Letter Writing TIps.pdf

Introductions There are a variety of ways to write introductions and with practice you can develop a formula that works for you. For the purpose of this document, the opening salutation and subject will be included as part of the introduction. Salutation: If the name of the person is included in the case notes then it should be used. This can be followed by either a comma or full colon. o o

Dear Dr. Wilson, Dear Dr. Wilson:

If the name of person is not mentioned then you can begin with Sir/Madam o

Dear Sir/Madam,

Subject: The subject is a place where information such as the name & age of the patient can be included. This can save you words in the body of the letter, but be careful not include too much information here, and definitely no phrases or sentences. Both Re & RE are acceptable. o o

Re: Dylan Charles D.O.B. 04/12/2009 RE: Dylan Charles D.O.B. 04/12/2009

Handy Tip 1 You can save on word length by added some detail after Re, such as the patient name and age. However, take care not to write too much here, and always use note form i.e nouns only (no articles, verbs, adjectives) Basically, the introductory sentence of the letter can contain the following:

1. Background information such as name, age, occupation, marital status

and gender of the patient if relevant and not mentioned in the subject line

2. A brief summary of the chief complaint, purpose of writing or your main concern It will usually be only 1 or 2 sentences long and detailed information about the patient's history and condition should go in the main body of the letter.

Important Grammar Rules The important patterns to learn are as follows: Example 1 Relative Clauses: A relative clause is a useful sentence structure to use in the introduction. It allows the write to demonstrate the ability to write a complex sentence, which is a basic necessity to get B grade of higher.

1. Thank you for seeing this patient. He presented at my clinic today. He has painful wisdom teeth. 2. Thank you for seeing this patient who presented at my clinic today with painful wisdom teeth.

Example 2 Appositives: This is a noun or a noun phrase that is placed after another noun to explain or identify it, and a comma is required to separate these nouns. It has a very important use in the introductory sentence of referral letters as in the example below.

1. I am writing to refer Mrs. Betty Booth. She is 68 years old. She is a

pensioner. She is a widow. She presented with a complaint of painful wisdom teeth. 2. I am writing to refer Mrs. Betty Booth, a 68-year-old widowed pensioner who presented at my clinic today with a complaint of a swollen cheek. Example 3 Age: There are specific rules regarding how to refer to a patient's age. The first is that it must be hyphenated when used before a noun such as man/woman, and the second is that an article is required. For more details refer to Year Vs Years in the Grammar and Vocabulary Clinic. • •

Incorrect I am writing to refer this patient, a 63 years old man who lives alone. I am writing to refer this patient, 63 years old man who lives alone.

Correct • I am writing to refer this patient, a 63year-old man who lives alone. • I am writing to refer this patient who is 63 years old and lives alone.

Handy Tip 2 Mastery of the patterns above will ensure that you start your letter on a positive note.

Sample Introductions Introduction Analysis Dear Dr. Howard,

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Re: Mr. Malcolm Latham DOB: 29/11/1985

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Thank you for seeing this patient who presented to my clinic today with the complaint of painful wisdom teeth.

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Dear Dr. Hope:

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I am writing to refer Mrs. Betty Booth, a 68-yearold widowed pensioner who presented at my clinic today with a complaint of a swollen cheek.

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Dear Dr. Kwang, Re: Mrs. Sheila Macbeth Thank you for seeing Mrs. Macbeth, a 74-year-old

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Does not include patient name or age as this is clearly stated after Re Uses relative clause sentence structure which demonstrates ability to use complex sentences Summarises the chief complaint Does not use Re. Therefore, includes a lot of background information concisely including full name, age, marital status and occupation Uses appositive and relative clause sentence structure which demonstrates ability to use complex sentences Note comma placement and use of relative clause Includes name written in shortened form Summarises the current situation and diagnosis

widow who has recently undergone a sleep study and was diagnosed with obstructive sleep apnoea in February 2010. Dear Doctor, Re: Christina Hollis DOB 20/03/1950

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Thank you for seeing this patient who presented at my surgery with a re- occurrence of inflamed gums and shiny red patches in the mouth, tongue and both the cheeks. Dear Dr. Lee, Re: Mr. Carl Racket DOB: 17/01/1950

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Does not include patient name or age as this is clearly stated after Re. Summarises the current condition of most recent visit

Purpose of writing stated clearly Informs that Mr. Racket is a mutual patient Summarises treatment required

I am writing this letter to seek advice from you regarding this patient’s cardiovascular status and medication prior to the commencement of surgery. Mr Racket, who is a patient of yours, requires surgical extraction of his lower left first molar.

Common Errors Incorrect

Correct

Dear Dr. Jones,

Dear Dr. Jones,

Re: Mr. Adrian Lamp DOB: 10/10/1965

Re: Mr. Adrian Lamp DOB: 10/10/1965

Thank you for seeing this patient. Mr. Adrian lamp presented to my clinic today with the complaint of painful wisdom teeth. Explanation: No grammatical errors, but it lacks sophistication in the use of simple sentences. Also, it repeats the patient name in full which is not necessary and repetitive since it was written directly above in the subject line. Thank you for seeing Mrs. Saunders, an 80-yearold dementia patient,presented to my clinic on 05/09/2008 with a complaint of loose upper partial denture. Explanation: Relative pronoun required. Dear Dr. Howell, Thank you for seeing Mrs. Jabore a 69-year-old lady who presented at my surgery today, complaining of swelling in her left cheek. Explanation: Incorrect comma usage Thanks for seeing Mr. David Lee who presented at my clinic today complaining of sever pain associated with the teeth 2.6 and 2.7. Explanation: Two errors. 1. Thanks is a casual expression. 2. common spelling error with sever I am referring Mr Roberts to you because he presented to my clinic today with a complain of a painful wisdom tooth. Explanation: Incorrect word form: Complain is a

Thank you for seeing this patient who presented at my clinic today with the complaint of painful wisdom teeth.

Thank you for seeing Mrs. Saunders, an 80-yearold dementia patient who presented to my clinic on 05/09/2008 with a complaint of loose upper partial denture. Dear Dr. Howell, Thank you for seeing Mrs. Jabore, a 69-year-old lady who presented at my surgery today complaining of swelling in her left cheek. Thank you for seeing Mr. David Lee who presented at my clinic today complaining of severe pain associated with the teeth 2.6 and 2.7.

I am referring Mr Roberts to you because he presented to my clinic today with a complaint of a painful wisdom tooth.

verb and the noun form is required here. Study Strategy When writing introductions, find a style which you like and use it for all tasks. However, take care to understand the basic grammar rules and always remember to include the chief complaint and/or purpose of writing. Practice writing introductions using the sample case notes provided in your course.

Body Paragraphs Most referral letters will contain 2 or 3 body paragraphs located between the introduction and the conclusion. Each of the paragraphs should have a main idea which the writer needs to convey to the reader. All the sentences with the paragraphs must relate to this main idea. The length of the paragraphs will vary, but an approximate guideline to meet the required word length of 180~200 words in OET is as follows: • • • • •

Introduction: 25 words Body paragraph 1: 40 words Body Paragraph 2: 40 words Body Paragraph 3: 70 words Conclusion: 25 words

Paragraph Structure A good paragraph will contain 3 main elements:

1. A Topic Sentence which introduces the reader to the main idea of the

paragraph. In many cases it will identify and/or summarise an area of concern regarding the patient. Quite often it is written in original words rather than from words in the case notes. 2. Supporting sentences which may contain the detail regarding patient history, descriptions of symptoms, significant aspects from the treatment record, causes and effects, trends and so on. Quite often this information can be taken directly from the case notes, and written as full sentences. However, you will need to paraphrase the information into your own words. This includes o Changing verbs to nouns: complain=complaint o Changing nouns to adjectives: diabetes=diabetic o Using synonyms o For more details on how to paraphrase, follow this link: Paraphrase 3. Signal words link sentences together so that the information flows smoothly and is easy to read. Common signal words which can help you present information clearly and logically include: o

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Time: At that time, On review today, On consultation today, Recently, Over the past 3 weeks...., Two weeks later, On her next visit, During, Since that time, Initial examination..., On 19/08/10... Location: During hospitalisation, Initial examination at my clinic revealed...,On examination....

o o o o o o

o o

More information: In addition, Moreover, Also, Apart from this.. Contrast: However, Despite, Although Result: Therefore, Consequently, As a result, For this reason... Emphasis: Please note, May I remind you, My main concern is...., What concerns me most is..... Sympathy: Unfortunately, Regrettably, Fortunately, Subject: In terms of her social history..., With regard to her medication....,Based on the blood test results....., Regarding her medical history....., Her dental history shows..., The risk factors include....., Treatment to date includes... Advice: It is important to..., I recommend that you....., Please ensure that.... Chronology: Firstly, Secondly, Finally,

Example 1

Case Notes

Paragraphs

Analysis

Medical History GP Dr Roslyn Andrews (07) 4568 2487 Hypothyroidism High blood pressure Medications: Thyroxine 150 mg daily, Karvea 150mg daily February 2010 diagnosed with obstructive sleep apnoea Weight loss advised along with dental consultation regarding mouth guard to control snoring. Dental History Patient at this practice for 35 yrs. Regular 6 month check-up, scale and clean Dental hygiene very good Amalgam fillings Adverse to needles - generally refuses to consider Good diet

Regarding her medical history, Mrs. Macbeth has hypothyroidism and a high blood pressure. She regularly takes Thyroxine 150mg and Karvea 150 mg daily. Her doctor has advised her to reduce weight and referred her to our clinic for assessment regarding the possibility of a mouthguard to control her snoring.

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Her dental history shows that she has regular dental check ups with scaling and cleaning twice a year. In addition, her oral hygiene is very good although amalgam fillings have been done.

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Examination 15/03/2010 All teeth present Amalgams fillings 16, 35, 36, 37, 46, 47 Gums in good condition Provided basic information on how mouth guard works and success rate claimed Advised necessity of a professionally manufactured and fitted mouth guard – not obtained from shop.

Today’s examination revealed no missing teeth in her oral cavity and most of the molars were filled with amalgam. In addition, her gums are in good condition. I have already explained to her about the mouth guard and how it works and the success rate after using it. I also advised her that a professionally manufactured and fitted mouthguard is the most suitable for her.

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Topic sentence is introduced with the phrase: Regarding her medical history Supporting sentences transform case notes into complete sentences The information is paraphrased

Topic sentence is introduced with the phrase: Her dental history shows Supporting sentences transform case notes into complete sentences Signal words connect ideas and express contrast o In addition, o although

Topic sentence is introduced with the phrase: Today's examination revealed..... Supporting sentences summarise case notes into complete sentences Signal words connect ideas and express contrast o In addition, o also

Example 2 Case Notes Medical history High blood pressure Type 2 Diabetes Smoker- Social Taking anti-depressants

Paragraphs Regarding her medical history, the patient is hypertensive and a type 2 diabetic. In addition, she takes anti-depressant drugs and has a habit of smoking.

Analysis •

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• Treatment Record 18/04/09 Edentulous Soft tissue healthy 20/04/09 Impression F/F (full upper and lower denture) 25/04/09 Bite registration mould/ shade selection A 3 30/04/09 Trial fit 10/05/09 Fit F/F

Mrs. Jabore initially presented at my clinic for a complete upper and lower denture on 18/04/09. At that time, an examination revealed healthy soft tissue. Two days later, I commenced with the impressions of full lower and upper denture and after 5 days bite registration along with shade selection were done, followed by try-in on 30/04/09. Complete dentures were delivered to Mrs Jabore on 10/05/09, the fit of which was good. 20/8/09 Today, the patient presents Examination with a soft fluctuant swelling Dry mouth. Occlusal wear on the left cheek which is and heavy calculus. Deposits painless and has been on F/F. Soft fluctuant increasing and decreasing in swelling left cheek increasing size over the last week. In and decreasing over last addition, an examination week. No pain. Suspected revealed there is occlusal salivary gland swelling. wear and heavy calculus Prescribed Amoxil 500mg. deposits on the upper and lower dentures. Moreover, Mrs. Jabore suffers from dry mouth. In my view, it is most likely a salivary gland swelling. Please note that I have prescribed amoxicillin 500mg.

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Topic sentence is introduced with the phrase: Regarding her medical history Supporting sentences transform case notes into complete sentences Displays paraphrasing techniques including use of synonyms and changing nouns to adjectives o High Blood Pressure:hypertensive o diabetes: diabetic Signal words connect ideas Topic sentence is introduced with the phrase: Mrs. Jabore initially presented..... Supporting sentences transform case notes into complete sentences Signal words create a clear time line o ...initially... o At that time, o Two days later, o ...along with... o ...followed by...

Topic sentence is introduced with the phrase: Today, Supporting sentences expand case notes into complete sentences including correct use of articles A wide range of signal words are used o In addition, o Moreover, o In my view, o Please note,

Some useful sentences for writing: •

Thank you very much for the referral of Peggy to our office for an orthodontic evaluation.

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Thank you very much for referring Courtney to our office for an orthodontic evaluation. We

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I saw Ann for a consultation appointment to present my diagnostic findings and recommended treatment. This letter and summary are to inform you of the pertinent findings and my recommendations for Ann.

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After a thorough examination, orthodontic concerns,…

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This letter is a review of the diagnosis and treatment plan we discussed at Carla’s recent orthodontic consultation. My evaluation of her teeth reveals:

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and

discussion

of

the

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I recently saw Carla for an Adjustment visit appointment. She presents with the following findings.

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Your patient, Carla Joiner, recently visited our office and will be undergoing orthodontic treatment. We completed a Full Phase orthodontic consultation for Carla that presented the following findings:

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Orthodontic treatment is definitely indicated and we recommended that comprehensive diagnostic records be taken. However, Jim decided not to schedule this appointment at this time. We have provided him with a report that includes our examination findings, preliminary treatment plan, appliance description, and recommended next step. We hope that this information will help to reinforce our discussion and enhance understanding of the problems. If Jim schedules an appointment for diagnostic records, I will be sure to summarize my complete diagnosis and treatment plan for you. After our discussion of the orthodontic problems, we decided to proceed with full diagnostic records, and we scheduled this appointment while she as here. Following our consultation

appointment I will provide you with a summary of our full diagnosis and treatment plan. •

At the appropriate time, we will take comprehensive diagnostic records and following our consultation appointment, I will provide you with the details of my diagnosis and recommended treatment.

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With pressure applied, both jaws elicited pain, a sign of inflammation. It appears that one or more teeth have failed to erupt normally. Probing between the teeth and gums found excessively deep pockets. Noticeable wear on the biting surface of some teeth was present. Prior trauma to the head and face may become a factor.

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After completing and evaluating Carla’s diagnosis, I developed the plan for her, outlined below:

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I recommend the following treatment plan:

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I suggest comprehensive orthodontic therapy addressing all noted problems. Removal of four premolar teeth. A removable upper expander which can be taken out for eating and brushing. An appliance to help resolve the previously mentioned oral habits. Removal of skin around rotated teeth to enhance long-term stability.

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I estimate Carla’s orthodontic treatment to be approximately 24 months. The actual treatment time will be largely dependent upon her cooperation, such as keeping teeth and appliances clean, avoiding hard or chewy foods, and keeping all appointments

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I have provided Peggy with a report summarizing my examination findings, and have enclosed a summary for your records. I have enclosed my examination findings and preliminary treatment plan. If you have any questions or comments, please do not hesitate to give me a call. During our discussion, I stressed the importance of Ann returning to your office for regular dental checkups and cleanings. We will keep her and your office reminded of when it is time for these appointments.

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Carla has been told the importance of keeping regular visits with you. If she fails to come in for an appointment, please

call our office and we’ll be glad to reinforce the importance of periodic checkups. •

If you have any questions about my findings or my recommendations against treatment, please give me a call. I welcome any comments or suggestions regarding Carla's treatment.. Thank you again for this kind referral.

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My goal is to provide the very best orthodontic treatment available, and part of this care includes keeping the lines of communication open with all of Ann's care providers. Your comments and questions will help me to provide this type of care. Thanks again for the privilege of working with you and your patients.

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I am referring Emily to your office for an evaluation. I have enclosed a summary of my diagnostic findings and treatment recommendations for your records. If you have any questions regarding Emily's proposed treatment, please give me a call. Once you have completed your evaluation, please forward copies of your findings for my records and contact me so that we may more fully discuss an appropriate treatment plan.

FORMAT FOR A REFERRAL LETTER - OET WRITING

Date your letter Dr Joe Bloggs Emergency Department Colac Hospital COLAC 3250

Please see p.2 of this formatted letter for examples of wording.

Dear Dr Bloggs Re

Catherine Robinson 75 y.o.

FIRST PARAGRAPH Short and sweet. Sums up what you want the specialist to do and why this person is being referred. NEXT PARAGRAPH Medical History History of medication taken over recent years. NEXT PARAGRAPH Current problem Current medication NEXT PARAGRAPH Any special “social / lifestyle” considerations that need to be advised. NEXT PARAGRAPH What do you want this specialist person to do? (Repeat – more fully – what was alluded to in the very first paragraph.) Do you want the specialist to examine and report back to you? Do you want him/her to make an assessment? Perhaps you are referring this patient to a hospital / rehabilitation unit / an aged care facility – to take over the care and management of this patient? Are you enclosing xrays or test results for this specialist’s information? FINALLY – Please do not hesitate to contact me if you require any further information. Yours truly, DOCTOR.