Compare an original OET referral letter for poorly controlled type 1 diabetes mellitus with an improved version and learn how clearer purpose, stronger organisation and more natural clinical language make the referral easier for the receiving endocrinologist to act on.
A general practitioner is referring Ms Tabitha Taborlin, a 45-year-old woman with poorly controlled type 1 diabetes mellitus, to an endocrinologist after recurrent diabetic ketoacidosis and ongoing difficulty adhering to treatment.
The main challenge is to present the clinical risk clearly, remove informal wording and explain why specialist diabetes management is now required.
The original letter includes relevant clinical information, but frequent spelling mistakes, grammar problems, awkward collocations and one clinically inaccurate statement increase reader effort and reduce the professional quality of the referral.
Expressions such as “a patient called” and “poor controlled type 1 diabetes” weaken the professional register from the first sentence.
Recurrent diabetic ketoacidosis and poor adherence are the strongest reasons for referral and should be made clear early.
Spelling errors, incorrect pronouns, awkward medical expressions and inaccurate wording around HbA1c reduce the reader’s confidence.
The opening paragraph should immediately identify the patient, the main clinical problem and the reason specialist input is required.
I am writing to refer to your clinic a patient called Ms Tarbolin, a 45 year old female with poor controlled type 1 diabetes.
I am writing to refer Ms Tabitha Taborlin, a 45-year-old woman with poorly controlled type 1 diabetes mellitus, for specialist assessment and optimisation of her diabetes management following recurrent episodes of diabetic ketoacidosis and persistent difficulty adhering to treatment.
This version keeps the original clinical meaning while improving accuracy, organisation, professional tone and the clarity of the specialist referral request.
Dr Sharon Farquad
Endocrinologist
Endocrine Specialists and Associates
115 Burke Street
Omaha
27 January 2026
Dear Dr Farquad,
Re: Ms Tabitha Taborlin, 45 years old
I am writing to refer Ms Tabitha Taborlin, a 45-year-old woman with poorly controlled type 1 diabetes mellitus, for specialist assessment and optimisation of her diabetes management following recurrent episodes of diabetic ketoacidosis and persistent difficulty adhering to treatment.
Ms Taborlin was diagnosed with type 1 diabetes mellitus at the age of seven. Due to poor adherence to treatment, she has experienced multiple episodes of diabetic ketoacidosis. Her medical history also includes essential hypertension. In addition, she is physically inactive, smokes approximately two cigarettes per day and is currently underweight at 48 kg, with a BMI of 18.2.
On 2 April 2018, she was admitted with diabetic ketoacidosis. Her blood glucose level was 550 mmol/L, and she was treated with intravenous fluids and insulin. She responded well to treatment and was discharged in a stable condition.
Despite her current stable condition, Ms Taborlin remains non-compliant with her insulin regimen and has not been following the recommended diabetic diet. She has received education regarding glucose monitoring, correct insulin administration and smoking cessation.
Given her history of recurrent diabetic ketoacidosis and ongoing difficulties managing her condition, I would appreciate your assessment for stricter glycaemic control and consideration of insulin pump therapy.
Please do not hesitate to contact me if you require any further information.
Yours sincerely,
Doctor
Although both letters describe the same patient, the revised version makes it much easier for the receiving endocrinologist to understand the patient's current situation, the reasons for referral and the management expected after specialist review.
The corrected opening explains exactly why the patient is being referred before introducing the supporting medical history.
The endocrinologist immediately understands that recurrent diabetic ketoacidosis and poor long-term diabetes control are the main concerns requiring specialist intervention.
Specialists often read referral letters quickly. Stating the referral objective in the opening sentence reduces reader effort and allows the remaining paragraphs to support that purpose naturally.
Instead of presenting information as a simple chronology, the corrected letter groups related clinical details together.
Grouping related information helps the receiving clinician locate important details quickly without repeatedly moving between different parts of the patient's history.
Many of the student's expressions communicate the correct meaning but do not sound natural in professional healthcare correspondence.
| Student wording | Improved wording |
|---|---|
| patient called | Ms Tabitha Taborlin |
| poor controlled diabetes | poorly controlled type 1 diabetes mellitus |
| insulin regime | insulin regimen |
| importance on | importance of |
| smoking cessation counseling | smoking cessation counselling |
One important improvement is the removal of the statement that the patient was discharged with a "stable HbA1c."
HbA1c reflects average blood glucose over approximately two to three months and cannot become stable during a short hospital admission. The corrected letter instead states that the patient was discharged in a stable condition.
Clinical inaccuracies can negatively affect the overall professional impression even when the grammar is otherwise correct.
The opening paragraph often determines how easily the receiving doctor understands the referral. Small improvements here can have a significant impact on the overall communication score.
I am writing to refer to your clinic a patient called Ms Tarbolin, a 45 year old female with poor controlled type 1 diabetes.
I am writing to refer Ms Tabitha Taborlin, a 45-year-old woman with poorly controlled type 1 diabetes mellitus, for specialist assessment and optimisation of her diabetes management following recurrent episodes of diabetic ketoacidosis and persistent difficulty adhering to treatment.
An effective referral letter begins with the patient's current clinical problem rather than simply introducing the patient. Once the receiving doctor understands why the referral has been made, the supporting clinical information becomes much easier to follow.
One of the fastest ways to improve your OET Writing score is to compare individual sentences instead of reading only the finished model letter. The examples below show how relatively small changes create clearer, more professional communication.
I am writing to refer to your clinic a patient called Ms Tarbolin, a 45 year old female with poor controlled type 1 diabetes.
I am writing to refer Ms Tabitha Taborlin, a 45-year-old woman with poorly controlled type 1 diabetes mellitus for specialist assessment and optimisation of her diabetes management.
Since 7 years old Ms Tarbolin has found herself diabetic.
Ms Taborlin was diagnosed with type 1 diabetes mellitus at the age of seven.
Due to poor adherence to the treatment he has experienced multiple episodes of diabetic ketoacidosis. Besides that, she has a history of essential hypertension, does not exercise, is a smoker (2 cigarettes a day), does not exercise and is currently underweight.
Due to poor adherence to treatment, she has experienced multiple episodes of diabetic ketoacidosis. Her medical history also includes essential hypertension. In addition, she is physically inactive, smokes approximately two cigarettes per day and is currently underweight at 48 kg, with a BMI of 18.2.
The patient responded well to the treatment and was discharged with stable HbA1Ac.
She responded well to treatment and was discharged in a stable condition.
The original statement about a stable HbA1c is clinically inaccurate. HbA1c reflects average glycaemic control over approximately two to three months and cannot become stable during a short hospital admission.
Considering the past medical history and the risks of complications; she needs a higher level of care, thus I refer her to your clinic for sticter glycemic control and possible insulin pump.
Given her history of recurrent diabetic ketoacidosis and ongoing difficulties managing her condition, I would appreciate your assessment for stricter glycaemic control and consideration of insulin pump therapy.
Many candidates believe that achieving a higher OET Writing score requires learning complex vocabulary or memorising templates. In reality, stronger referral letters usually result from dozens of small improvements in organisation, grammar, medical collocations and information selection. Each correction reduces reader effort and makes the communication more effective.
One of the most important OET Writing skills is deciding which clinical information deserves the greatest attention. High-scoring referral letters are not necessarily shorter—they simply present information in the order that best supports clinical decision-making.
The original draft generally presents information in the order it happened. While most of the important clinical details are included, the referral purpose competes with background information and language errors for the reader's attention.
The endocrinologist must continue reading before fully understanding why specialist management is being requested.
When the patient's history dominates the opening paragraphs, the receiving specialist has to identify the referral objective while simultaneously processing background information.
The revised version immediately establishes the patient's current problem before presenting the supporting history. Every subsequent paragraph explains why specialist endocrinology input has become necessary.
Nothing clinically important has been removed. The information has simply been reorganised according to the receiving clinician's priorities.
Good information selection is rarely about deleting details. It is about presenting those details in the order that helps the recipient make clinical decisions efficiently.
An endocrinologist reading this referral naturally wants the answers to several questions. The corrected letter addresses them in a logical sequence.
Current problem
1Referral purpose
2Relevant history
3Previous DKA
4Current management
5Specialist request
6Many candidates assume that including more medical information automatically improves an OET letter. In reality, additional details only help when they explain why specialist assessment or management is required.
In this case, the patient's long history of diabetes, recurrent diabetic ketoacidosis, poor adherence, hypertension, smoking and low BMI are all relevant because they justify referral for specialist diabetes management. Presenting these details after the referral purpose makes the communication much easier to follow.
Every paragraph in an effective referral letter should answer one clinical question. Mixing unrelated information forces the receiving doctor to work harder than necessary.
The opening immediately explains why the patient is being referred and what specialist assessment is required.
The patient's diabetes history and important risk factors provide the clinical context without distracting from the referral objective.
The diabetic ketoacidosis admission demonstrates the seriousness of the patient's condition and supports the need for specialist review.
The patient's ongoing non-adherence explains why previous treatment has not achieved adequate glycaemic control.
The endocrinologist receives a clear explanation of what assessment and treatment optimisation are being requested.
The letter ends with a courteous invitation to request further information while maintaining a collaborative professional tone.
Strong organisation not only improves communication but also contributes directly to the OET Writing assessment criteria. When each paragraph has a single purpose, the receiving clinician can understand the patient's situation with minimal reader effort.
One of the clearest differences between average and high-scoring OET referral letters is the use of natural healthcare English. Accurate grammar is important, but using the medical collocations that healthcare professionals expect to read makes the communication more fluent and more credible.
Several expressions communicate the intended meaning but sound unnatural or inaccurate in professional correspondence.
| Student wording | Why it weakens the letter |
|---|---|
| poor controlled type 1 diabetes | Incorrect grammar and medical collocation. |
| patient called | Informal wording for professional correspondence. |
| found herself diabetic | Not natural medical English. |
| insulin regime | "Regimen" is the correct medical term. |
| importance on glucose monitoring | Incorrect preposition. |
| doing well | Too conversational for a referral letter. |
| stable HbA1c | Clinically inaccurate after an acute admission. |
The corrected version replaces informal wording and awkward expressions with language commonly used in communication between healthcare professionals.
| Improved wording | Benefit |
|---|---|
| poorly controlled type 1 diabetes mellitus | Standard medical terminology. |
| I am writing to refer Ms Taborlin | Professional opening. |
| diagnosed at the age of seven | Natural clinical wording. |
| insulin regimen | Correct medical collocation. |
| importance of glucose monitoring | Correct grammar. |
| remains non-compliant | Professional clinical register. |
| discharged in a stable condition | Clinically accurate description. |
Learning complete medical expressions rather than individual vocabulary items helps your writing sound much more natural during the OET Writing exam.
Poorly controlled diabetes mellitus
Insulin regimen
Blood glucose monitoring
Diabetic ketoacidosis
Clinical stabilisation
Discharged in a stable condition
Specialist assessment
Optimisation of treatment
Ongoing endocrinology management
Candidates often believe that sophisticated vocabulary produces higher scores. In reality, examiners reward natural healthcare English that allows another clinician to understand the patient's condition quickly and accurately.
Most grammar mistakes do not completely change the meaning of a sentence, but together they increase reader effort. Correcting these small issues produces communication that is smoother, clearer and more professional.
Many candidates think they need to rewrite an entire referral letter to improve their OET Writing score. In reality, most improvements come from correcting dozens of small language decisions involving grammar, organisation, collocations and information selection. Together, these changes make the communication significantly easier for the receiving clinician.
OET Writing is assessed across six communication criteria rather than through a single overall impression. This correction demonstrates how improving organisation, language and information selection can strengthen every aspect of the referral.
Purpose
3 / 3Content
5 / 7Conciseness & Clarity
3 / 7Genre & Style
3 / 7Organisation
5 / 7Language
2.5 / 7The referral purpose is established immediately and the overall chronology is logical. However, numerous grammar mistakes, spelling errors, awkward medical collocations and several informal expressions substantially increase reader effort. One clinically inaccurate statement regarding HbA1c also weakens the professional quality of the communication.
Overall, this original draft would likely achieve an estimated score in the 280–310 range (Grade C+). Improving language accuracy, professional register and proofreading would significantly strengthen the letter.
Although every assessment criterion contributes to the final score, not all weaknesses affect communication equally. The comments below explain where this referral performs well and where the greatest improvements can be made.
The purpose is introduced immediately. The endocrinologist understands from the opening paragraph that specialist assessment for poorly controlled diabetes is being requested.
The referral objective is easy to identify from the beginning of the letter.
The patient's diabetes history, previous diabetic ketoacidosis, hypertension, smoking history and current management are all clinically relevant.
Presenting these details in a clearer structure would make the referral easier to follow.
Awkward wording, repetition and several long sentences reduce readability even though the intended meaning is usually understandable.
The communication would become much clearer by simplifying sentence structure and removing unnecessary repetition.
Several expressions sound conversational or translated directly from another language rather than reflecting communication between healthcare professionals.
Natural medical collocations are used inconsistently throughout the letter.
The information generally follows the patient's clinical history and finishes with an appropriate referral request.
Grouping related clinical information into clearer paragraphs would further reduce reader effort.
Frequent spelling mistakes, grammar errors, incorrect medical collocations and occasional clinical inaccuracies collectively reduce the overall quality of the referral.
Most language errors are individually minor, but together they create a noticeably less professional piece of clinical communication.
The problems identified in this diabetes referral appear frequently in OET Writing across many different medical specialties. Learning to recognise them will help improve future referral letters regardless of the clinical scenario.
Expressions such as "insulin regime" or "poor controlled diabetes" reduce the professional quality of the communication.
Incorrect verb forms, pronouns, articles and punctuation collectively increase reader effort throughout the referral.
Errors involving names, medical terminology and common English words negatively affect the Language criterion.
Phrases such as "patient called" or "doing well" sound conversational rather than professional.
Statements such as "stable HbA1c" after an acute admission reduce clinical credibility because they are medically inaccurate.
Simple spelling, formatting and punctuation errors could have been corrected before submitting the final referral letter.
Most OET referrals do not lose marks because candidates misunderstand the medicine. They lose marks because language problems make otherwise accurate clinical information more difficult for another healthcare professional to read efficiently.
Candidates preparing for OET Writing often encounter similar problems when writing referral letters for chronic disease management. The answers below explain the communication decisions demonstrated throughout this correction.
The original letter identified the referral purpose, but the language was unnatural and contained several grammatical errors. The corrected version immediately explains why the patient requires specialist endocrinology assessment while using professional healthcare English.
Healthcare professionals would normally identify the patient directly rather than writing "a patient called...". A more natural opening is simply "I am writing to refer Ms Tabitha Taborlin...".
Although the words are similar, regimen is the accepted medical term describing a treatment plan. Using the correct collocation makes the referral sound more natural and professional.
HbA1c reflects average blood glucose control over approximately two to three months. It would not become "stable" during a short hospital admission for diabetic ketoacidosis. Describing the patient as being discharged in a stable condition is both clinically accurate and more appropriate.
Yes. OET Writing assesses communication between healthcare professionals. Appropriate medical terminology improves clarity provided it is used naturally and accurately.
No model letter can guarantee a particular score because examiners assess the complete response using the official OET Writing criteria. However, this corrected version demonstrates communication principles commonly associated with higher-scoring letters, including a clear purpose, logical organisation, concise information selection and natural professional language.
Although this case focuses on a patient with poorly controlled type 1 diabetes mellitus, the lessons extend well beyond endocrinology. Every effective referral letter depends on the same core principles: a clear purpose, logical organisation, appropriate information selection and natural professional language.
As you compare referral letters from different specialties, these communication patterns become easier to recognise and apply independently during your own OET Writing exam.
If you're unsure why your referral letters aren't achieving the score you need, personalised feedback can show you exactly where your purpose, organisation, language, register and information selection need improvement before your next OET Writing test.