How to write non-adherence, alcohol use and refusals in an OET letter
Describe sensitive information in an OET Nursing letter as neutral, observable facts: what the patient did or said, how often, and what support has been offered, for example 'She has not been taking her insulin regularly' instead of 'She is non-compliant'. Include it only when it affects the reader's care, and avoid labels and blame such as 'refuses to cooperate' or 'alcoholic'.
Why sensitive details need careful wording
Case notes often contain information that is awkward to write about: a patient who stops taking their tablets, drinks heavily, smokes, misses appointments, refuses a test or argues with staff. Nurses read the notes and sometimes copy the shorthand: "non-compliant", "poor historian", "refuses to cooperate", "alcoholic".
In a letter to a colleague, those labels are a problem in two ways:
- They are unclear. "Non-compliant" does not say which medicine, how often or why.
- They sound judgemental. A professional letter describes behaviour and offers support; it does not blame the patient. This affects how appropriate the tone and register are for the reader, which is part of the Genre & Style criterion.
The rule: facts, frequency, reason, support
For any sensitive point, ask four questions:
| Ask | Example answer |
|---|---|
| What exactly does the patient do or say? | Has not taken metformin since March |
| How often or how much? | Most days |
| What reason did they give, if any? | Says it upsets his stomach |
| What has been offered or done? | Switched to a slow-release tablet; diabetes nurse referral |
Then write one or two sentences from those answers:
Mr Hale stopped taking his metformin in March because it upset his stomach. He has been changed to a slow-release tablet and referred to the diabetes nurse.
Labels to replace
| Avoid | Write instead |
|---|---|
| "She is non-compliant with her medication." | "She has not been taking her blood pressure tablets regularly." |
| "He is an alcoholic." | "He reports drinking about six cans of beer a day." |
| "He refuses to cooperate." | "He declined the blood test, saying he is afraid of needles." |
| "She is a heavy smoker." | "She smokes about 25 cigarettes a day." |
| "Poor historian." | "He was unable to recall his medicines or recent appointments." |
| "Difficult patient." | (Describe the specific behaviour that affects care, or leave it out.) |
| "He keeps missing appointments." | "He has missed his last two clinic appointments." |
| "She doesn't care about her diet." | "She finds it difficult to follow the low-salt diet." |
Notice the patterns: numbers instead of "heavy", "declined" instead of "refused", "reports" or "says" for information the patient gave, and a reason where the notes provide one.
When to include it, and when to leave it out
Include sensitive information when the reader needs it to act safely:
- Medicine adherence affects a dose change, a blood test or a home-support plan.
- Alcohol may affect withdrawal risk, falls risk, medicine interactions or a referral.
- Smoking matters for a cardiac, respiratory or wound-healing plan, or a stop-smoking referral.
- Missed appointments explain why follow-up is being arranged differently.
- A refusal tells the reader what has already been offered so they do not repeat it blindly.
Leave it out when it has no bearing on the plan: an old conviction, past drug use many years ago with no current relevance, or an argument with a ward visitor. Including irrelevant sensitive detail costs Content and Conciseness marks and may embarrass the patient. For general guidance, see how to select case notes and writing the social history.
Writing to the patient or family
If the reader is the patient or a relative, be even more careful. Use "you" or the person's name, keep it supportive, and focus on what will help:
Mrs Lane has found it difficult to remember her tablets in the evening. A pharmacist has arranged a weekly pill organiser, and it would help if you could remind her at dinner time.
See writing to a non-clinical reader.
Worked example (invented case)
Case summary (invented): Mr Gareth Hale, 61, lives alone, recently unemployed. Admitted 4 October with high blood sugar and dehydration. Background: type 2 diabetes, high blood pressure. Notes: "non-compliant with metformin – stopped March, GI upset"; "ETOH ~6 cans/day, wants to cut down"; "refused diabetes education session D2 – tired"; "DNA x2 diabetes clinic". Changed to slow-release metformin. Agreed to referral to alcohol support service. Diabetes clinic re-booked 25 October. Enjoys fishing. Discharge 9 October. Task: write to the GP practice nurse.
Weak version:
Mr Hale is non-compliant with his metformin and is an alcoholic. He refused diabetes education and never attends his appointments.
Improved version:
Mr Hale stopped taking his metformin in March because it upset his stomach, and he has now been changed to a slow-release tablet. He reports drinking about six cans of beer a day and has agreed to a referral to the alcohol support service. He declined a diabetes education session on the ward because he felt tired, and he has missed his last two diabetes clinic appointments; the next one has been booked for 25 October.
I would be grateful if you could check that he is tolerating the new tablet, offer diabetes education at his next visit and encourage him to attend the clinic.
The improved version gives the reader the same information plus the reasons and the plan, without a single label. Fishing is left out because it does not affect care.
Practise full letters under timed conditions at /writing/, or check your letter for sentence-level corrections and an estimated mark for Genre & Style.
Quick checklist
- Replace every label with what the patient does, how often and why.
- Use numbers for alcohol and smoking where the notes give them.
- Use "declined" and "reports" rather than "refused" and "claims".
- Say what support has been offered or arranged.
- Include it only if it changes what the reader does.
Related: formal tone and Genre & Style, mental health patient letters and medications in OET letters.
Sources
This guide is medEmu's writing advice, not official OET guidance or clinical advice; all patients and plans are invented for practice. The network used for this run could not reach oet.com, so no OET test facts are stated beyond the criterion names. For OET's official Writing information, see oet.com.