The question of "Which tense should I use?" is a common query we encounter while preparing students for the OET Writing test. Students often ask specific questions like, "If the patient still has the condition, should I use the present tense? But if he presented with the condition 5 weeks ago, should I use the past tense? And when should I use the present perfect?"

The distinctions between present and past tenses can be challenging, especially when writing referral and discharge letters. Choosing the appropriate verb tenses depends heavily on context and can be complex.

Here are some guidelines to help you recognise which verb tenses are suitable for different situations.

Using the present simple (e.g., do, make, come)

The present simple tense is used in OET Writing to report unchanging facts. This is typically done at the beginning of the letter when reporting the patient's age, name, and status. For example: "The patient is 49 years old. She is divorced and has two dependent children." Such information remains true in the present and is not subject to change, making it suitable for the present simple tense. Another example is "the patient is allergic to penicillin," which represents a fact that remains constant over time.

Using the past simple (e.g., did, made, came)

After providing the patient's unchanging status and profile, the past simple tense is commonly used to provide background information linked to a past time period. For instance, "The patient first presented two months ago with a bowel complaint, and displayed symptoms consistent with IBS." Here, the use of the past simple tense is indicated by time phrases like "two months ago," signalling events that occurred in the past but are relevant to the letter's context.

Using the present perfect (e.g., has done, has made, has come)

The present perfect tense connects past actions or states to the present. It is often used to discuss recent treatments, actions, or attitudes that remain relevant to the present moment. Time phrases indicating specific past moments are generally avoided in the present perfect tense. For example, "The patient has responded well to treatment" demonstrates an action with ongoing relevance to the present.

Notice that there is not a specific time phrase in this example. This is because the intention of the writer is to link a past event to the present to show its continued relevance to the current moment. 

You can use time phrases like “for” and “since” with 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, the patient received the therapy in the past and receives it up to now.

Using the present continuous (e.g., is doing, is making, is coming)

Unlike the present perfect, the present continuous tense focuses on present actions without direct reference to the past. It is used to communicate new or recent developments that require immediate attention or response from medical practitioners. For instance, "The patient’s condition is deteriorating" or "The patient is refusing to take her medication" highlight current situations that differ from previous ones. The present continuous tense underscores the distinction or contrast between past and present states, emphasising the active relevance to the current moment.

Recap

• 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 and don’t have a specific time reference).

• 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 different to the past).

Practice

Choose the correct verb tenses to complete the referral letter.

Dear Dr Williams,

 
Re: Mr Zach Foster, D.O.B: 25/10/96

 I am writing to refer the aforementioned patient, who requires management of his unstable asthma.

 In relation to the patient’s medical history, he 1.___________________(diagnose) with asthma aged three, 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.

 Mr Foster 5._______________(present) on 11 /10/14 with a three-week history of wheezing and a cough that was disturbing his sleep, as well as 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 and his peak flow was (500L/Minute). I 9.______________(speak) 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.

Yours sincerely,

Dr Lindsay

Answers

 Dear Dr. Williams,

Re: Mr. Zach Foster, D.O.B: 25/10/91

I am writing to refer the aforementioned patient, 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.

Mr Foster 5. presented (past simple) on 11 /10/14 with a three-week history of wheezing and a cough that was disturbing his sleep, as well as shortness of breath. He 6. reported (past simple) increased the use of his Ventolin inhaler in response. A burning sensation was also reported. 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. spoke (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.

Yours sincerely,

Dr. Lindsay