OET Writing for doctors: the letter patterns

The OET Writing sub-test gives doctors 45 minutes: five to read a set of case notes, forty to turn them into a 180–200 word letter. Most doctors walk in believing this is the sub-test they least need to prepare for — they write clinical correspondence every working day. Then the practice-test scores come back a band lower than their Speaking, and the feedback is confusing: the grammar was fine, the medicine was right, and the mark still was not there.

Here is the uncomfortable truth the six-criterion scoring rubric encodes: OET Writing is not a test of medical knowledge, and it is barely a test of English. It is a test of selection — whether you can decide, under time pressure, what the reader needs and cut everything else. The case notes are deliberately overloaded with plausible-looking material so that candidates who transcribe rather than select run out of words, out of time, or both.

This post is the Medicine mirror of our nursing referral-letter patterns guide. The structural discipline is the same; what changes for doctors is the reader, the register, and — above all — the volume of clinical data you must refuse to include.

Why doctors specifically underperform here

Nurses tend to under-select — they include too little interpretation. Doctors reliably fail in the opposite direction, and for an honest reason: the case notes read like your own admission clerking, and you know what all of it means. Every abnormal result feels significant. Every medication change feels worth reporting. The discipline OET is testing is precisely the one ward rounds erode: writing for a reader who needs four facts, not a colleague who might quiz you on all forty.

Three case-note habits from real clinical documentation leak into OET letters and cost marks:

1. Telegraphic style. "Pt c/o SOB on exertion, worsening 3/52, PMH: IHD, T2DM" is perfect clerking and a genre error in a letter. The rubric's Language criterion expects full, connected prose.
2. Unexpanded abbreviations. OET's official guidance is to use only abbreviations any reader would know. When your reader is a physiotherapist or a social worker, "TFTs NAD" is not communication.
3. Data dumping as reassurance. Listing every normal result to show thoroughness. The Content criterion scores whether you included what the reader needs — and the Conciseness & Clarity criterion penalises the rest.

The diagnostic: identify the reader before you read the notes twice

Every Medicine task tells you three things in the task instruction: who the reader is, what they are being asked to do, and how urgently. Those three facts determine the pattern — and the pattern determines what 80% of your selection decisions will be before you have engaged with a single clinical detail.

Ask, in order:

1. Is the reader taking over care, or continuing it? Taking over → they need the story from the beginning. Continuing → they need only what changed.
2. Is the reader a doctor, another health professional, or a layperson? This sets register and how much clinical shorthand survives.
3. Is this urgent? Urgency inverts the structure: the request moves to the first line.

Four patterns fall out of these answers. Between them they cover nearly every Medicine task OET sets.

Pattern 1: referral to a specialist

The task: GP or ED doctor refers a patient to a specialist for assessment or management. The most common Medicine task by a wide margin.

What the reader needs: why this patient, why your specialty, why now. The specialist will take their own history — your letter's job is triage, not transfer of the entire record.

The skeleton:

• Opening: one sentence — who the patient is and what you are asking for. "I am referring Mr X, a 58-year-old teacher, with a six-week history of progressive exertional dyspnoea for cardiology assessment."
• Paragraph 2: the presenting problem's course — onset, progression, what you found, what you tried.
• Paragraph 3: only the background that changes the specialist's thinking — relevant comorbidities, relevant medications, relevant risk factors. The word is relevant, three times.
• Closing: the specific request, and any safety-netting already in place.

The selection trap in this pattern: the notes will contain an entire past medical history; usually two or three items matter to this referral. A cardiology referral needs the diabetes and the smoking; it does not need the childhood appendicectomy the notes offer you. Including it signals to the examiner that you transcribe.

Pattern 2: discharge letter to the GP

The task: hospital doctor writes to the patient's GP after an admission.

What the reader needs: what happened, what changed, and — the part that carries most of the marks — what you are asking the GP to do now. A discharge letter with no follow-up actions is a diary entry.

The skeleton:

• Opening: patient, admission dates, discharge diagnosis. One sentence.
• Paragraph 2: admission course, compressed. Presentation → key findings → treatment → response. Four sentences maximum; the GP does not need day-by-day obs.
• Paragraph 3: medication changes, stated explicitly. Started, stopped, doses altered — and why. This is the highest-yield paragraph in the entire pattern; ambiguity here is the error real clinical-safety literature is full of, and the examiners know it.
• Closing: the GP's tasks, itemised — repeat bloods at two weeks, titrate the ACE inhibitor, review if symptoms recur.

The selection trap: the admission notes are the longest OET gives, sometimes spanning a week of entries. Candidates who narrate chronologically drown. Select backwards instead: start from what the GP must do, then include only the events that explain those instructions.

Pattern 3: transfer of care to another doctor

The task: transferring a patient wholesale — patient moving cities, doctor retiring, care transferring between services.

What the reader needs: everything active, nothing resolved. The receiving doctor inherits ongoing management, so the letter is organised around problems, not around history.

The skeleton:

• Opening: who, and why care is transferring.
• Middle: one short paragraph per active problem — current status, current treatment, current monitoring rhythm. Two problems is typical; three is a heavy task.
• Closing: outstanding appointments, pending results, and the single thing that most needs watching.

The selection trap: resolved problems. The notes will tell you about the cholecystectomy in 2019 and the depression that remitted in 2022. If nothing about them is active — no ongoing drug, no surveillance requirement — they do not travel. This pattern punishes completeness-instinct harder than any other.

Pattern 4: the urgent letter

The task: ED referral, urgent admission request, or same-day specialist review. The task instruction will contain the word "urgent" or a same-day timeframe.

What changes: structure inverts. In patterns 1–3 you build context and then request; urgency puts the request and the red flag in the first sentence and lets context follow.

• Opening: "I am referring Mrs Y, a 72-year-old woman with suspected mesenteric ischaemia, who requires urgent surgical assessment today."
• Paragraph 2: the findings that justify the urgency — and only those.
• Paragraph 3: the minimum background that changes immediate management: anticoagulation, allergies, relevant comorbidity.
• Closing: what you have already done (analgesia, fluids, bloods sent) so the receiving team starts from your baseline, not from zero.

The selection trap: softening. Clinical training teaches hedged language — "possibly consistent with", "cannot exclude". In an urgent letter the rubric rewards the Purpose criterion being unmissable. State the suspicion and the timeframe plainly; save the epistemics for the discussion section of a paper.

The meta-skill: reading the notes backwards

Across all four patterns the highest-scoring candidates share one habit: they read the task instruction first, decide the pattern, and only then read the case notes — hunting for the material the pattern needs, rather than reading forward and deciding later what to keep. Reading forward makes every detail feel ownable; reading backwards makes irrelevance visible instantly.

A workable 5-minute reading routine:

1. Minute 1: task instruction. Reader, request, urgency → pattern chosen.
2. Minutes 2–4: case notes, marking only material the pattern's skeleton asks for.
3. Minute 5: number the marked items in the order the skeleton will use them. You now have a paragraph plan without having written a word.

Common pitfalls across all four patterns

• The 200-word panic. The window is 180–200 words and, as the scoring guide explains, moderate overshoot is not directly penalised — but needing 260 words is a symptom of failed selection, and selection is scored. Cut facts, not grammar words; telegraphic compression re-introduces case-note style.
• Copying case-note phrasing verbatim. The notes say "denies chest pain"; your letter should say "he reports no chest pain". Lifted phrasing is scored as weak language range, and examiners see the notes too.
• Writing to show medicine rather than to communicate. Adding differential diagnoses the reader did not ask for, or pathophysiology the GP already knows, spends words the Content criterion gives no credit for.
• Forgetting the letter is an instrument. Every OET letter exists to make one thing happen. If a colleague could read yours and not know what to do next, no quality of English will save the Purpose mark.

The next step

Patterns are learned by writing against them, not by reading about them. Take any Medicine practice task, run the 5-minute backwards read, name the pattern out loud, and draft to the skeleton. Then score yourself against the six criteria — or better, against a scorer that never gets tired.

OET Live's Writing practice runs this exact loop: timed case notes, the 180–200 word editor, and per-criterion AI scoring that tells you which selection decisions cost you — not just that something did. Doctors who train the selection discipline typically find the language marks follow on their own, because the words they were wasting on transcription come back as room to write actual prose. And if Speaking is the other half of your preparation, the doctor-specific Speaking guide applies the same principle to the role-play: the exam is testing the communication, never the medicine.