This case study demonstrates how an OET referral letter for severe hydronephrosis and a hepatic mass can be strengthened through clearer organisation, more natural medical English, improved clinical reasoning and more effective communication with the receiving urologist.
Mr Tom Cribb developed severe right lower abdominal pain radiating to the groin. Although ureteric colic was initially suspected, subsequent investigations identified severe hydronephrosis together with a hepatic mass, requiring urgent specialist assessment and further imaging.
The original referral contains the relevant clinical information, but awkward wording, inaccurate medical collocations and several language errors increase reader effort. This corrected version demonstrates how the same information can be presented more naturally while meeting the communication standards expected in OET Writing.
This referral illustrates a common challenge faced by many OET candidates. The clinical facts are appropriate, yet the language and organisation prevent the letter from communicating as efficiently as it could. Small improvements in structure and wording produce a much stronger referral without changing the underlying clinical information.
The opening identifies the patient's condition but delays the specialist request. The corrected version immediately explains why urgent urological assessment and further investigation are required.
Expressions such as "started to feel", "the exams showed" and "On the suspicion of" communicate the meaning but are not typical of professional medical correspondence.
The ultrasound findings fundamentally change the direction of the patient's management. Presenting these results more clearly helps the receiving specialist understand why urgent review is necessary.
The first paragraph should explain the purpose of the referral before presenting the supporting clinical history.
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.
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.
The revised version below preserves the original clinical information while improving purpose, organisation, professional register and language accuracy expected in higher-scoring OET Writing responses.
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
Both versions describe the same patient and the same clinical findings. The difference lies in how efficiently the information is communicated to the receiving urologist. The revised letter reduces reader effort while making the referral purpose much clearer.
Rather than introducing unnecessary wording, the corrected version immediately identifies the patient's current condition and explains why specialist assessment is required.
Receiving specialists often review many referrals each day. Identifying the clinical concern in the opening sentence allows them to understand the purpose before reading the supporting history.
The patient's symptoms, initial management, follow-up investigations and ultrasound findings are organised into separate paragraphs, allowing the clinical progression to unfold naturally.
The opening paragraph establishes the purpose of the referral before presenting the patient's clinical history. This allows the receiving urologist to understand immediately why the patient requires specialist review.
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.
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.
Referral letters should begin with the patient's current clinical problem rather than describing background information. Once the receiving clinician understands why the patient is being referred, the remaining information becomes much easier to interpret.
Many OET Writing candidates improve dramatically by analysing individual sentences rather than reading only the final corrected letter. The examples below illustrate how relatively small changes produce much more professional communication.
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.
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.
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.
Mr Cribb presented with severe right lower abdominal pain radiating to the groin, accompanied by nausea without vomiting.
During physical examination the abdomen presented mild tenderness in lower quadrants, no guarding or rebound.
On examination, the abdomen was mildly tender in the lower quadrants, with no guarding or rebound tenderness.
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.
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.
Professional healthcare communication generally uses terms such as investigations demonstrated or imaging revealed instead of conversational expressions like the exams showed.
The strongest OET referral letters rarely contain more information than average responses. Instead, they reduce reader effort through clearer organisation, more accurate medical collocations and concise professional language.
One of the most important OET Writing skills is deciding what information deserves priority. Higher-scoring referral letters organise information according to the recipient's clinical needs rather than simply following the order in which events occurred.
The original version generally describes events in chronological order. Although the clinical facts are relevant, the most important investigation findings do not receive enough emphasis until later in the letter.
The receiving specialist has to read several paragraphs before fully understanding why urgent assessment is required.
The revised version establishes the reason for referral immediately, then explains how the patient's symptoms, examination findings and investigations support the need for specialist management.
Effective referral letters present the patient's current clinical problem first, followed by the evidence supporting the referral.
The corrected referral answers the urologist's most important clinical questions in a logical sequence.
Current problem
1Reason for referral
2Presenting symptoms
3Initial management
4Investigation results
5Specialist request
6The patient's history explains how the diagnosis developed, but it should never overshadow the current reason for referral. The receiving specialist first needs to understand what has been found and what assessment is required.
Each paragraph in the corrected letter has a single clinical purpose. Separating different objectives allows the recipient to process the information much more efficiently.
The opening immediately explains why specialist assessment is required.
The patient's symptoms and examination findings establish the initial clinical picture.
Initial treatment and follow-up arrangements are summarised clearly.
The imaging findings naturally explain why referral is necessary.
The specialist is told exactly what assessment and management are requested.
The letter ends politely while inviting further communication if required.
Examiners assess not only what information you include but also how effectively you organise it. Presenting information according to clinical priorities significantly reduces reader effort.
Many candidates lose marks because their English sounds translated rather than naturally clinical. Learning common healthcare collocations makes referral letters read much more like authentic medical correspondence.
| Student wording | Issue |
|---|---|
| started to feel | Conversational English |
| the exams showed | Informal clinical wording |
| On the suspicion of | Incorrect medical collocation |
| drink a moderate amount of fluids | Awkward expression |
| specialist evaluation | Less natural than specialist assessment |
| Corrected wording | Benefit |
|---|---|
| presented with | Standard clinical collocation |
| investigations demonstrated | Professional register |
| As ureteric colic was suspected | Natural medical phrasing |
| maintain adequate fluid intake | Common clinical advice |
| specialist assessment | Typical referral terminology |
Higher-scoring OET referral letters do not rely on complicated vocabulary. They sound professional because they use familiar clinical collocations that healthcare professionals expect to read in everyday correspondence.
Many grammar mistakes in OET Writing do not completely change the meaning of a sentence, but they increase reader effort and reduce the professional quality of the communication. Small corrections collectively make a significant difference.
Most Band B and Grade A referral letters are not dramatically different from average responses. They simply avoid the numerous small grammar, collocation and organisational issues that gradually increase reader effort.
Based on the original draft, this referral would probably receive a score in the 320–340 range (Grade C+ / Borderline B). The purpose is clear and the information is relevant, but repeated language inaccuracies reduce the overall effectiveness of the communication.
Purpose
3.5 / 3.5Content
5 / 7Conciseness & Clarity
4 / 7Genre & Style
4 / 7Organisation
5 / 7Language
3.5 / 7The referral purpose is clear and the patient's clinical progression is easy to follow. However, awkward collocations, repeated spelling mistakes, informal expressions and several grammatical inaccuracies increase reader effort throughout the letter. More natural medical English and improved sentence control would likely raise the score into Band B.
The language issues found in this referral frequently appear in OET Writing tasks across many different specialties.
Expressions such as "started to feel" or "the exams showed" sound conversational rather than professional.
Using common clinical expressions such as "presented with" and "investigations demonstrated" creates more natural communication.
The important investigation findings should receive greater prominence because they explain the reason for referral.
Repeated spelling mistakes, particularly medical terminology such as hydronephrosis, reduce the Language score.
Professional healthcare correspondence should avoid informal transitions and direct translations.
The referral should explain precisely what assessment or management is expected from the receiving clinician.
These are some of the most common questions candidates ask after studying this referral correction.
"Presented with" is a standard medical collocation used routinely in referral letters and clinical documentation. It communicates the same idea in a more professional way.
Usually not. Once the patient's name and title are provided, describing someone as a "male patient" rarely adds useful clinical information.
Both expressions are understandable, but "specialist assessment" is considerably more common in healthcare correspondence written in UK English and aligns more closely with OET Writing conventions.
No model letter can guarantee a particular score. However, this version demonstrates communication principles commonly found in stronger OET Writing responses, including clearer purpose, improved organisation and more natural professional language.
Reading corrected examples is one of the best ways to improve your writing. Receiving personalised feedback helps you identify the specific language, organisation and communication issues preventing you from achieving the score you need.