Hydronephrosis Referral Letter Correction
This corrected OET referral letter follows a patient with severe hydronephrosis and a hepatic mass. Instead of showing only a polished model answer, the case compares the student’s original wording with the corrected version so you can see what changed and why.
What happened to Mr Tom Cribb?
Mr Cribb presented with severe right lower abdominal pain radiating to the groin and nausea. Ureteric colic was initially suspected.
His pain later resolved, but investigations showed an enlarged kidney. An abdominal ultrasound subsequently revealed a hepatic mass and severe hydronephrosis, prompting referral for specialist assessment and further investigation.
The student’s draft contains the main clinical information. The problems are mainly in word choice, medical collocations, sentence construction and the way the referral request is expressed.
What you can learn from this referral
The useful part of a correction is not simply seeing a better final letter. It is understanding why particular sentences were changed.
State the purpose precisely
The urologist should understand from the opening sentence what has been found and why specialist input is being requested.
Use natural clinical English
Expressions such as presented with, investigations demonstrated and specialist assessment are more appropriate here than conversational or directly translated alternatives.
Connect findings to the referral
The ultrasound result is not just another detail in the history. It explains why the patient now requires specialist assessment and further investigation.
The student’s opening and the corrected version
The student’s sentence communicates the general idea, but several small problems make the referral sound less natural and less precise.
Student version
I am writing to refer Mr Tom Cribb, a male patient with an abdominal mass and severe hidronephrosis that needs further investigation with a CT scan and specialist evaluation.
Corrected version
I am writing to refer Mr Tom Cribb for your specialist assessment of severe hydronephrosis and a hepatic mass requiring further investigation, including CT imaging and ongoing urological management.
What was corrected?
- “a male patient” was removed because it adds little to the referral purpose.
- “hidronephrosis” was corrected to “hydronephrosis”.
- “abdominal mass” became “hepatic mass”, which is more specific to the information given.
- “specialist evaluation” became “specialist assessment”.
- The sentence now links the findings directly to the reason for referral.
Corrected OET referral letter
Read the complete version first. The individual corrections are explained immediately afterwards.
Dr B. Comber
Urologist
Southport Hospital
Gold Coast
6 February 2026
Dear Dr Comber,
Re: Mr Tom Cribb, DOB: 23/05/1982
I am writing to refer Mr Tom Cribb for your specialist assessment of severe hydronephrosis and a hepatic mass requiring further investigation, including CT imaging and ongoing urological management.
Mr Cribb first presented on 12 May 2010 with severe right lower abdominal pain radiating to the groin, accompanied by nausea without vomiting. He denied haematuria, urinary frequency, fever and any history of trauma. On examination, his abdomen was mildly tender in the lower quadrants, with no guarding or rebound tenderness.
As ureteric colic secondary to renal calculi was initially suspected, analgesics were prescribed. In addition, he was advised to maintain adequate fluid intake and normal activity as tolerated before returning for review with the results of his intravenous pyelogram (IVP) and urological flow rate (UFR) investigations.
At review on 14 May 2010, Mr Cribb reported complete resolution of his pain and no new symptoms. However, investigations demonstrated an enlarged kidney without evidence of renal calculi. An abdominal ultrasound was subsequently arranged, which revealed a hepatic mass together with severe hydronephrosis.
Mr Cribb is currently unemployed following redundancy and is eager to return to work to help support his family. Given these findings, I would appreciate your specialist assessment, CT evaluation and further management.
Please do not hesitate to contact me if you require any further information.
Yours sincerely,
Doctor
What changed in the student’s letter?
Now compare the original wording with the corrected sentences. These are the changes that are most useful to understand and reuse in other OET referral tasks.
Presenting the referral purpose
Student version
I am writing to refer Mr Tom Cribb, a male patient with an abdominal mass and severe hidronephrosis that needs further investigation with a CT scan and specialist evaluation.
Corrected version
I am writing to refer Mr Tom Cribb for your specialist assessment of severe hydronephrosis and a hepatic mass requiring further investigation, including CT imaging and ongoing urological management.
Why change it?
The revised sentence removes unnecessary wording, corrects the spelling of hydronephrosis, uses the more precise hepatic mass and makes the requested specialist involvement clearer.
Describing the presenting complaint
Student version
The patient started to feel a very severe pain in the lower right abdomen that radiated to the groin, associated with nausea but no vomiting.
Corrected version
Mr Cribb presented with severe right lower abdominal pain radiating to the groin, accompanied by nausea without vomiting.
Why change it?
“Presented with” is concise and natural in clinical correspondence. The correction also removes “started to feel” and “a very severe pain”, producing a cleaner description of the presenting complaint.
Reporting the examination findings
Student version
During physical examination the abdomen presented mild tenderness in lower quadrants, no guarding or rebound.
Corrected version
On examination, his abdomen was mildly tender in the lower quadrants, with no guarding or rebound tenderness.
Why change it?
An abdomen does not normally “present tenderness” in this context. “The abdomen was mildly tender” is the more natural construction. Adding “rebound tenderness” also completes the clinical expression.
Explaining the initial clinical impression
Student wording
On the suspicion of ureteric colic secondary to renal calculi…
Corrected wording
As ureteric colic secondary to renal calculi was initially suspected…
Why change it?
“On the suspicion of” sounds awkward here. The corrected structure expresses the clinical reasoning directly and connects it naturally to the treatment that followed.
Giving advice about fluid intake
Student wording
drink a moderate amount of fluids
Corrected wording
maintain adequate fluid intake
Why change it?
The corrected phrase is shorter and fits professional healthcare correspondence more naturally.
Reporting the investigation results
Student version
The exams showed an enlarged kidney, but no stones. An abdominal ultrasound was ordered, and revealed a mass in the liver and a severe hidronephrosis.
Corrected version
Investigations demonstrated an enlarged kidney without evidence of renal calculi. An abdominal ultrasound was subsequently arranged, which revealed a hepatic mass together with severe hydronephrosis.
Why change it?
“The exams showed” is understandable, but “investigations demonstrated” fits written clinical communication better. “No stones” becomes “without evidence of renal calculi”, while “mass in the liver” becomes the more concise “hepatic mass”.
Medical English from this correction
These are not phrases to insert mechanically into every OET letter. They are useful examples of how everyday wording can be expressed more naturally in this particular clinical context.
| Student wording | Corrected wording | What changed |
|---|---|---|
| started to feel a very severe pain | presented with severe pain | More concise clinical phrasing. |
| the abdomen presented mild tenderness | the abdomen was mildly tender | Natural examination language. |
| On the suspicion of | As … was initially suspected | Clearer sentence construction. |
| drink a moderate amount of fluids | maintain adequate fluid intake | More appropriate clinical wording. |
| the exams showed | investigations demonstrated | More natural in written medical correspondence. |
| no stones | without evidence of renal calculi | More precise clinical terminology. |
| mass in the liver | hepatic mass | More concise terminology. |
| specialist evaluation | specialist assessment | More natural wording for this referral. |
How the clinical information supports the referral
The history is useful because it explains how the case progressed from suspected ureteric colic to findings that require specialist review. The important point is not simply to reproduce the chronology, but to make the relationship between those events easy to follow.
Initial presentation
Severe right lower abdominal pain radiating to the groin, together with nausea, explains why ureteric colic was initially considered.
Examination
Mild lower-quadrant tenderness without guarding or rebound adds relevant information about the patient’s presentation.
Initial management
Analgesia and follow-up investigations show what had already been done before the referral became necessary.
Investigation findings
The enlarged kidney, severe hydronephrosis and hepatic mass change the clinical picture and provide the immediate reason for specialist assessment.
What should stand out?
In this case, the investigation findings deserve particular prominence because they explain why the patient is being referred even though his pain had resolved by the time of review.
The student’s main problem was not missing clinical information
Most of the information needed for the referral was already present. The draft became weaker because several sentences sounded translated or conversational and because the specialist request could have been expressed more precisely.
Spelling
Hydronephrosis is an important term in this case, so repeatedly misspelling it is particularly noticeable.
Collocations
Knowing individual medical words is not enough. They also need to be combined naturally: presented with, on examination and specialist assessment.
Sentence control
Shorter, cleaner sentences make it easier to separate symptoms, findings, investigations and the referral request.
Use this case to check your own referral letter
After writing your next OET referral, review it once for communication and once for language rather than trying to correct everything at the same time.
First: check the communication
- Can the recipient understand the referral purpose immediately?
- Are the important clinical findings easy to locate?
- Does the history explain rather than obscure the reason for referral?
- Is it clear what you want the recipient to assess, investigate or manage?
Then: check the language
- Have you used natural clinical collocations?
- Are important medical terms spelled correctly?
- Can any translated or conversational expression be simplified?
- Are any sentences unnecessarily long?
Questions about this OET referral letter correction
Why was “started to feel” changed to “presented with”?
“Presented with” is concise and commonly used when describing the reason a patient sought medical attention. In this sentence it removes unnecessary wording without losing clinical information.
Why remove “male patient” from the opening?
The phrase does not help explain why Mr Cribb is being referred. Removing it allows the sentence to move directly from the patient’s name to the clinical problem and requested assessment.
Why change “the exams showed”?
The meaning is understandable, but “investigations demonstrated” is more natural in formal written clinical communication. The important lesson is not to make the sentence complicated, but to choose wording appropriate to the context.
Why is the ultrasound finding so important in this referral?
Mr Cribb’s pain had resolved, but the ultrasound revealed severe hydronephrosis and a hepatic mass. Those findings explain why further investigation and specialist assessment remain necessary despite the improvement in symptoms.
Should I memorise the corrected phrases?
Learn how the expressions are used rather than copying them into every letter. “Presented with” may be useful in many clinical histories, for example, but the correct wording always depends on the patient, recipient and purpose of the task.
Does a corrected model letter guarantee a particular OET Writing score?
No. A corrected example can show stronger choices in purpose, organisation and language, but an individual OET Writing result depends on the candidate’s performance on the assessed task.
Study more corrected OET referral letters
Comparing cases from different specialties helps you see which writing decisions remain useful even when the patient, recipient and clinical problem change.
Have a referral letter you want corrected?
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