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 Dear Dr. Wilson, o 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 Re: Dylan Charles D.O.B. 04/12/2009 o 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 line2.
A brief summary of the chief complaint, purpose of writing or your main concernIt 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 widowedpensionerwho 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
Correct
•
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.
• I am writing to refer this patient, a
63-year-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,
Re: Mr. Malcolm Latham DOB: 29/11/1985 Thank you for seeing this patient who presented to my clinic today with the complaint of painful wisdom teeth.
• 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 Dear Dr. Hope:
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.
• 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 Dear Dr. Kwang,
Re: Mrs. Sheila Macbeth
Thank you for seeing Mrs. Macbeth, a 74-year-old
• Includes name written in shortened form • Summarises the current situation and
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
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.
• Does not include patient name or age as this is clearly stated after Re.
• Summarises the current condition of most recent visit
Dear Dr. Lee, Re: Mr. Carl Racket DOB: 17/01/1950
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.
• Purpose of writing stated clearly • Informs that Mr. Racket is a mutual
patient
• Summarises treatment required
Common Errors
Incorrect
Correct
Dear Dr. Jones,
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.
Dear Dr. Jones,
Re: Mr. Adrian Lamp DOB: 10/10/1965
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-year-old dementia patient,presented to my clinic on 05/09/2008 with a complaint of loose upper partial denture.
Explanation: Relative pronoun required.
Thank you for seeing Mrs. Saunders, an 80-year-old dementia patientwhopresented 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.
Explanation: Incorrect comma usage
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.
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
Thank youfor seeing Mr. David Lee who presented at my clinic today complaining
ofseverepain 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 complain of a painful wisdom tooth.
Explanation: Incorrect word form: Complain is a
I am referring Mr Roberts to you because he presented to my clinic today with acomplaintof 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 includeso 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 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... o Location: During hospitalisation, Initial examination at my clinic
o More information: In addition, Moreover, Also, Apart from this.. o Contrast: However, Despite, Although
o Result: Therefore, Consequently, As a result, For this reason... o Emphasis: Please note, May I remind you, My main concern is....,
What concerns me most is...
o Sympathy: Unfortunately, Regrettably, Fortunately,
o 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...
o Advice: It is important to..., I recommend that you..., Please ensure that....
o 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.
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.
• Topic sentence is introduced with the phrase: Regarding her medical history
• Supporting sentences transform case notes into complete sentences • The information is
paraphrased
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
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.
• 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 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.
• 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
Paragraphs
Analysis
Medical history High blood pressure Type 2 Diabetes Smoker- Social Taking anti-depressants
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.
• 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 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.
• 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...
20/8/09 Examination
Dry mouth. Occlusal wear and heavy calculus. Deposits on F/F. Soft fluctuant swelling left cheek increasing and decreasing over last week. No pain. Suspected salivary gland swelling. Prescribed Amoxil 500mg.
Today, the patient presents with a soft fluctuant swelling on the left cheek which is painless and has been increasing and decreasing in size over the last week. In addition, an examination revealed there is occlusal wear and heavy calculus 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.
• 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,