“Which tense should I use?” Is a question that I have heard with regularity when preparing students for OET writing. More specific comments include: “If the patient still has the condition then it should be the present, right?
But he presented with the condition 5 weeks ago, so I should use the past… And what is the present perfect for, anyway?!”
The distinctions between present and past can often seem less than simple. When in the midst of writing that referral and discharge letters. And the decision on which tense to use can often be complex and highly context-dependent.
Here are some guidelines which should prove useful to help recognise which tenses best fit which situations.
1. Using the present simple (eg: do, make, come)
Starting with the easiest, the present simple will be used, in the context of OET writing, to report unchanging facts.
So, this should be at the beginning of the letter when you report the patient’s age, name, and status. For instance: “The patient is 49 years old. She is divorced and has two dependent children.”
This sort of information is true in the present and is not subject to change any time soon and can, thus, be regarded as an unchanging fact. Another example: “the patient is allergic to penicillin”. This is another fact which is not subject to change; hence, we use the present simple.
2. Using the past simple (eg: did, made, came)
Once you’ve provided the patient’s unchanging status and profile. The past simple is the tense you will most likely go on to use in your referral/discharge letter.
This is because the past simple provides background information which has been specifically linked to a past time period.
For example, “The patient first presented two months ago with a bowel complaint. Now, she displayed symptoms consistent with IBS.”
Here we are using the past simple for background because we are referring to something which occurred in the past.
The use of the time phrase “two months ago” tells us this. Other time phrases referring to the past such as “the previous month”, “last week”, “yesterday” will all also require the use of the past simple for the same reason.
Using the past simple tense doesn’t mean that the information is irrelevant to the present. It just means that the information is being presented in a context that is in the past and only in the past (“two weeks ago”, for example, cannot be the present). It may be developed and expanded upon in the following parts of the letter.
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3. Using the present perfect (eg: has done, has made, has come)
Very generally, the present perfect connects a past action or state to the present. Once you’ve given the background of the case, it is likely that you will move on to focus on elements of the situation. Although they began in the past, they are more clearly linked to the present.
This is likely to relate to more recent treatment or advice the patient has received, or more recent actions or attitudes which have been associated with the patient, which, as a result of their relevance to the present, may not carry a specific time marker.
Examples of this would be: “I’ve prescribed the patient propranolol to help control his anxiety.” or “The patient has responded well to treatment.”
Notice that in neither of these examples is a specific time phrase. Such as “two weeks ago” or “yesterday” included. This is because the intention of the writer is not to communicate this information as a background. Rather, he wishes to link a past event to the present to show its continued relevance to the current moment.
The writer is communicating that there has been no change in terms of relevancy from the past to the present in these cases.
But you can use time phrases like “for” and “since” to present perfect as both these prepositions can be used to link past and present actions.
For example: “The patient has received massage therapy for the last 5 months.” In this case, she received them in the past and receives them up to now.
4. Using the present continuous (eg: is doing, is making, is coming)
In contrast to the present perfect, the present continuous focus on the present action without relating it to the past.
We would tend to use the present continuous in our referral/discharge letters. When we want to communicate a piece of information which has occurred recently.
It will likely be something new that wasn’t occurring before. Which the medical practitioner will have to respond to or take into account in an active manner.
For example “The patient’s condition is deteriorating” or “The patient is refusing to take her medication”. Using the present continuous in these cases indicates that the situation in the present is different from the situation in the past. In the past, the patient’s condition was not deteriorating but now it is. In the past, the patient was not refusing to take her medication, now she is. The use of the present continuous provides some sort of distinction from/potential contrast to a previous situation. Its disassociation from the past is what makes it unique in its relevance to the present.
Use present simple for something which is unchanging/likely to be true for a long time (eg, patient’s profile).
Use past simple for background information set specifically in the past (eg, background to patient’s condition).
Use present perfect for information which links the past to the present (eg, responses to the patient’s condition which are consistent with the past which doesn’t have a specific time reference or use a time reference with for or since).
Use present continuous for current information which requires a present reaction or response and is likely to be different to the past (eg, developments in the patient’s situation which are distinct from/different to the past).
Choose the correct tenses to complete the referral letter.
Re: Mr Zach Foster, D.O.B: 25/10/96
I am writing to refer the aforementioned patient. A 22 year-old builder, who requires management of his unstable asthma.
In relation to the patient’s medical history. he 1.___________________(diagnose) with asthma aged 3. Which he 2.______________(treat) with Ventolin and Pulmicort (200 mg) inhalers. It is important to note that the patient 3.________________(be) a heavy smoker for the past four years. And there 4._______ (be) a positive family history of asthma as his sister 5.________(be) also asthmatic.
The patient 5._______________(present) on 11 /10/14 with a three-week history of wheezing. A cough that was disturbing his sleep. also to a shortness of breath. He 6.______________ (report) an increased use of his ventolin inhaler in response. A burning sensation was also reported. It 7.__________(be) not clear if he was regular and compliant with his medications. Upon conducting a chest examination, there 8.____________(be) no abnormality detected. His peak flow was (500L/Minute). I 9.______________(discuss) with the patient about a cessation of smoking. Blood tests and a chest x-ray 10.__________________(order).
On review today, Mr Foster reported that he 11.________________ (not take) Pulmicort. And that he 11._______________(still smoke). His chest-x-ray result was normal.
Based on the above information. I would appreciate it if you could advise this patient as you feel appropriate. It would also be advisable to assess his lung function.
If you need further information do not hesitate to contact me.
Re: Mr. Zach Foster, D.O.B: 25/10/91
I am writing to refer the aforementioned patient. A 22-year-old builder, who requires management of his unstable asthma.
In relation to the patient’s medical history, he 1.was diagnosed (past simple) with asthma aged 3 which he 2. treats (present simple) with Ventolin and Pulmicort (200 mg) inhalers. It is important to note that the patient 3.has been (present perfect) a heavy smoker for the past four years and there 4. is (present simple) a positive family history of asthma as his sister 5. is (present simple) also asthmatic.
Initially, the patient 5. presented (past simple) on 11 /10/14 with a three-week history of wheezing and a cough. That was disturbing his sleep. Besides the shortness of breath, he 6. reported (past simple) increased the use of his Ventolin inhaler in response. A burning sensation was also reported. Unfortunately, it 7. was (past simple) not clear if he was regular and compliant with his medications. Upon conducting a chest examination, there 8. was (past simple) no abnormality detected and his peak flow was (500L/Minute). I 9. discussed (past simple) with the patient about a cessation of smoking. Blood tests and a chest x-ray 10. were ordered (past simple).
On review today, Mr. Foster reported that he 11. is not taking (present continuous) Pulmicort and that he is still 11. smoking (present continuous). His chest-x-ray result was normal.
Based on the above information, I would appreciate it if you could advise and manage this patient as you feel appropriate. It would also be advisable to assess his lung function.
Please do not hesitate to contact me should you require further information.
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