How to write an OET referral letter

The Occupational English Test writing component is frequently a referral letter. Having looked at the many official materials from the OET website, it is clear that they do not want candidates to follow any kind of “template” or set structure for their letters. However, even as a native speaker; I personally needed some guidance when I learned to write these letters as a medical student. I have now written hundreds of these in real life, I have helped OET candidates and I have studied the exam requirements in depth. This is my personal guide to how to write these letters!

Read the case notes!

This sounds really obvious and it is! You have only 5 minutes reading time and you need to use them wisely. Before you start reading the notes, make sure you fully understand the task, and be very clear WHO you are writing to and WHY (what do you want them to do). Keep these two things clear in your mind as you read the notes. Therefore, as you read, you can filter the notes in your head as to which information is most relevant.

For example, you may have a task of writing to a gastroenterologist (who) for a definitive diagnosis (why). In this case, complaints regarding other body systems (e.g. respiratory) are less relevant. Any provisional diagnoses mentioned in the case notes will be very relevant. However, if you are referring for urgent management, other information might be more relevant (current vital signs for example).

In this way, before your writing time has even begun, you have some idea about the structure and content of your letter.

The structure

There are many examples online as to how to structure the patient details/address etc. so I won’t go into that here. I am therefore focusing on the tricky bit; how to structure the letter itself, after “Dear Doctor Smith”

I’ve said it above and I’ll say it again, the OET examiners specifically do NOT want you to follow a strict template or structure. Therefore it is very important that you can adapt your structure to suit your specific case notes. Feel free to use your professional judgement based on your medical experience. However, this is the structure I use to write my professional referral letters, I think of it as STBR:

Situation

Timeline of events

Background

Recommendations

This is my personal adaptation of SBAR, a commonly used international communication tool for verbal handovers between professionals. Read on for what these headings mean and how to use them.

Situation

This is your opening paragraph and it should make the purpose of your letter incredibly clear! Be very specific as to who your patient is, the purpose of your referral and the urgency. For example:

I am writing to urgently refer this 55 year old female who has presented multiple times over the past month with worsening symptoms of angina. Please arrange appropriate investigations and manage accordingly.

The above succinctly gives the reader an idea of the patient; expresses urgency and clearly explains what you as the referrer wants the reader to do with the referral. This type of approach should help you score points for “purpose” and for “clarity” in the OET writing task

In real life, having a clear opening paragraph is also very important. This is because many referrals are initially read by the secretary of the department you are referring to. By making it clear what you want, the secretary will know how urgently to pass on the referral, and also will be able to redirect it to the appropriate department if necessary. Using the above example, if this letter was accidentally sent to a cardiologist specialising in arrhythmias, this could be easily redirected to the correct department to deal with chest pain.

Timeline

This is the part where you put all of the information about what has happened so far with the patient, that is immediately relevant for this referral. This is likely to represent the main body of your letter, and be at least 2 paragraphs.

It is in this section where you will discuss the patient’s symptoms, examination findings and any investigation results you have. These should be presented in a way to clearly describe the patient’s story and how it has evolved.

The information can either be presented in a “backwards” or a “forwards” direction depending on your opinion for each case. For example, with “forwards” you would start with when they first presented with relevant symptoms, and continue summarising the case notes up until the most recent presentation. With “backwards” you would start with how they presented most recently, then mention previous relevant presentations. There is no rule about which is better, it depends on the case which you feel is more appropriate. In general, if I am referring urgently about an acute problem I would start with today’s presentation and then say what has happened previously.

Remember to only include very relevant information to the reader here. Only things that are directly related to the referral should be mentioned.

Background

Here is where I would put any information which has some relevance but is not key information to the referral. For example, other past medical history, drug history, family history and social history. Some things in the above categories may be very relevant to the reader (for example, in angina, if the patient is a heavy smoker, has had a previous MI, or has an extensive family history). In this case I would mention these things in either the “Situation” or the “Timeline” sections.

It is also important not to include completely irrelevant background information. If normal, there is no reason to mention the height and weight of the patient for example. It can be useful to summarise “pertinent negatives” here. For example:

Mrs X is generally fit and well with no significant past medical history or relevant family history. She takes no prescribed medications. She is a non-smoker and works as an accountant.

The length of this section will vary depending on the case notes, but it would be unusual for it to need more than one paragraph.

Recommendations

This is the concluding paragraph to your referral. It is in this part where you say what you would like the reader to do. This may involve some repetition from the “Situation”. However, I would aim to change your wording and possibly be more specific. If the case notes have mentioned a provisional diagnosis then if you haven’t put it in the Timeline section I would put it here. It is very important for the exam that you do not try and diagnose the patient if it is not mentioned in the case notes. Don’t forget this is an English exam and not a medical exam!

Make this a short and to the point paragraph, summarising the very key information from the letter and making it very clear why you are referring and what you want the referrer to do. Try to avoid phrases such as:

“please review for further assessment and management”

While these phrases are correct and used in real life, the examiners want to see that you have interpreted the case notes correctly and that you can build your own relevant sentences. Refer back to the writing task to see exactly how they have worded what the referral is for. A better example would be:

“please take Mrs X under your care for immediate investigation and any necessary intervention”

The more specific the better!

The checking stage!

Whether in your practice letters or on the day of the exam it is absolutely vital that you check your work after you have finished writing. If possible, aim to read it over twice.

Firstly, read it from the perspective of the reader; the person you are referring to. Try and put yourself into the role of the person reading the referral. Is it clear what is being asked of you? Is there completely irrelevant information? Have you been told everything you need? This can help you make changes to help improve your letter.

Secondly, read your text checking for spelling and grammar errors. Particularly check areas you know you make mistakes. For example do you struggle with articles (a/the)? Are you using the correct tenses in your sentences? Don’t let small errors that you know how to correct cost you marks!

Now Practise!

I hope you have found this article useful. This is based on my personal opinion, but many students have told me they find this helpful. The best way to improve in the writing is by practising lots and lots of times! If you would like me to personally give feedback on any writing tasks you have prepared then get in contact with me! I would love to help you get the marks you need in the OET writing, as well as improving your writing skills for when you write a referral for real.