meal, fast. ​Yes / No
1.6 ​Skeletal survey and urinanalysis test were ordered. ​Yes / No
1.7 ​Endoscopy was not recommended because of it could
damage the oesophagus. ​Yes / No
1.8 ​On examination, vital signs were BP 120/80, P 70/min.
​regular, rest of the examination was clear. ​ es / No
Y
1.9 ​ ccordingly, Paracetamol/Codine mixture was added
A
to the prescription. ​ es / No
Y
1.10 D ​ uring hospital stay, surgical debridement of
​ ound as well as daily dressing was undertaken.
w ​ es / No​2.
Y
Adjectives and adverbs

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.
It’s a good idea to write adjectives next to the noun; adverbs next to the verb.
Of course – one needs to ask the question: Why bother? Do we need them?
Well – yes – because they make your writing more descriptive and come in handy when
trying to write concisely – and at the same time give details – about a patient.

Can you pick the adverbs (ADV) / the adjectives (ADJ) / the nouns ?
(Answers are given at the end of the book.)
2.1 ​Unfortunately, the patient had uncontrolled pain with persistant numbness in the
lower right leg. [3 adjectives and 4 nouns]

2.2 ​His feet need to be examined by a podiatrist regularly. [Adverb or adjective?]

[2 nouns / 1 verb / + ADV or ADJ?]

These two sentences, written without adverbs or adjectives, would end up:
2a The patient had pain with numbness in the leg.
2b His feet need to be examined by a podiatrist.

By adding adjectives and adverbs, you add richness, detail, a deeper understanding of
one’s particular patient - - which is valuable stuff for the specialist - - and your chances
of getting a pass in the OET or a Band 7 score in IELTS.

Exercise: Include the (bracketed) word in the appropriate place in the sentence.
Answers are given at the end of the book).
2.3 ​(chronic) ​The patient is suffering from diahhorrea.
2.4 ​(Indian) ​I attended the Doctor yesterday.
2.5 ​(high) ​The baby has a temperature.
2.6 ​(amazed) ​The patient looked at the xray result: no cancer!
2.7 ​(nervous) ​The new triage nurse made some silly mistakes.
2.8 ​(widowed) I​ am referring the above male, a 54 year old Engineer.
​3. Articles “a” “an” “the” - or nothing at all

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*
or proper/collective nouns.

“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.*

Exercise: Circle the correct option : “a” “an” “the” or [ no article at all ] in the
following sentences. Answers are given at the end of the book.)

3.1 ​ a / an / the / --- patient is still recovering.

3.2 ​Expert opinion seems to be that a / an / the / --- Western
medication is a / an / the / --- best thing for you at
a / an / the / --- this time.

3.3 ​I can understand why you are anxious, but there is no need to be.
a / an / the / --- medical team here in this Hospital is excellent. Don’t worry!

3.4 ​The patient reports having a / an / the / --- measles and

a / an / the / --- mumps as a child but good health in her adult life.
​
3.5 ​You need to exercise empathy when talking to Mrs Jones. She has
a / an / the / --- cancer and only found out yesterday.

3.6 ​You need to exercise empathy when talking to Mrs Jones. She has
a / an / the / --- liver cancer and only found out yesterday.

3.7 ​These days, having a / an / the / --- cancer is not necessarily a death
sentence.

3.8 ​You need to cut down on surgary foods as they are exacerbating a / an / the
/ --- pimples on your face.

3.9 ​Harry has terrible acne and is using a / an / the / --- soap which his
Doctor recommended. a / an / the / --- soap seems to be helping.

3.10 ​She lives with her parents and two brothers and studies at
a / an / the / --- Melbourne University.

4. Apostrophes

APOSTROPHES are little marks, like a comma but written above the line, and have
three uses:

Use No.1 ​To show a letter has been left out.

​I’ve done it. Instead of: I have done it!

Use No.2 ​To show something belongs to someone (singular possessive). The
apostrophe goes before the “s” The nurse’s mask was a blue colour.
Can you see a subject? You can?
Amazing! This author can’t !!
 Amazing! This author can’t !!
Use No.3 ​To show things belonging to more than one person (plural possessive).
The apostrophe goes after the “s” . ​ he nurses’ masks were
T
blue.

DO YOU NEED TO KNOW ABOUT THE APOSTROPHE ? Yes! Because your

patient’s name [singular possessive] might be Mr Blackmore. You might want to
write:
On review, Mr Blackmore’s vital signs had changed for the worse.

Now … what about a patient whose name is, say, Mrs Jones – her name ends in an “s”.
On review, Mrs Jones’ vital signs had changed for the worse.

Although Mrs Jones is only one person – and the vital signs belong to her – strictly
speaking you should write Mrs Jones’s 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’. If you read Christian articles, you will see
Jesus’ name written with the apostrophe after the “s”.

Another little word that connotes possession is “ its “ . Note there is NO apostrophe.
If you write “ it’s “ - it is equivalent to It is Confused? Keep going ! Here
are some examples of using the possessive apostrophe as well as the word its in a
possessive way:

Mrs Brown’s medication was increased to four-hourly.

Mrs Jones’ medication was increased to four-hourly.

​Using possessive apostrophes – continued

The patient’s medication was increased to three times a day.

The patient’s history was noted and filed in the filing cabinet.
The dog’s owners were very happy with their dog’s new-found mobility.
The Physiotherapist’s exercise regime was closely followed by the patient.
The horse had calmed down. Its fever had passed and it was on the road to recovery.
The Nurses’ Station is manned 24 hours a day.
A Hospital needs to closely monitor hygiene levels otherwise its reputation will suffer.

Note that “its” used possessively – has NO apostrophe.

Ah – English ! At times it’s not easy !

Exercises: Apostrophes* Do the following sentences require an apostrophe?

(Answers are at the end of the book.) *Pronounced A-poss-troh-feez

4.1 The patients behaviour was very strange.

4.2 Its OK to miss one tablet, but not two.
4.3 Mrs Stromess headaches were getting worse.
4.4 The doctors performing the surgery were all specialists.
4.5 The patients in the Waiting Room were becoming impatient and noisy

5. Joining words ( yet, and, but; consequently, therefore;

furthermore, in addition, moreover; )
The definitions of these words can overlap, so you want to be careful about how and
when you use them.
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 . . . a
his interview; consequently he was able to ask very good questions . . . a

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: Miguel’s car didn’t start this morning. He got a jump start from his
neighbor and was able to make it to his appointment on time.
​Revision: Miguel’s car didn’t 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 Clinic
finishing the report.
Revision: Priya seems to be a workaholic; in fact, she spent the holiday in her Clinic
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
Pathology Department for months. When he went there, the Receptionist was quite
rude.
Revision: All his friends have been praising the high quality of service in the new
Pathology Department for months; nevertheless, when he went there, the Receptionist
was quite rude.

then: Something happening in sequence, after a previous event.

Example: Wenyu carefully reviewed the credit card offers she had received this
month. She chose the one with the best terms and completed the application.
Revision: Wenyu carefully reviewed the credit card offers she had received this month;
then, she chose the one with the best terms and completed the application.

‘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].
So how do you make this long sentence better? By making it into two sentences!
Tom never attended lectures. Somehow he passed his exams, went on to be a
doctor in Guatemala where he has lived for six years, married, and had two
children: I think he likes his life.

​6. Making up complex sentences – joining 2 sentences together

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 two 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.

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 /

Exercises: Joining words* Join the following sentences - make each pair into
one sentence, using an appropriate joining word. Choose from however, but, so,
subsequently, when. (Answers are at the end of the book.) * Also known as
conjunctions.

​1
st
half of sentence ​2nd
half of sentence

6.1 Spring is coming: a wonderful time of year. The nights are cold and the days, sunny.
6.2 The patient received a blood transfusion. ​ After the transfusion, he turned pink.
6.3 Some mothers get post partum depression. Most of them get over it and move on.
6.4 Some mothers get post partum depression. Not all mothers are afflicted.
6.5 Some mothers get post partum depression. The fathers need to exercise patience.
 More exercises on joining words: choose from and, whereas, despite, unless, moreover

6.6 The patient was very anxious about the dentist’s drill. She was trembling all over.
6.7 The patient was scared about getting his teeth checked. He kept his mouth shut tight.
6.8 The nurse explained everything. The surgeon just kept his distance, waiting for the
nurse to stop talking.
6.9 The nurse explained everything. The patient being only semi conscious after the surgery.
6.10 All trauma accident victims require fluids of one kind or another. Of course, this is not
the case if the accident victim has only sustained light injuries.

7. Prepositions
Prepositions help describe position: at school, in the room, on the table, under the bed.
Prepositions help describe direction: handed the paper to him, I received a present from him.
I am travelling to the city. I will come to see you tomorrow. I poured water into the jug. I
am standing under the shower.
th
Prepositions pinpoint an actual time: on that day, on the 12 May, in June of that year,
in 2004, on the first day of every month.
Below is a list of prepositions in the English language:

Aboard, ​about, ​ above, ​across,

​after, ​ ​against, along, ​amid,
​among, ​around, ​before, ​behind, below,
​beneath, ​ beside, ​between, ​ beyond,
​by, ​ down, ​during, ​except, ​for,
​like, ​ near,
of, o​ ff, ​onto, ​out, ​over, ​ past,
since, ​through, ​throughout, ​toward, ​under,
​underneath,
until, ​ ​unto, ​up, ​ upon, ​with, ​within,
without
To make these prepositions highly relevant to your letter writing, consider the
following examples:

The scars will reduce over time. ​2001 ​2002 ​2003 ​2004 ​2005
The patient reached over the bench, lost his balance, fell down and twisted his knee.
His slippers were under the bed and he could not find them.
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, were listening intently to the surgeon.

Exercises: Prepositions - Choose an appropriate preposition to complete the

following.
You will need the following prepositions: up / over / on / at / in / into / to / under / towards / out
Exercise 7.1 – 7.13
(Answers are given in the back of this book.)

The nurse had good reason to complain. While checking (1) __ __ old Joe Brown this
afternoon, she could not help notice that he had taken out his dentures and placed them (2)____
the glass beside his bed. It was one of his bad habits. He had also used his bedpan and pushed
it (3) ____ the bed. She could smell the stale urine. What a job she had! And now her shift
was almost (4) ____. “Nurse! Nurse!” someone cried (5) ____ . She turned and saw Joe
standing (6) ____ the doorway, holding himself (7) ____ with a walking stick. “What now?”
she thought. She smiled and turning (8) ____ him, she queried: “Yes?” “You forgot
this”, said Joe. She looked (9) ____ what he held in his hand. It was an envelope. “But . . .”
she started to say. “No buts,” said Joe, “just take it.” “What is it?” she asked. “Oh, just some
scribblings of mine. Here.” Joe thrust the envelope (10) ______ her.
He turned and walked slowly (11) _____ his bed. “Goodnight, see you tomorrow” she said.
“Maybe” said Joe. It was about an hour later when she had arrived home, taken off her shoes,
made a coffee, and sat down. She could hear the clock ticking. It was only then that she
remembered the envelope and opened it. You light (12) ____ my days, love Joe. “Dear Joe”
she said quietly to herself. She decided to take a perfumed candle (13) ____ Joe in the
morning.

8. Punctuation

The ones discussed here are the colon : the semi colon ; and the comma ,
the ellipsis . . . [3 dots] ; and the dash -
First, the colon : the semi-colon ; and the comma ,

- 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)
- Commas divide the sentence into digestible / easily understood parts.

​Examples:
The patient was taking much medication: Amoxycillin, Lipitor, Aspirin and Ramipril.
[Note the use of a colon : and commas after each drug tradename].

The patient was taking much medication: Amoxycillin (120mg b.d.); Lipitor (20 mg
1/mane); Aspirin (100 mg 1/mane) and Ramipril (1.25mg 1/mane).
[Note the use of a semi-colon ; after each drug tradename, strength and dosage information].

More examples:
The patient has had a long history of drug abuse: alcohol, amphetamines, smoking and
caffeine.

Same sentence, but with more detail – and separating each “item” on the list with a semi-colon: Using
semi colons means that every item is as important as each other – there is no hierarchy of importance.
The patient has had a long history of drug abuse: alcohol (4 x 750 ml. bottles of beer
every night); amphetamines (cocaine and crack since the age of 18); smoking (20 to
30 cigarettes a day since the age of 15); and caffeine (up to 10 strong coffees a day
since the age of 16).

Exercise on using colons, semi-colons – or just commas

Should the following sentences have a colon, semi-colons, commas or a mixture of all
three?
8.1. The patient has been attending this Clinic for the past two years complaining of
dyspepsia GORD hypertension and insomnia.
8.2. The patient has been suffering for the past week from a number of complaints a
runny nose bilateral headaches dizzy spells and nausea.
8.3. The patient has been suffering for the past week from a runny nose bilateral
headaches dizzy spells and nausea.
8.4. 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 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 out loud (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 – before you turn
blue].

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
sleep last night? I would just like to check your temperature, and look at the
surgical wound. Would that be OK? [Ah! Much better!]

Exercise on using commas - please add them where you think they should be.
(Answers are given in the back of this book).

9.1 ​I am referring the above patient who presented today with a severe migraine
for an EEG test.

9.2 ​This patient has been suffering from chonic pain for the past five days and now
requires I believe surgical intervention.

9.3 ​Dental procedures done on this patient in the past have been protracted and
somewhat painful and consequently the patient has now become highly anxious.

9.4 ​The woman is suffering from post partum depression due largely to the
Caesarean section (performed without any problems) and her inability to understand
fully because of language difficulties why she had to have the procedure rather than a
normal delivery.

9.5 ​In the past triage nurses have had overall responsibility for the patient’s care
however new legislation will change this.
9.6 ​As a discharge plan Mrs Jones and her family need your help in her four
hourly pressure area care her daily sponge bath assistance with all care and application
of Duoderm dressings to a small pressure sore on the right buttock.

9.7 ​
I am pleased to refer the above patient with multiple myeloma for
monitoring of her diet plan and medication.

9.8 ​I am pleased to refer Mrs. Brown a 70 year old lady non smoker non
alcoholic widowed with 3 children who lives alone with symptoms and signs of
myocardial infarction for further assessment and management.

And now, the ellipsis and dash:

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 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 section
you are omitting.

The Dash “- ”

If used with care, a dash can be a very useful bit of punctuation. Dashes are
particularly useful in an appositive phrase - setting off the main pieces of information.
For example:

(A) I am referring the above patient - forty three, divorced, has suffered a
​cardiac arrest thirty minutes ago - for admission and urgent attention.

Be warned: dashes are best left to the academics writing narratively. If you are
an OET candidate, then it is safer to write this example as per (B) below:
(B) I am referring the above patient, a forty three year old, divorced male,
who has suffered a cardiac arrest thirty minutes ago, for admission and urgent
attention.
Note the differences.

10. 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. [Think of ice - advice - like icecream - which is a noun – so advice is the noun
form.]
Loose is the opposite to tight - His shirt was loose because he was so thin.
Lose is when you have lost something. Have you seen my shirt? I don’t want to lose it.

Since a particular time or event – something has happened.

Ago refers to things that happened before now – before this time.

​More 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 had breathing
problems.

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.

Exercise: Choose the right word (noun or verb?) in each sentence. (Answers are
given in the back of this book.)
10.1 ​If you want my advise / advice you will stay in bed.
10.2 ​I advised / adviced the patient to drink more fluids but he was non compliant.
10.3 ​The patient was advised / adviced to eat more fresh fruit.
10.4 ​I need you to losen / loosen your tie.
10.5 ​Did you lose / loose something?
10.6 ​Hospital gowns are very loose / lose and revealing!
10.7 ​ ow long since / ago you saw her last?
H
10.8 I​ t has been a long time since / ago I spoke to him – at least two years.
10.9 ​Since / Ago that time many things have changed.
10.10 ​Since / Ago then the exam format has changed.
10.11 ​What have you been doing since / ago then ?
10.12 ​Since 2004 / Ago 2004 the patient has had many epileptic episodes.
10.13 ​The patient has had many epileptic episodes ever since he starting seeing me
​three years ago / since.
10.14 ​ hen this patient came to see me three weeks
W since / ago, she was very
​anxious and confused.

​11. 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. [Incidentally, these two sentences are fine – no problems at all.]

* = straight away, you are using past tense [Past tense must be used]
** = now you are using present tense [Present tense must be used]

Both these sentences are in the same paragraph – as they should be, as they are both
referring to the patient’s physical condition.

Here is someone who clearly does not use the correct object:
A man walked into the Medical Clinic saying: “I’ve hurt my arm in several places.”
The doctor said, “Well don't go there anymore.”
Q: What should he have said – to make it perfectly clear to the doctor what has happened ?
A: I’ve sustained several injuries to my arm. [Don’t use the word ‘places’]

Try some of these exercises - make sure you use the past tense of the doing word (the
‘verb’ ) in sentences relating to things in the past - and present tense of the verb word
for things relating to the present time.

Exercise: Getting the verb tense right

11.1 ​The patient sat / sits over there on that seat yesterday.

11.2 ​Last week, when I see / saw this patient, everything seemed fine.

11.3 ​I have explain / explained everything to him.

11.4 ​I explain / explained how to use the insulin syringe but he does not listen.
11.5 ​Whenever this patient
try / tries / tried to walk without the walking frame,
she becomes nervous and slides her feet along the floor.

11.6 ​It’s amazing how improve / improved Mrs Jones was after just the first
​injection.

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 this colour,
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 nuts-
and-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 don’t put a comma before and after the appositive,
it will not be a grammatically correct sentence!

Let’s see if you can put a comma in before and after the appositive phrase in the
following sentences (in other words – can you identify the appositive phrase) :

Exercise: Writing appositives

12.1 ​Mrs Williams a forty five year old with lupus came to see me this morning.
12.2 ​This patient requires urgent surgery if possible before noon tomorrow in
order
​to prevent his inguinal hernia from increasing in size.
12.3 ​ he nurse having instructed the patient on the correct dosage and need to
T
 ​comply with the doctor’s instructions left the Outpatients Department to go
​home.
12.4 I​ am referring the above patient a sixty-three year old widowed woman who
​is suffering from severe varicose veins for vascular surgery as soon as possible.
12.5 ​ he dental surgeon having completed the operation removed his mask and
T
gloves as he walked out the room.

12. More tricky stuff: Had / Has had / Had had

Ah! The past tense! In English there are many kinds of past tense - past perfect, past
imperfect, and past continuous. Let’s try and simplify things.

If you look at the past as having different degrees of past - recent past - and long-
time-ago past - then it makes it easier to use these ‘past participles’, little helping
words “has” as in has had and “had” as in 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.

Exercise: Using past participles (Choose the correct option in the following
sentences):
All past tense
13.1 ​ he patient
T had / has been very anxious when she arrived this
morning.

13.2 ​The patient had / has a prolapsed disk.

13.3 ​Three years ago, the patient has had / had had a laminectomy.

13.4 ​Last week, the patient had / has had / had had a laminectomy.
13.5 ​Mrs Jones has / has had / had had much chronic pain over the last two
​years.

13.6 ​Mrs Jones has / has had / had had chronic pain over the last two years
​but with the new analgesics she found relief.

13.7 ​Bert Smithers has / had / has had / had had a vasectomy last week.

13.8 ​Bert Smithers has / had / has had / had had an appendectomy when he was
​only eighteen and now, in his seventies, he has / had / has had / had had
​a proctectomy just last week.

13.9 ​We had / have had a great time last Saturday at the party.

13.10 ​We had / have had many memorable office parties over the years.

Answers start on next page

ANSWERS TO THE EXERCISES

Exercises on Is it a sentence or not?

1.1 ​Yes
1.2 ​No ‘Surgery’ is not a subject. The surgery – this would make it a sentence.
1.3 ​No The blood pressure … would make it a sentence.
1.4 ​Yes
1.5 ​No. Would need: Before a Barium Meal, you need to fast.
1.6 ​No. See 1.2 and 1.3
1.7 ​No. See 1.2 and 1.3
1.8 ​No. Would need: On examination, the vital signs …
1.9 ​No. Would need: Accordingly, the Paracetamol/Codine …
1.10 ​No. Would need: During the hospital stay, the surgical …
Exercises on Adjectives and Adverbs
2.1 ​3 adjectives: uncontrolled / persistent / lower right
​No adverbs.
​4 nouns: patient / numbness / pain / leg
2.2 ​2 nouns: feet / podiatrist
​1 verb: examined
​“regularly” is the adverb
(an adverb of frequency)
Placement of adverb/adjectives in a sentence:
2.3 ​The patient . . . chronic diahhorrea.
2.4 ​. . . the Indian Doctor yesterday.
2.5 ​. . . has a high temperature.
2.6 ​The patient looked amazed at the xray result: no cancer!
2.7 ​The new nervous triage nurse . . .
2.8 ​I am referring the above widowed male, a 54 year old Engineer.
​Or:
​I am referring the above male, a 54 year old widowed Engineer.

Exercises on Articles
3.1 ​The
3.2 ​Expert opinion seems to be that Western medication is the best thing for you at
this time.
3.3 ​… but there is no need to be. The medical team here …
3.4 ​… having measles and mumps as a child …
3.5 ​She has cancer and only found out yesterday.
3.6 ​She has liver cancer and only found out yesterday.
3.7 ​These days, having cancer is not necessarily …
3.8 ​… as they are exacerbating the pimples on your face.
3.9 ​Harry has terrible acne and is using the soap which his Doctor recommended.
The soap seems to be helping.
3.10 ​She lives with her parents and two brothers and studies at Melbourne
University.

​Exercises on Apostrophes
4.1 ​The patient’s behaviour was very strange
4.2 ​It’s OK to miss one tablet …
4.3 ​Mrs Stromess’ headaches were …
4.4 ​The doctors performing …
4.5 ​The patients in the …

Exercises on Complex sentences using joining words (conjunctions)

6.1 ​Spring is coming: a wonderful time of year when the nights are cold and the
days are sunny.
6.2 ​The patient received a blood transfusion and afterwards, turned pink.
6.3 ​Some mothers get post partum depression but most of them get over it and
move on.
6.4 ​Some mothers get post partum depression however not all mothers are afflicted.
6.5 ​Some mothers get post partum depression so the fathers need to exercise
patience.
6.6 ​The patient was very anxious about the dentist’s drill and was trembling all
over.
6.7 ​The patient was scared about getting his teeth checked: moreover he kept his
mouth shut tight.
6.8 ​The nurse explained everything, whereas the surgeon just kept his distance,
waiting for the nurse to stop talking.
6.9 ​The nurse explained everything, despite the patient being only semi-conscious
after the surgery.
6.10 ​All trauma accident victims require fluids of one kind or another unless, of
course, the victim has only sustained light injuries.

Exercises on Prepositions
7.1 ​up on
7.2 ​in
7.3 ​under
7.4 ​over
7.5 ​out
7.6 ​in
7.7 ​up
7.8 ​towards
7.9 ​at
7.10 ​towards
7.11 ​towards / to
7.12 ​up
7.13 ​to

​Exercises on Punctuation: colons, semi colons, commas

8.1 ​The patient has been attending this Clinic for the past two years, complaining
of dyspepsia, GORD, hypertension and insomnia.
8.2 ​The patient has been suffering for the past week from a number of
complaints: a runny nose, bilateral headaches, dizzy spells and nausea.
8.3 ​The patient has been suffering, for the past week, from a runny nose, bilateral
headaches, dizzy spells and nausea.
8.4 ​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.

Exercises on Punctuation: using commas

9.1 ​I am referring the above patient, who presented today with a severe migraine,
for an EEG test.
9.2 ​This patient has been suffering from chonic pain for the past five days, and now
requires, I believe, surgical intervention.
9.3 ​Dental procedures done on this patient in the past have been protracted and
somewhat painful and, consequently, the patient has now become highly anxious.
9.4 ​The woman is suffering from post partum depression due largely to the
Caesarean section (performed without any problems), and her inability to understand
fully, because of language difficulties, why she had to have the procedure rather than a
normal delivery.
9.5 ​In the past, triage nurses have had overall responsibility for the patient’s care,
however, new legislation will change this.
9.6 ​As a discharge plan, Mrs Jones and her family need your help in her four hourly
pressure area care, her daily sponge bath, assistance with all care, and application of
Duoderm dressings, to a small pressure sore on the right buttock.
9.7 ​
I am pleased to refer the above patient with multiple myeloma, for
monitoring of her diet plan and medication.
9.8 ​I am pleased to refer Mrs. Brown, a 70 year old lady, non smoker, non
alcoholic , widowed, with 3 adult children, who lives alone, with symptoms and signs
of myocardial infarction, for further assessment and management.

Exercises on: tricky words

10.1 ​If you want my advice you will stay in bed.
10.2 ​I advised the patient to drink more fluids but he was non compliant.
10.3 ​The patient was advised to eat more fresh fruit.
10.4 ​I need you to loosen your tie.
10.5 ​Did you lose something?
10.6 ​Hospital gowns are very loose and revealing!
10.7 ​How long since you saw her last?
10.8 ​It has been a long time since I spoke to him – at least two years.
​10.9 ​Since that time many things have changed.
10.10 ​Since then the exam format has changed.
​ hat have you been doing since then ?
10.11 W
10.12 ​Since 2004 the patient has had many epileptic episodes.
10.13 ​The patient has had many epileptic episodes ever since he starting seeing me
​three years ago.
10.14 W ​ hen this patient came to see me three weeks ago, she was very
​anxious and confused.
Exercises on: Getting the verb tense right
11.1 ​The patient sat over there on that seat yesterday.
11.2 ​Last week, when I saw this patient, everything seemed fine.
11.3 ​I have explained everything to him.
11.4 ​I explain how to use the insulin syringe but he does not listen.
11.5 ​Whenever this patient tries to walk without the walking frame,
she becomes nervous and slides her feet along the floor.
11.6 ​It’s amazing how improved Mrs Jones was after just the first
​injection.

Exercises on: using appositives

12.1 ​Mrs Williams, a forty five year old with lupus, came to see me this morning.
12.2 ​This patient requires urgent surgery, if possible before noon tomorrow, in
order to prevent his inguinal hernia from increasing in size.
12.3 ​The nurse, having instructed the patient on the correct dosage and need to
​comply with the doctor’s instructions, left the Outpatients Department to go
​home.
12.4 I​ am referring the above patient, a sixty-three year old widowed woman, who
​is suffering from severe varicose veins, for vascular surgery as soon as possible.
12.5 T ​ he dental surgeon, having completed the operation, removed his mask and
gloves as he walked out the room.
​
Exercise: Using past participles
13.1 ​The patient had been very anxious when she arrived this morning.
13.2 ​The patient had a prolapsed disk.
13.3 ​Three years ago, the patient had had a laminectomy.
13.4 ​Last week, the patient had a laminectomy.
13.5 ​Mrs Jones has had much chronic pain over the last two years.
13.6 ​Mrs Jones had had chronic pain over the last two years, but with the new
analgesics she found relief.
13.7 ​Bert Smithers had a vasectomy last week.
13.8 ​Bert Smithers had had an appendectomy when he was only eighteen and now,
in his seventies, he had a prostectomy just last week.
13.9 ​We had a great time last Saturday at the party.
13.10 ​We have had many memorable office parties over the years.

Good luck with your OET Test – or IELTS Test. If you have any queries, please Email: info@oetworkshop.com
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