OET Writing is the sub-test where doctors most commonly fall short. The clinical knowledge is not the problem — it is the letter-writing format, content selection, and the six grading criteria that trip candidates up. Most failures come from a handful of repeated mistakes, all of which are fixable with awareness and practice. Here are the seven most common reasons doctors score below Grade B in Writing.
1. Writing a Case Summary Instead of a Letter
This is the single biggest mistake. Many doctors default to listing every finding, investigation, and result in chronological order — as if they were writing a medical record. But the OET Writing task is not a case summary. It is a letter to a specific reader for a specific purpose. A cardiologist receiving a referral does not need the patient's dermatological history. A GP receiving a discharge summary does not need every blood result from a seven-day admission.
Fix: Before you start writing, ask yourself: who is reading this, and what do they need to know? Select only the information that is relevant to that reader and that purpose.
2. Burying the Purpose
The purpose of the letter must appear in the first sentence. 'I am writing to refer Mr. Kumar for cardiology assessment' — not in the second paragraph after a summary of his medical history. Examiners check for purpose immediately, and a buried or absent purpose statement costs marks on two criteria: purpose and organisation.
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Fix: Write your opening sentence first, before you read the case notes in detail. 'I am writing to [refer/inform/request]...' forces you to lead with purpose.
3. Copying Case Notes Verbatim
Case notes use abbreviations, telegraphic style, and shorthand: 'Pt c/o SOB on exertion x 3/7, ECG NAD, troponin pending.' A letter must paraphrase this into professional prose: 'The patient has reported experiencing shortness of breath on exertion over the past three days. An ECG on admission was normal, and troponin levels are pending.'
Fix: Practise transforming case note language into letter language. Every time you encounter an abbreviation in the notes, write it out in full in your letter.
4. Exceeding the Word Count
The target is 180 to 200 words. Writing 250+ words signals poor content selection and conciseness — two of the six grading criteria. Every sentence should earn its place. If you can remove a sentence without changing the reader's understanding, it should not be there.
Fix: After writing your letter, count the words. If you are over 200, identify and cut the least essential detail.
5. Using the Wrong Tone
A referral letter is a professional communication between colleagues. It should not sound like a textbook ('Hypertension is defined as...'), a patient education leaflet ('You should eat less salt'), or a case presentation ('This is a 58-year-old male presenting with...'). It should sound like a senior doctor writing to another senior doctor.
Fix: Read Grade B sample letters aloud. Notice the professional but concise tone — neither formal nor casual, but clinical and direct.
6. Missing the Closing Request
A referral letter without a clear closing request is incomplete. 'I would appreciate your assessment and ongoing management' is sufficient. 'Thank you for seeing this patient' is vague. The examiner wants to see that you understand the purpose of the referral extends to what you want the reader to do.
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Fix: Write your closing before you finish the body. This ensures you do not run out of time and forget it.
7. Not Proofreading
Grammar errors, spelling mistakes, and missing articles ('the,' 'a') accumulate across a letter and drag down the language criterion. Many doctors write excellent clinical content but lose marks on avoidable errors because they do not leave time for proofreading.
Fix: Aim to finish writing in 35 minutes, leaving 5 minutes for proofreading. Read your letter once for content (does it make sense?) and once for language (are there errors?).
The Pattern Behind These Mistakes
Almost every OET Writing failure comes down to one underlying issue: writing as a doctor rather than as a communicator. The exam tests your communication skills, not your clinical knowledge. You already know the medicine — the challenge is selecting, organising, and expressing that knowledge in a concise, reader-appropriate letter. Shift your mindset from 'documenting everything' to 'communicating what matters,' and your Writing score will improve significantly.