Chapter 1

What’s new in the UPDATED OET

SPEAKING TEST?

There are no changes to the format of the Speaking sub-test. However, new assessment criteria are being
introduced from September 2018 which has been discussed in detail below.

Speaking Sub-Test Overview

The speaking sub-test takes about 20 minutes. It is a profession-specific test in which the candidates are
required to complete two role plays based on typical workplace situation. The candidates take this part of
OET using materials specially produced for their profession. In other words, you would be enacting the
role of a nurse and will be expected to demonstrate the ability to deal with situations that occur
realistically in the workplace. For instance,

• Asking questions to the patient.

• Answering the patient’s questions

• Engaging with a variety of patient types, e.g., different ages, various health problems,
different concerns.
• Explain medical conditions and treatments in a clear and accessible way.
• Rephrase ideas in a variety of ways to help or persuade a patient.
• Reassure a worried or angry patient.
The interlocutor will take on the role of a patient or in some cases, a patient’s caregiver or family
member.

Structure of the test

Initially, there is a short warm-up talk about your professional background following which you are given
two role-plays, one by one, and you have 3 minutes to prepare yourself for each role play. The interview
is recorded, and two different assessors in Australia then assess the recording. The interlocutor is not
assessing you. Each role play is 5 minutes long.
Updated Assessment Criteria-Speaking sub-test

Linguistic criteria (6 marks Communication criteria (3

each) marks each)

Intelligibility Relationship building

Fluency Understanding and incorporating the patient’s

perspective

Appropriateness of language Providing structure

Resources of grammar and Information gathering

expression

Information giving

Linguistic Criteria
Intelligibility – how well your speech can be heard and understood. It includes pronunciation, intonation,
stress, rhythm, pitch, and accent*.

TIPS
• Consider each aspect that makes up this criterion: not just pronunciation, but also use of stress
to emphasize the most important

information, and use of intonation to signal whether you are asking a question or making a
statement.

• Practice the pronunciation in English of common words and phrases used in your profession.

Fluency – how your speech is delivered in terms of the rate (speed) and natural flow of speech.

TIPS

• Speak at a natural speed. If your speech is too slow, the listener might feel frustrated while
waiting for you to finish or may lose the flow of the argument. Similarly, if the speed is too fast,
it might difficult for the listener to comprehend.

• Pauses contribute to an improved understanding- therefore, use pauses effectively in your

speaking. Please refer to the example in this book to understand how pauses can be used
effectively during your OET Speaking.

• Aim for even speech [not broken up into fragments] – reduce excessive* hesitation or speaking
in ‘bursts’ of language or excessive self-correction or fillers.
*The word excessive here is used because some repetition or hesitation or self-correction or
during speech is natural and is acceptable. However, if these have an impact on your ability to
be understood, then your score will be affected.

Appropriateness of language – including the use of suitable professional language and the
ability to explain in simple terms as necessary and appropriately, given the scenario of each
role-play.

TIPS

• Practice explaining medical and technical terms and procedures in an appropriate

language (non-medical words) to patients. For instance, giving general advice for
good health about diet, losing weight, care of wounds, smoking cessation, etc.

• Consider how your language will need to be adjusted to suit the patient type and
context. For example, consider how your tone, pitch, and language will vary when
you are delivering bad news to a patient or when speaking to an angry or withdrawn
or depressed patient.

Resources of grammar and expression – including the accuracy and range* of the language
used; how effectively and naturally you can communicate in a healthcare setting.

TIPS
Demonstrate your ability by paraphrasing or different phrases to communicate the same idea
to the patient.

Make sure you can form questions correctly (word order) – particularly those questions that
you often use with patients while investigating the presenting complaint or taking medical
history [‘How long...?’, ‘When’].

TIP:

*Choose to demonstrate a range of grammar in your OET Speaking. A student who chooses
to use simple grammar and does not make any mistake is not likely to get a high score in the
Speaking sub-test. In other words, to score a high grade in the OET exam, it’s not enough to
make any mistakes (accuracy), you will also need to use a variety of grammatical struc
Communication criteria
Relationship building consists of 4 sub-criteria
 Initiating the interaction appropriately

Greeting your patient in a friendly, confident, and welcoming manner to establish

rapport

 Demonstrating an attentive and respectful attitude

Seeking patient’s permission or consent before asking questions or moving on during

the consultation.

 Being sensitive to patients when talking about embarrassing matters

Adopting a non-judgmental approach

 Being accepting and respectful towards patient views and avoid making any
judgmental comments or statements

Showing empathy for feelings/predicament/emotional state

Understanding and incorporating the patient’s

perspective consists of 3 sub-criteria
1. Eliciting and exploring patient’s ideas/concerns/expectations – this means finding out
more about patient’s perspective or feelings of their illness and, if required,
encouraging elaboration by asking follow-up questions. Once the patient’s worries or
anxieties are known, it’s easier to reassure them and construct an effective
management plan.

2. Picking up patient cues like hesitation, change in volume or tone, pauses and using
verbal facilitation techniques like using reflecting statements to encourage patient
participation.

3. Relating explanation to elicited concerns or expectations- this means using patient

perspective when providing information later. For example: let’s assume your patient
says that it’s hard for her to take time off from work and she’s concerned that she
might be diagnosed with something that will have a significant impact on her life.
When you are explaining the treatment advice, you could say “I know that you have a
busy schedule, and you are concerned about making any big changes to your routine.
So, I suggest that we take small steps to manage this condition.”
Proving structure consists of 3 sub-criteria
1. Sequencing the interview purposefully and logically – Controlling the direction of the
conversation and sequencing the conversation logically and purposefully. That being
said, it needs to be balanced with a patient-centered approach.

2. Signposting changes in the topic – use discourse markers to move from one task to
another.

3. Using organizing techniques in explanations (outlined below)

Categorization, i.e., forewarning about categories about to be provided. For example, Let’s
first talk about your medical history and later I’d like to ask some questions about your routine
including eating and sleeping habits.

Labelling – attaching a label to the “advice” to persuade your patient. It’s imperative that you
take some steps to control your weight. OR

It’s vital that you cut down your drinking.

It’s imperative that you take your medications on time to recuperate.

Chunking – Breaking down the information into chunks and giving it to the patients in small
increments and allowing them time to absorb each block of information.

Repetition – repeating the information and summarizing at the end.

For example:

To summarize what we have discussed today,….

Just to go over what we have discussed today,…

summarizing gives the patient an opportunity to clarify details, make corrections and add
further contributions

Information gathering consists of five sub-criteria

1. Facilitating the patient’s narrative using active listening, Back- channeling, using
echoing statements to encourage patient participation, paraphrasing and reflecting
statements.

2. Using initially open questions appropriately moving to closed questions. This is

commonly referred to as the cone technique. In this book, you will also learn about
using focused questions and probes to gather information from the patient.
 3. Not using compound/multiple or leading questions – explained later in the book in the
section titled “What not to do during history taking in this book.”

4. Clarifying statements which are vague or need amplification.

For example:

• Could you please explain what you mean by........................?

• I am sorry, but I missed the last sentence. Could you please repeat it?

• Here’s what I have understood,..........................................................Is that correct?

1. Summarizing information to encourage connection and invite further information

For example: So, what you are saying is……..Is that an accurate summary or would you add
something to that?

Summarizing provides the patient with an opportunity to clarify details, make corrections and add
further details.

• To go over what you have told me,.........................Is that an accurate summary?

Summarizing would give your patient an opportunity to clarify details, make corrections, and
add additional information if necessary.

Information giving consists of 5 sub-criteria

1. Establishing initially what the patient already knows – This means assessing what the
patient already knows and giving information accordingly. Find out what the patient
knows and has experience of to understand what and how much more they want to
know. It will also assist you in providing the correct amount and type of information to
the patient.

2. Periodically pausing when giving information, using the patient’s response to guide
next steps – Use ‘chunking and checking’ to provide information in small blocks of
information and then checking the patient’s understanding before proceeding further.
This helps the patients in retaining and recalling the information better. Don’t forget to
clear and simple language, avoiding any medical jargon, when giving information to the
patients, and use the patient’s responses as a guide to decide what information to supply
next.

3. Encouraging patient to contribute reactions/feelings – This means encouraging active

participation from the patient and allowing them to ask questions, express doubt, or
seek clarification regarding the information.
 4. Checking whether the patient has understood information –Use statements like “To
ensure that you have understood everything correctly, would you mind repeating back
to me what we have discussed?” to check the patient’s understanding.

5. Discovering what further information, the` patient needs – This means asking directly if
the patient would like to know additional details.

For example: Are there any other questions that I can answer?

 To enhance active patient participation, employ patient engagement techniques and use
more open-ended questions to elicit information regarding patients’ needs and
preferences, and encourage patients to ask questions.

 Use tools such as the teach-back method to determine whether patients understand the
risks, benefits, and alternatives to treatment. Teach-back can help to focus patients and
clinicians on what’s important.

 Make use of everyday language instead of medical jargon in communicating with

patients or substitute decision-makers.

Remember that OET is a test of English-language skills – NOT a test of professional

knowledge. The medical information needed to carry out the role- play is provided on the cue
card. The role-play is designed so that knowledge of a medical condition or treatment will not
advantage or disadvantage you in any way. You will be assessed on how effectively you deal
with the communicative situation on the card, NOT on your knowledge of the specific
medical topic.

General Tips

 The introductory section of the Speaking sub-test is not assessed. Use this time to
“warm up’ and get used to speaking to the interlocutor. During this time, ask the
interlocutor if you have any questions about what a word/phrase means, how it is
pronounced, or how a role-play works.

 When preparing for the OET test, practice using the communicative functions that you
are likely to need in any consultation context: explaining, summarizing, clarifying,
eliciting information, reassuring etc.

 Speak loudly and clearly at a natural speed.

 You are allowed to make notes on the cue-card and keep it with you while performing
the role-play.
 Take time to read through the role play card carefully.

 Don’t follow a formula for the role-play that may not be appropriate –

 e.g. sometimes you do not need to introduce yourself because it is clear you know the
patient already.

 Use the notes on the role card to guide the role-play: What is your role?

 What role is your interlocutor playing patient, parent/son/daughter, carer?

 Where is the conversation taking place? What is the current situation?

 How urgent is the situation?

 What background information are you given about the patient and the situation?

 What are you required to do?

 What is the primary purpose of the conversation [e.g., explain, find out, reassure,
persuade]?

 What other elements of the situation do you know about? [E.g. The patient appears
nervous or angry; you don’t have much time].

 What information do you need to give the patient?

 Take the initiative to start the roleplay yourself.

 Don’t worry if the interlocutor stops the role-play after five minutes – there is no
penalty for not completing all the elements on the role card.
 Chapter 2

Useful Skills for OET Speaking Test

Step 1
The first step is introducing yourself and your role in a confident and friendly manner. It
helps in establishing rapport with the patient.

(Note: At times, your cue card may suggest that you already know the patient, so an
introduction would not be necessary; however, you may still ask how your patient will prefer
to be addressed).

This depends on how you greet your patient and introduce yourself, ensuring that you
have clarified your role.

For introducing yourself, you may use the following:

• Hello, my name is (your name here), and I will be your attending nurse today.

• Hello, my name is (Your name here), and I am one of the Registered Nurses in
this facility.

• Hello, my name is (Your name here), and I will be looking after you today.

Your introduction will match the setting of the roleplay. If the setting is in the Emergency
Department, you could say:

• Hello, my name is Gurleen, and I am one of the Registered Nurses on duty today.

Some of the settings commonly used in OET role plays are:

• Medical Centre

• Community Health Centre

• General Practice

• Emergency Department of a hospital

• Home visit to a patient’s house

 • Hospital outpatient department

• School

Use a polite and welcoming opening like:

“Good morning/good afternoon” My name is ,

and I will be your attending nurse today.

“Good morning/good afternoon” My name is ,

and I am one of the Registered Nurses in this facility.

Next step would be to ask the patient’s name.

• Can you give me your name, please?

Then, ask how he/she would like to be addressed.

Some people prefer to address the patient as “sir” or “ma’am,” using this language can feel
systematic, as though you are following a script.

The student should ask the patient what he/she would prefer to be called (first name or last
name).

This is merely a matter of courtesy and respect as some people prefer to be called by their
first names while others prefer to be addressed as Mr. or Mrs. followed by their last name.

• How may I address you?

• What do you prefer to be called?

NOTE: In some cases, you may already know the patient (for instance when the patient is
returning for a follow-up visit or has been admitted to the hospital ward). In those cases, an
introduction may not be necessary. During the preparation time, you could ask the interlocutor
what he/she would prefer to be called, and begin the role play.

For example:

• Good morning David, how are you feeling today?

• Good afternoon Samantha, how are you doing today?

Alternatively, you could say:

• May I confirm your ID details with you. Please confirm your first and last name for
me.
Step 2
Use the background information to understand what you already know about the patient’s
current situation and use this to formulate the initial question or statement. In other words, the
opening statement or question should match the background information on the cue card.

For instance, if you are meeting the patient for the first time, use the following open-ended
questions to open up the discussion.

Use open-ended questions like:

• What brings you here today?

• What would you like to discuss?

• How can I help you today?

• How may I assist you today?

• I see that you rang the buzzer. What can I do for you? (When the patient is admitted
to the hospital).

Use a closed-ended question when you already know the reason for patient’s visit, or it’s a
follow-up visit?

For instance:

• Am I right in thinking that you have been referred by your doctor to discuss
regarding your weight/smoking/hypertension? (Depending on the cue card)

• Am I right in thinking that you have come here about your arthritis?

• Am I right in thinking that you are here to talk about your hypertension?

Use the background information in the cue card to identify clues or elements which can form
the basis for your opening question. For instance- if the cue card states that the patient has an
emotional reaction (seems anxious, upset, and angry, frustrated), address this in your opening
question.

• I can see you that seem upset/anxious/angry/frustrated. Could you tell me what is
bothering you?
• I can see you that seem upset/worried/anxious/angry/frustrated. Would you mind
telling me what the problem is?
Step 3: Complete the tasks on the cue card
Plan the execution of the role play depending on the tasks mentioned in the cue- card.
Signposting could be useful to explain the schedule or sequence of the tasks. Since you are
responsible for initiating the role play, these expressions will be helpful in structuring the role
play.

Do not forget to obtain the patient’s agreement while doing this.

• Shall we start with… and then we will discuss the treatment options later. Is that
okay with you?

• Before proceeding further, I would like to ask you some questions to get a
detailed picture of your situation. Would that be okay?

• Would it be okay if I can ask you some questions about your and then discuss some
things you can do to manage your condition?

• So, here’s what I am going to do. First, I will ask you some questions about your
lifestyle. Then, I would suggest some things you can to do to manage your condition.
And later/after that, I would be happy to answer any questions that you might have.
May I proceed?

Before I take you through the treatment options, I’d like to ask you some

• questions about your condition. Is that alright?

Step 4: Concluding the role play.

Your conclusion will match the cue card; however, some ways your roleplay can be
concluded: reiterate the advice, schedule an appointment for review, or offer a patient
information leaflet to reinforce the patient’s understanding of a medical condition, etc. This
will match the situation on the cue card. This is by no means an exhaustive compilation but
lists commonly used scenarios.
Examples:

Example 1 – Briefly summarize what has been discussed during the role-play

• To reiterate, you will gradually cut down on the number of cigarettes daily and
join a smoking cessation program.

• To summarize what we have discussed today,

• Just to go over what we have discussed today,………………………

• Now, if you wouldn’t mind going over the advice, I have just given?

• Now, if you won’t mind, can we go over the advice I have just given?

Example 2 – Let the patient know what happens next

• I will review your progress after two weeks. (include a timescale, if mentioned
on the cue card)

• What I will do for you right away is.....................(as suggested on the cue card)

Example 3 – Ask the patient if there is anything else that they can be helped with.

• I’m glad that I was able to help today. Is there anything else I can help you with?

• Is there anything else that you would like to ask?

• Before we finish, is there anything more you want to ask?

Example 4 – Offer a patient-information leaflet, if mentioned on the cue card

• Thank you. Here is a patient-information leaflet which you will find useful. If you
have any additional questions, please do not hesitate to contact me. (if mentioned on
the cue card)
Showing courtesy in OET SPEAKING
Using language that reflects common courtesy will keep your interactions with the patient
respectful and consequently improve rapport.

Below are some other examples of responses that should be avoided and some courteous
phrases that can be used to replace them.

Phrases to avoid Phrases to use

You will need to wait to see the If it’s ok with you, can you wait for some time to
doctor see the doctor?

If you don’t mind, can you wait for some time to

see the doctor?

The doctor is attending to a critical patient who

needed to be seen quickly. I apologize for the
inconvenience this has caused.

Would you mind waiting just a few more minutes?

I don’t know Let me find out…..

Allow me to find that out for you

I am afraid it’s not within my scope to answer this

question at the moment. Please allow me a little time to
get that answer for you.
The Basics

Let’s look at the most common courtesy words, which can be used in a conversation
as a signal of mutual respect.

“Please”

Do not forget to say please when asking for information from the patient! Doing otherwise
seems rude.

“Thank you.”

When the patient answers your questions and provides information, say Thank you for
answering my questions.

“Sorry”

If your patient is angry or agitated about something, it is courteous to apologize.

I am sorry for the inconvenience that this has caused. I am

sorry that your pain is so high.

I apologize that you had to wait for so long.

Doing so demonstrates that someone has taken it personally upon themselves to resolve their
concern/query and helps in reassuring the patient.

Providing Reassurance and Immediacy

To assure the patient that his/her concern is crucial to you, it’s vital to provide them with a
sense of immediacy. This demonstrates that you understand the value of the patient’s
time/their concern and you are doing your bit to speed up the process.

“Right away.”

Using this phrase signals that the process addressing the patient’s concern has been enacted.
For example:

“I’ll contact the doctor right away and let him know that you are in pain so he can prescribe
some medication to relieve your pain.”
 Using positive words in OET SPEAKING
Definitely
I will definitely make sure that it gets sorted…/the concern is shared with the doctor/Ward
Manager (conflict resolution)
Absolutely
I absolutely agree… (To empathize with patients)….
Certainly
Small changes in your lifestyle will certainly help in making a big difference to your health in
the long run.
Fantastic
That is fantastic (to motivate your patient)

Clarifying a Situation
There will be occasions when the patient feels as though they have fully detailed their
symptoms/condition, yet you cannot quite understand the situation.

In these scenarios, use the following phrases:

“Pardon me.”

Rather than using ‘what?’ Use more formal expression such as ‘Pardon me’ when you miss a
small part of the conversation.

“Forgive me…”

For example, “Forgive me, I didn’t quite catch the last sentence. Could you please repeat it
for me?”
Backtracking – going back to something in the conversation. In OET
Speaking, it can be used to

1. Clarify the meaning of something you don’t understand.

• When you say , do you mean…?

• Could you please explain what you mean by……?

• I am not sure I understood that completely. Do you mind repeating it for me?

2. To recap the patient’s responses

For example:

From what I have understood so far, you have been experiencing indigestion for the past
few weeks, and at times, it is accompanied by headaches which last for a few hours and are
only relieved with medication. You feel the indigestion is caused when you eat rice for
dinner. Is that right?

OR

• In summary, it seems that………. (patient’s symptoms

here)

………………… Have I covered everything?

3. At the end of the role-play as a final summary of what has been agreed so far

For example:

• So, to backtrack,

• So, to reiterate what we have discussed so far,…

• To recap what we discussed today,

• Just let me check what you have told me so far… Is that an accurate summary?
Acknowledging a patient’s feelings
To build rapport with your patient, it is vital that the patients feel that their thoughts have
been acknowledged.

• I understand your perspective.

• I understand where you are coming from.

• “I realize this is difficult” This is effective in terms of acknowledging the patient’s

problem without voicing any personal thoughts on the matter.

• “Now that I’m aware, I will ensure that your concerns are taken care of, and you
don’t face any inconvenience.”

• I can appreciate this is difficult for you.

Signposting language to structure the role play

Signposting is used to provide a structure to a consultation; it can be used when moving from
one section to another. It also helps the patient to understand the direction the conversation is
going in and why and can be used to obtain the patient’s consent when asking questions on
sensitive or embarrassing topics.

In OET Speaking, signposting can be used at different stages of the role play.

Transitioning from the introduction to history taking

• OK, before proceeding further, I’d like to ask you some questions about your pain. Is
that alright?

• I’d like to start by asking some general questions to understand your condition.

• To give me a better understanding of your situation, is it okay if I can ask you

some questions.

• If you don’t mind, I am just going to ask you a few questions about your lifestyle.
Would that be okay?

It is a good idea to provide a rationale or reason or asking the question. For example:

If you don’t mind, I want to ask some questions about your medical history. It will help me to
assess your condition in a better way.
To ask permission before moving to the information-
gathering stage.
• Can I start with questions about your lifestyle before discussing treatment options?

• May I ask you some questions about your family history?

• I am going to ask you some questions about your lifestyle. Is that ok?

• Is it OK if I ask you some questions about your lifestyle?

To ask personal questions or questions on sensitive

topics
• I have to ask you some personal questions if that’s OK.

• If it’s alright with you, I need to ask you some personal questions.

• If you don’t mind, I’d like to ask some questions about your sexual history.

• Do you mind if I ask some questions about your lifestyle?

To justify a specific line of questioning

• Since this condition can be hereditary, I’d like to ask some questions about your
family history.

• If you don’t mind, I want to ask you some questions about your sexual partners and
sexual practices. I can appreciate that these questions are very personal, but they are
crucial for the examination.
To outline the sequence of the consultation
• First, I’d like to ask you some questions to get a detailed understanding of your
condition and then we can talk about ways to treat the problem.

• I am going to divide this talk into two parts: I’d like to start by asking you some
questions about your lifestyle and routine and then I will go

on to some suggestions about making changes to your current lifestyle. Is that okay?

• First, I’ll ask you some questioning about your complaints

• Then, I will explain the likely cause of your symptoms

• After that, I will take you through some treatment options and things you can do to
manage your condition

• Following that/Finally, you can ask me any questions that you may have.

To move from one topic to another

• Now that we’ve discussed some treatment options, I’d like to know about any
questions or concerns that you have on your mind.

• What I’d like to do now is to discuss some ways you can manage your present
condition.

• Before I can discuss the treatment options, I’d like to summarize your symptoms to
ensure I have accurate information

• Thank you for answering my questions. I have all the information I need, and now
I’d like to suggest some lifestyle modifications to improve your health.

Closing
• Before we wrap-up, is there anything that you would like to ask?
 Chapter 3
Questioning Techniques
Investigating the presenting complaint or taking a
history of the patient
In OET Speaking, asking about the presenting complaint requires a series of questions in a
particular order. During the role-play, you would be making use of both open-ended and closed-
ended questions.

Open-ended questions let the patient answer with something other than yes or no, encouraging
patient elaboration or further conversation with the patient, maximizing opportunities for
listening for understanding and symptom-defining answers. Open questions open up the
discussion and encourage the patient to give a detailed response, allowing patients to express
themselves in their own words.

For example,

• How are you doing today?

• How are you feeling? • Why did you cease taking your
medication?
• How is everything going?
• Which medicine did you take at
• How have you been? home?

• What brings you in today? • How did you hurt your arm?

• What seems to be the problem? • How long have you had the pain
for?
• Who brought you to the hospital?
• Tell me about the pain.
• What did you eat today?
• What are you doing for the pain?
• Where do you feel pain?

• Why didn’t you seek any

treatment earlier?
Closed questions: (require a one-word answer) (Yes, no, or a specific piece of
information), without encouraging the patient to express themselves in any detail.

• Do you exercise?

• Are you feeling any pain?

• Did you take any pain-killers before coming here?

• Are you allergic to anything?

• Do you work?

• Do you have any ongoing medical conditions?

• Have you ever been hospitalized?

• Have you ever had any surgery?

• Is anyone in your family suffering from this condition?

• Has your appetite/weight changed recently?

• Are you available at 11.30 am tomorrow for your next appointment?

• How often do you exercise?

• Are you taking any medication?

Closed-ended questions Open-ended questions

Where is the pain? Tell me about the pain.

Do you have any pain at the moment? How are you feeling?

Ae you married? Tell me about your family.

Can you come next week on Tuesday for your When are you available for your follow-up
follow up? appointment?

Do you exercise regularly? Tell me about how much physical activity do

you get daily.
Focused questions: Questions that are used to limit the range of query to a specific topic are
called focused questions. These can be used to ask for more information about a particular
problem. These questions narrow the range of patient responses but still invite more than a one-
word response from the patient.

Examples:

• You mentioned that you feel anxious/scared. Could you please tell me more about
it?

• You said that you sometimes get a mild pain in your right shoulder. Do you mind
telling more about it?

Probes: Probing means to inquire into someone or something specifically. Probes are used to ask
for further detail about a specific topic. Probes aren’t necessarily questions; these can be words
or a set of phrases that are used to gain more information about the same topic. In other words,
probes are used to facilitate the patient’s response.

Examples:

• How does that make you feel?

• How do you feel about that?

• Is there anything that I left out?

• Would you like to add anything to that?

• How long have you had these problems?

• Is there anything that alleviates your pain?

• Is there anything that exacerbates your condition?

What not to say or do in OET SPEAKING?
Do not use “Multiple” or “Leading” questions in OET Speaking.

Multiple questions- several questions asked at the same time can be confusing for the patient;
therefore, you should ask one question at a time.

• Does the pain always occur in the same place, and how painful is it on a scale of 0-
10 where 0 is no pain and ten is the worst?

• Do you drink and smoke?

This question may be confusing for a patient to answer in case he/she does one of the above. The
patient could be a smoker but not a drinker or vice-versa.

Transforming multiple questions

Multiple questions Transformation

How do you feel this morning – did you get How do you feel this morning? (pause for
enough sleep last night and enough to eat for reply)
breakfast? How did you sleep last night (pause for
reply)?

How was breakfast this morning? (Pause

for reply)

Where do you live, and how many people Tell me about your living situation.
live with you.

Did stress, travelling or something else What do you think caused the
cause the problem? problem?

What have you been eating this past month? Tell me about your eating habits this past
How much do you eat at one time? How month.
often do you eat?
Leading questions- those that “lead” the patient towards a particular answer.

Transforming leading questions

You are not eating too well, are Have you noticed any
you? changes to your appetite?
Back-channeling can be used to encourage the patient to talk more. It can be used to show
interest, attention and a willingness to keep listening. Back channeling is the feedback you give
to the patient to show that you understand what he/she is saying.

It usually takes the form of utterances such as uh-huh, yeah, mmm, okay, right, I see, ahan, go
on…. OK, wow! Really?

When used appropriately, this can facilitate communication and create rapport between listener
and speaker.

Take note of the intonation

Using a falling tone usually indicates that you think the patient has finished or that you want to
take a turn in the conversation

Examples:

• uh-uh, go on, I see, right, yes (rising intonation)

• I’m listening; please continue

• Tell me more….

• And….

• Uh-hmm…(followed by silence/pause)
Communicating with patients on sensitive or embarrassing topics
When talking with your patients about sensitive or uncomfortable topics, use the following steps to make your p
1.Use probes to investigate a concern further Examples: I hope you don’t mind me asking, but ... would you like
Is there anything else you’d like to tell me about this?
2.Reassure the patient that the consultation is confidential and that they can openly share their information with

Example: Everything that you tell me in here is completely confidential.

3.Justify – provide a rationale for asking questions: explain why certain questions are relevant to the discussion

Examples: This question will help in getting a detailed picture of your condition.
It’s important that I ask you some questions about your sexual history. I know it’s personal, but it will help me i

4.Acknowledge - validate that you have understood what the patient has said and thank them for providing info

Examples: I can understand that this was hard for you to tell me, so I really appreciate your honesty.

Thank you for telling me about that.

Thank you for answering my questions. I know this wasn’t easy. What you’ve told me is really helpful.
Choosing an appropriate language for the patient you are speaking to is an integral part of the
OET speaking test. When your patient is sensitive or embarrassed about the condition, it is better
to use indirect language. Indirect language is unnecessary for conditions which are routine or for
when the patient feels comfortable.

For instance, men and women react differently to illnesses and may be embarrassed or
uncomfortable talking about certain conditions. To encourage such patients, it’s important that
questions are asked politely.

Direct vs. Indirect Language when asking questions

Use the following starting phrases to make your questions politer. Adding these phrases would
soften the questions and demonstrate a sensitive and respectful attitude towards your patients
while asking questions about uncomfortable or sensitive topics.

• Can you tell me ...

• Would you mind telling me

• Tell me ...

• I wondered ...

• I wonder…

• Can I ask ...

• Would you be able to tell me ...?

• May I ask ...

• Please tell me ...

• I wonder if you could tell me ...

• Let me ask you ...

• Can I ask ...

• Can you tell me ...

• Do you mind telling me about….

• I am wondering if you can tell me something about your….

 • Would you mind telling me about……?

Examples of indirect questions:

• Would you mind if I asked you some question to get a better understanding of
your condition?

• If you don’t mind, I would like to ask you some questions about your
health/general lifestyle before proceeding further.

• In your own time, could you describe your symptoms/complaints to me?

• I am afraid I need to ask some personal questions/a personal question – May I

proceed?

• Firstly, I would like to talk about your feelings. Are you comfortable discussing
them right now?

• Would you mind telling me about the difficulties you and your children are facing?

• Could you tell me how you have been coping at home?

Reflective listening skills and paraphrasing for

clarification
Patients often use vague language during a consultation, using word choices that may not
accurately reflect what they mean. An effective way to make sure you understand what the
patient wishes to say and to ensure that you don’t miss relevant information is to paraphrase
what the patient has said. Paraphrasing is repeating in your words what you interpreted
someone else to be saying. This will enable you to identify the patient’s meaning rather than
just focusing on the words they use.

To reiterate, the purposes of paraphrasing are

• To check your understanding of what a patient is saying.

• Helping the patient by simplifying, focusing what they are saying.

• Encouraging the patient to elaborate.

• Providing a check on the accuracy of your perceptions
Examples:

• “If I hear you right, you conveyed that…?” Is that correct?

• “If I heard you right…?” or “If I understand you correctly…?”

• “If I understand you right, you’re saying that…?” or “… you believe that…?” or
“… you feel that…?”

• You mean…………

• So, to put it another way, you believe/feel that…

• To rephrase what you said,…

• So, what you are saying is….Is that correct?

• Let me see if I have everything we talked about?

• So it sounds like…..

• In other words…..

• It looks like…..

• So what you are saying is….You mean…………

• It seems that……

Always clarify whether what you have paraphrased is accurate by asking:

• Is that right?

• Is that correct?

• Would you like to add anything to that?

• Is that an accurate summary?

• Have I understood that correctly?

• Is there anything else

Examples of how you can paraphrase patient responses

Patient’s response Paraphrase

I haven’t been eating well due to having back- In other words, due to competing demands on
to-back meetings at my office. I often skip your time, you have been missing meals and
breakfast because I am running late, and I not eating properly.
don’t get time for lunch due to work, and
dinner is usually a quick bite because I am
busy working on my presentations for the next
day.

The doctor told me to take these antibiotics As I understand it, you stopped taking the
until the pills ran out, but I felt better the next medication when you felt better even though
day, so I stopped. your doctor told you to finish the prescription.

I don’t believe that drinking regularly is bad. I So, what you are saying is, you are not
have been drinking whiskey regularly and convinced that drinking alcohol regularly is
nothing bad has happened to me. dangerous because it hasn’t affected you.

I’d like to lose some weight, but with my To put it another way, you feel that this is a
friend’s weddings around the corner, I feel it difficult time of the year to lose weight.
won’t be possible.

Example

Nurse: Alright. Thank you for answering my questions. Let me ensure I have noted
everything correctly: You have been having chest pain for the past few days which sometimes
radiates to your shoulder. The pain is about a 6 on a scale of 0 to 10 and is a burning feeling
that causes tightness in the chest. The pain usually lasts 10 minutes but can last as long as 40
minutes. Getting overexerted at work seems to trigger the pain, and it gets better with an
aspirin. Is there anything else that you would like to add?
Useful tips When the patient talks for too long
Could I just interrupt you there for a second?
So what I have understood so far is thatIs that right?
What if the patient says something that is confusing or unclear?
Ask the patient for clarification:
I am sorry to interject, but I am not sure I understood that completely. Could you repeat it?
I am sorry to interrupt; I missed the last few words you said.
didn’t quite follow that. Can you say it again, please?
Sorry, could you repeat that for me, please?
Can you please clarify what you mean when you say……?
Do you mean?
Sorry, I don’t understand what you mean.
I am sorry, I am not sure I understand what you mean by….
Sorry, I am not sure I know what you mean.
Active Listening
Picking up on patient cues
(Listening to verbal cues or the change of pace and intonation in the patient’s tone)
You sound a little worried about your situation.
That must have been difficult.
You said that you feel miserable; could you tell me more about these feelings/why you have been feeling this
When you say that “…….”, would you add some information/give more details regarding this?

Identify whether the patient is unconcerned / angry / agitated / sad / nervous / embarrassed ] from cue- card.
 • It looks like…..

• It seems that.

• I sense that you are very sad/embarrassed/angry; would it help to talk about it?

• You sound sad/concerned/anxious/unsure when you say this; would it help to talk
about it?

• I sense that you are not quite happy/satisfied/sure with the explanation/about the
advice you have been given – Is that right?

• Am I right in thinking that you are reluctant/resistant to the advice you have been

given?

Pauses
Pauses play a significant role in your OET Speaking and encourage patient understanding and
participation. They are used to separate different thoughts or ideas. You should pause
periodically to allow the listener to digest the message you have delivered to that point.

Consider the change in impact when you practice the dialogue given below with and without
pauses.

Version 1 (without pauses)

Now, Ralph, I’d like to briefly summarize your history to be sure I have the details correct.
You have been suffering from stomach pain since yesterday, and you have experienced some
heartburn. You have taken medication from the pharmacy, but it has not relieved your
symptoms. Is that right so far?

Version 2 (with pauses)

Now, Ralph, (Pause) I’d like to briefly summarize your history (Pause) to be sure I have the
details correct. (Pause) You have been suffering from stomach pain since yesterday (pause),
and you have experienced some heartburn. You have taken medication from the pharmacy
(pause), but it has not relieved your symptoms(pause). Is that right so far?

Pausing at each stage enables the listener to absorb the information and, if necessary, gives
them the opportunity to stop and correct you.
Let’s quickly revise what we have learnt up to this point.
 Steps involved when taking a patient’s history in OET Speaking

Establishing rapport

(Begin with a nice greeting; introduce yourself and your role in a welcoming manner)

Questioning technique for gathering information: Use the cone technique for taking the history of
the patient- moving from open to closed questions.

Using verbal facilitation skills as Back channeling “I see, go on” to encourage the patient’s
responses

Using clarifying questions, where necessary.

• Could you elaborate more about the problems you have been having?

• Could you describe your symptoms to me in a little more detail?

• I am sorry, but could you please repeat that?

Summarizing the patient’s response to check the accuracy of the information

• So, I’d just like to briefly summarize your history to be sure I have the details correct
Is that right so far?

Normalizing statements
Some patients may have difficulty in disclosing some information about their problem or
condition, especially if they are anxious or embarrassed or uncomfortable talking about it.

One way of reassuring the patient is to use normalizing statements, i.e., statements that
normalize their problem. These statements are used to let your patient know that they are not
alone in having certain problems, symptoms, or experiences.

Starting your sentence with phrases like this is a common problem, many people feel
..., many people tell me ..., often I have been told that ... can make the patients comfortable
and encourage them to volunteer information about sensitive topics.
Examples:

• A lot of people have difficulty in taking the initial steps to lose weight.

• Many people find the instructions/guidelines for taking their medication

complicated.

• This is a common problem, and it is sometimes connected to not getting enough

physical activity.

• It is perfectly natural for people to feel this way.

• It is a common occurrence, and it’s not unusual for this to happen for people in your
age group.

•
Eliciting information: Communicating with challenging or withdrawn
patients

• You seem very low in yourself. Can you tell me what’s going on?

• You appear very distant – why is that?

• You seem very sad – can I ask what you are thinking?

• You look quite disturbed- what’s on your mind?

• I can see that you look very anxious- would you mind telling me what is bothering
you?

• You seem upset- do you mind telling what’s the problem?

• I understand this is very difficult for you talk about it.

• That must be very challenging for you.

• I can understand it’s hard as it’s a big change in your life, and it’s natural to feel
overwhelmed. Having said that, I am here to assist you.

• I know this must be distressing you. That being said, I am here to help you. (validating
a patient’s concern who is anxious, concerned or upset)

• You seem very far away! (used in case the patient is withdrawn or unresponsive)
Please tell me what is on your mind.
 • How are you feeling at the moment? How do you feel right now?

• I appreciate (appreciate here means to understand) the problems this has caused you.

• I can understand your frustration, but this is the only option we have at the moment to
ensure that you remain in good general health. (used to persuade a patient)

• I am sorry that you feel…………………… I can assure you it wasn’t intentional. (if the
patient is angry)

Empathetic Phrases
Empathy is a vital component of any health practitioner-patient relationship and has been
associated with improved patient outcomes. Empathetic phrases enhance the therapeutic
effectiveness of your communication as well increase the efficiency of gathering information
from the patient.

Some useful expressions that can demonstrate sensitivity and empathy during your
consultation are:

• I can see that must have been hard for you.

• Can you bear to tell me just how you have been feeling?

• Thank you for telling me how you have been feeling.

• I appreciate you telling me this. It helps me in understanding the situation

much better.

• Have you told me enough about how you are feeling to help me understand
things?

• I think I understand now a little of what you have been feeling. Let’s look at the
practical things that we can do together.

• I can see that this has been very difficult for you to cope with.

• I can appreciate how difficult it is for you to talk about this (here, appreciate
means to understand)

• I can sense how angry you have been feeling about your illness.

• I can see that you are quite upset

 • I can understand it must be frightening for you to know the pain might keep coming
back.

• That must have been (past)/must be (present) very difficult /tiring /Frightening
/Painful/ Emotionally draining for you.

• I know how you must be feeling.

• I am sorry to hear that!

• Aww, it’s a pity to hear that!

• I can perfectly understand how difficult that must for you to cope with.

• It can be quite distressing, but there are ways to help manage it.

• I can appreciate that it’s difficult to follow these instructions or I can appreciate that
it’s difficult to make these changes in your lifestyle. However, it is imperative that
you do this to ensure good general health or to ensure a complete recovery.

• I have noticed that you seem a little uncomfortable with this suggestion. Having said
that, this would be very beneficial for you or this would improve your health.

• I can understand why you feel that way, and it can be overwhelming.

• I am sorry to hear that.

Explaining treatment and advising patients

Like indirect language can be used while asking questions to make your patient feel
comfortable, it can also be used when giving instructions or when advising your patients.

When giving instructions, use tentative language such as (I was wondering) or modal verbs
such as (this might be, could you….., would you……) as it softens the instruction. Doing this
makes your patients feel like they are responding to suggestions instead of being told what to
do.
 Direct Indirect

You need to stop smoking (this might be If you could try to cease smoking, it would
considered a too direct and comes across as a be very beneficial for your health.
command rather than an instruction).

You need to lose weight If you could try to lose some weight, it
would be very helpful for maintaining good
health.

You need to cut down on salty and fat- Would you be able to cut down on salty
rich foods. and fat-rich foods?

You will need to incorporate some physical I would recommend that you incorporate
activity into your routine. some physical activity into your routine.

I was wondering if it’s possible for you to

incorporate some physical activity into your
routine.

If you want to lose weight, you should Could you try substituting the pizza that you
substitute items like pizza with a salad to have for lunch with a salad? It would be very
control the number of calories you consume. helpful in controlling the daily calorie
intake.
Use polite expressions to give advice:
• Are you willing to...?

• Would you be willing to...?

• Would you at least give me time/a chance to suggest some ways to manage
your condition?

• I will outline some things you can do…

• You could consider…

• Another option is….

• To begin with, I would suggest…..

• I would like to start by suggesting….

• Have you thought about……

• What I would like you to do is…….. (ensure compliance with medication/healthy

diet/eat more fruits and vegetables)

• Why not…. (try healthier alternatives?)

• Let’s consider some ways by which you can incorporate healthier changes in your
life.

• Would you like to try and quit smoking? There are medications and support groups
available for people who want to quit smoking. If you like, I can get you some
information about it.

• I’d like you to focus on what we can do now to improve your health. Have
considered giving up smoking?

• I’d like to talk with you about your diet.

• Exercise will benefit in maintaining good health. I know it might be little difficult at
first but it will have a profound impact on your health in the long run.

• I think you could start by walking 15 minutes every alternate day and gradually
increase the duration
 Version 1 (Judgmental Version 2 (Non-judgmental
approach towards the approach towards the patient’s
patient’s smoking) smoking)
Nurse: Hello Sigma. Nurse: Hello Sigma.

Sigma: Hello, Nurse. Sigma: Hello, Nurse.

Nurse: How are you feeling? Nurse: You seem disturbed. How are you
feeling?

Sigma: I can’t seem to catch my breath Sigma: I can’t seem to catch my breath
these days. It’s really scary these days. It’s really scary

sometimes….to gasp for air. sometimes….to gasp for air.

Nurse: Well, no wonder. All those years of Nurse: I can see that you are concerned.
smoking have affected your health now. Could you tell me more about it?
(judgmental about patient’s smoking)

Sigma: You are making me feel guilty. Sigma: Yes, I am frequently out of breath.
The other day, I was at the supermarket,
and I found myself gasping for breath.

Nurse: I didn’t mean to make you feel that Nurse: I understand how difficult that must
way. It’s just the reality. (no reassurance) be. Let’s focus on what we can do now to
improve your health. If you do not mind me
saying, this may have to do with your
smoking. Have you thought about quitting?

Sigma: I want to kick this bad habit. It’s

just……… I don’t know where and how to
start?

Nurse: I am glad that you are thinking about

it. That’s a good sign. We will do our best to
help you and support you every step of the
way.

Sigma: What if I fail. I am not sure if I will

be able to cope up.
 Nurse: It’s a reasonable concern. Think about
your choices here. What are the advantages
and disadvantages of quitting smoking? And
even if you do relapse, we will support you to

re-start again.

Sigma: Hmm okay.

Signposting language when explaining treatment and

giving advice to patients
• Let me explain what you can do to recover from this condition. Firstly,

…..Secondly,…………., Next,………

• That brings me to the next point….....

• Moving on to the next option…./next advice……. Another thing you can do

is……….

• There are three things you need to consider. First of all, you should lose weight.
Then, you must cut down…… Finally,…………………..

• Let me briefly outline what you can do to ensure good general health.

In addition,/Besides this, you could include portions of fruits and vegetables in your diet.

There are a few things I need to tell you about managing your current situation. Firstly,

• There are a couple of things I want to advise you.

• I want to suggest a few things which you can do to ensure a full recovery.

• Basically/Briefly, I have three things to say.

• I’d like to begin/start by ...

• Let’s begin/start by ...

• First of all, I’ll...

• … and then I’ll go on to…

 • Then/Next ...

Use the following linking words when adding items

• Also,
• Likewise,
• Moreover,
• Furthermore,
• In addition,
• As well as this,
• In addition to this,
• Apart from this,
• Besides that
• Moving on
• Going back to
• To sum up
• Finally

Vocabulary for “emphasizing” your advice

Really- You really need to reduce your weight

Certainly- If you follow my advice, it will certainly improve your health

Definitely- If you comply with my advice, it will definitely improve your health

Especially – To ensure good health, you will need to make changes to your lifestyle,
especially your smoking. I am concerned about your health, and I want you to know that
quitting smoking is the most important thing you can do to protect your current and future
health.

Marvelous- Many patients in similar situations/with similar conditions have had

marvelous/tremendous results by making small changes in their lifestyle.

Reassure - I reassure you that you will be able to make a complete recovery if you adhere to
these instructions.
Persuading reluctant or difficult patients
Use the following phrases to explain and highlight why adherence to your advice is
important

• Your weight is not in the ideal range, and I am concerned about the long-term effects
on your health.

• Your weight is higher than it should be, and I am concerned about your health.

• I understand what you are saying, but you must consider the long-term effects it can
have on your health. I know it’s hard, but I am afraid there’s no other way. If you do
not make these changes, you run the risk of....

• It is imperative that you lose weight, else it can make you susceptible to serious
complications for the future

• It is necessary that you comply with the treatment advice

• It is essential that you heed my advice.

• It is vital that you consider making these changes to your lifestyle.

• It is paramount…….

• It is indispensable……

• It is crucial………

• The most important thing is to…

• It would be beneficial if you can…..

• It is a good idea to include portions of fruits and vegetables in your eating

habits.

• It would be helpful…

• It is strongly recommended that…

• It is important for you to start doing some kinds of exercise for at least 20 minutes
every day.

• I am concerned about your health and want the best possible outcome for you.
• It is necessary for you to cut down on some of the foods in your diet that are not
particularly healthy. For instance, fried foods or foods rich in cholesterol.

• It is recommended that you try changing your lifestyle.

• It is imperative that you take your medicine regularly.

• It is paramount that you reduce your alcohol intake.

• It is indispensable that you quit smoking or at least try to cut down on the number
of cigarettes you smoke per day.

• It is crucial that you reduce your weight to avoid adverse effects on your health.

• In cases like these, the first thing to try is changing your lifestyle.

• I suggest that….

• I advise that…..

• I strongly recommend that…..

• It would be beneficial if you

• I am afraid it is extremely important/essential/imperative/critical/for you to…

• It’s really important that you…

• I strongly suggest/urge/advise you to…

• It is essential…

• This might not be what you were hoping to hear but the best way to improve
your health is….
Checking patient’s acceptance:
• Is that okay?

• How does that sound?

• Are you happy with that?

• How do you feel about what I am proposing?

• How do you feel about that?

• I hope I have cleared up/assuaged your worries? Does that make you feel a bit
better?

Verbal Reassurance is provided to show that

• The patient’s concerns or fears are real and important

• You understand the patient’s concerns or fears as a health professional

• There is hope for recovery

However, it must be genuine and truthful; otherwise, it can become false reassurance.

Consider the following examples.

Patient: I have had this infection for three weeks now, and the pain keeps getting worse. I am
so sick of this. I hate living like this. Is there a qualified doctor in this hospital who can make
me feel better?

Nurse: I understand that it has been quite challenging for you with all that you have been
going through. Indeed, health concerns can be very draining. I just want to let you know that
you are in the right place, and we are doing our very best to care for you.

Patient: It’s my second week in the hospital. My accident was seven days ago. Will I ever get
better?
Nurse: I can see that you are concerned about your health, but it can take several weeks to
recover for the injuries to heal completely. Having said that, you are making steady progress.

Patient: No one cares in this hospital. I rang the buzzer so many times, but it seems that no
one is bothered to check on me.

Nurse: I understand that you are angry. I was attending to a critical patient and therefore
couldn’t be here earlier. That being said, your health is my priority, and I will ensure that you
are looked after properly.

Patient: I have been independent all my life, and I do not want to become dependent on
medication. I can tolerate this pain.

Nurse: I understand your perspective. However, at this time, it is imperative to relive your
body of the pain so it can focus on healing itself. Therefore, you must take the medication.
Also, regarding your concern about becoming addicted, I assure you that nothing of this
would happen as this is a temporary arrangement.

Avoid offering ‘False Reassurance’ to your patient

You have nothing to worry about. (saying something that is not true)
Don’t worry. Everything will be alright (assuring the patient aboutsomething that may not happen)
There’s no need to cry. It will all work out. (promising something that may not happen)

Reassuring statements
• I hear what you are saying. You are concerned about your health.

• It’s ok to cry when you feel like it. I can wait for you.

• I appreciate that you are worried. Is there anything I can do for you?

• I know you are concerned that your progress is slow, but you are making
steady progress and would recuperate soon.

• You did the right thing coming to the hospital. We have experienced doctors and
the latest equipment to treat your condition.

• It’s okay to feel sad.

• It’s ok to cry.

• I will do everything I can to make you feel comfortable during your stay.

• Would you like me to contact the social worker to talk with you about any services
 that might be available for you while you recover your strength?

• With rest, the right medication, and a stress-free mind, you will feel better.

Showing Empathy
Empathy is the ability to experience a situation through the eyes and feelings of another person.
Empathy allows your patient to feel greater acceptance.

• That must have been (present perfect for actions that began in the past)/must be
(present) very

• ................(difficult/tiring/frightening/painful/emotionally draining) for you.

• I know how you must be feeling

• I understand your concern

• I understand how you are feeling

• I can relate to that.

• I understand how you feel. That being said............................(give advice)

• I understand why you have this concern. Having said that……(give advice)

• I understand/see why you are worried. However.............................(give advice)

• I am sorry to hear that!

• Aww, it’s a pity to hear that!

• I can see that you are not happy with this suggestion.

• I do see your point

• I do understand your perspective

• I do understand where you are coming from

• I can see how worried you are about making changes to your lifestyle, but you must
consider the long-term effects….

• I can see you are anxious about making changes to your routine.
Nevertheless,.

• If I were you, I would react in the same way

• It’s a reasonable reaction.

• Your reaction is justified

• It is indeed quite hard to accept something we are not ready to do.

• I completely understand that it must be very difficult for you, considering the
stage you are in, it must be overwhelming!

• I understand it is challenging for you to cope up with this situation. And it is a

reasonable reaction.

• Your concerns are understandable. It’s not unusual for people to react in this way.

• I understand you dislike this idea. It’s common for people to feel this way.

• I can understand your worries/concern.

• I completely understand that it must be very difficult for you, considering the
stage you are in, it must be overwhelming!

• I understand it is challenging for you to cope up with this situation. And it is a

reasonable reaction.

• Your concerns are understandable. It’s not unusual for people to react in this way.

• I understand you dislike this idea. It’s common for people to feel this way.

• I can understand your worries/concern.

• I know how you are feeling. With that said…

• I can understand how you feel. That being said……..

• I can see why you have this concern. Having said that……

• I understand/see why you are worried. However,…….

The next step would be to reassure the patient to manage their anxiety, fear or worries.

For instance,

• This Clinic/This hospital has an excellent reputation, and your health and safety is
our utmost priority

• There is no need to be alarmed. The staff here is very competent and will look
after you diligently.

• I am a qualified nurse with good nursing experience. Please do not worry at all

• Of course, the final decision is up to you. However, the sooner it will be done, the
better!

• There is nothing to be alarmed about

• I am afraid there is no other way.

• Believe me; if there were another way, I would have told you.

• This is the best option, I assure you.

• There are no two ways about it.

• It’s your health at stake here.

• We will be here to help you.

• We will be here to look after you. or We are here to look after you.

• Try not to worry about.

• I assure you there is nothing to worry about.

• I am certain that staying in the hospital is in your best interests.

• Please relax; we are here to help you and to suggest how to manage.

• I understand your concern; however, following my advice is imperative to your well-

being

• Believe me; if there were another way, I would have told you.

• This is the best option, I assure you.

 • There are no two ways about it.

• It’s your health at stake here.

• We will be here to help you.

• We will be here to look after you.

• Try not to worry about.

• I assure you there is nothing to worry about.

• I am certain that staying in the hospital is in your best interests.

• Please relax; we are here to help you and to suggest how to manage.

Explaining risks to their health in case they refuse the

treatment or advice
• If you do not comply with my advice, it can have adverse effects on your health

• The results of not getting the treatment can be detrimental.

• If you do not take your medication on time, it might delay the recovery time.

• If you do not modify your lifestyle, your disease may progress.

• Your condition might exacerbate if you discharge against medical advice.

Acknowledge the patient’s perspective before
outlining the risks
• I understand that it’s not easy, but if you continue like this, it will make your
condition worse!

• I know it’s not easy, but it’s imperative that you adhere to this advice to recover
from your illness.

• I can see you have concerns regarding this. That being said, it’s vital that you
follow my advice to ensure good general health.

• I can understand it’s difficult for you.

• I can appreciate that it’s going to be difficult making these changes.

• I understand it’s not easy, and it’s tough to make changes to a busy schedule, but as
I see it- there’s no alternative. If not make some changes now, you run the risk
of......

Reinforcement should follow the above explanation

• So, I hope you understand why it’s vital for you to stick to the diet/undergo the
tests/take the pills/not to smoke/to get plenty of rest and so on.

• This is the reason why you need to get admitted/undergo this treatment

• For this reason, you need to…………

Use statements like to check’s patient agreement

• I hope I have cleared up/assuaged your worries? Does that make you feel a bit
better?

• Is that okay?

• How does that sound?

• Are you happy with that?

The patient may become fearful/difficult/noncompliant/reluctant at this stage and may not
want to follow your suggested plan of action/treatment. It is crucial that you first
acknowledge or validate the patient’s concerns and then, provide a justification to make them
reconsider their decision. It is important to ascertain why the patient is having difficulty
coming to terms with your treatment recommendation. It is possible that the patient has
incorrect beliefs which can be addressed with a simple conversation. A patient must be
explained the implications of refusing your advice in simple terms that are understandable by
him/her, but at the same time, it is equally important to remember that it is within a patient’s
right to refuse medication or treatment and that decision must be respected.

• I appreciate what you are saying, and It’s your right to get discharged/refuse
treatment with an informed understanding of the risks involved in this decision. Can
I explain something the risks associated with getting discharged against medical
advice/refusing medication or treatment? Would that be okay?

• I understand that the final decision is up to you. However, you must understand
the risks involved with this. Is it alright okay if I can discuss that with you?

Negotiating
• I’d like to propose that…

• I recommend/suggest…

• How do you feel about…

Responding to patient concerns or reluctance
• Maybe it would be better to…

• Perhaps a better idea would be…

• May I offer an alternative? I propose that…

• Given your health, a better solution might be…

• Would you be willing to accept a compromise? How about….?

• Would you agree to….?

Giving a Reason in Negotiations (explaining the risks

associated with non-compliance)
• The reason for that is…

• This is because…

Prioritizing Interests
• The most important issue for us is…

• We intend to ensure that you recover completely. For this,…

• Our main priority is your health. For this,

• If you do not follow this advice, your health might exacerbate…

• If you do not comply with my treatment advice, your condition might deteriorate.
Checking patient’s agreement
• Is that acceptable to you?

• Does that sound reasonable to you?

• Does that seem realistic to you?

• Will you agree to this?

• Can you agree to that?

• Do we have an agreement?

If anything: use this phrase to correct an assumption

Summary
For example:
You may have to advise several lifestyle modifications to your patients that they may find
Patient: Will the medication improve my energy levels?
uncomfortable for example, weight loss/management, giving up smoking/drinking, making
Nurse: Well, if anything it will make you feel drowsy in the short term.
dietary adjustments, etc.
Patient: Will I start gaining weight as soon as I take this medication?
Use the following steps to approach conversations on sensitive topics.
Nurse: Well, if anything you will lose a little bit of weight first before the weight gain starts.
Step 1: Seek permission
Ask for the patient’s permission before opening up the discussion.

• Would it be okay if we discuss how your weight can be managed to ensure it’s in
a healthy range?

• If you don’t mind, I’d like to discuss some ways you can incorporate some
physical activity into your life to adopt a heart-healthy lifestyle.

Step 2: Using the ‘right’ words

Avoid unpleasant or judgmental language. Be firm but kind.

For example: Instead of saying, “You are obese and need to reduce weight.”, say “Your
weight is above the normal range; to ensure good health, it’s advisable to lose the excess
weight.”

Step 3: Explain risks with not complying with your

advice
(To persuade patients) Make it a compelling case, and to do so, highlight the risks associated
with not adhering to your advice.

I do understand your reluctance. It’s a daunting prospect to make changes to your everyday
routine; however, you must consider the risks associated with carrying excess
weight/smoking/sedentary lifestyle/etc.

Reducing your alcohol intake is an essential step towards avoiding medical problems like
cardiovascular disease or fatty liver disease.

Excess weight can put you at risk of having a heart attack.

Step 4: Engage the patient to show that you are on

his/her side and are concerned about their health
I am concerned about your health.

Step 5: Offer realistic advice to get agreement from the

patient
The advice you will offer should be based on the patient’s lifestyle. For some patients, a daily
walk will be a tremendous step forward while for others, a rigorous exercise regime may be
possible.

Example: If a patient eats large servings or portions of food in a day, provide tips about
slowing down when eating, filling up on lower-calorie foods and downsizing instead of
upsizing.

For others who skip meals, emphasize the importance of eating balanced meals
throughout the day.
 Ask questions about your patient’s lifestyle and everyday activities so that you can
suggest practical, manageable, and measurable goals.

For example, I understand your perspective. How about this? You can begin with 15
minutes of walk daily and gradually increase the duration of the walks.

You could also refer your patient to a support group or offer a patient information leaflet
for better management of the specific condition you are advising them on. Be sure to provide
advice that causes minimum disruption in their lives.

Step 6: Reinforce the importance of making changes

Stress the hopeful aspect of your advice and reiterate that small steps can lead to a big
difference in the long run.

Step 1 – Empathize Dealing with a reluctant

• If I were you, I would react in the same way.

• I understand how you feel.

• Of course, it’s difficult to be in your position right now.

Step 2 – Justify your advice by explaining the consequences of non- compliance and
make the patient realize that they are responsible for their health.

If you continue to do this, it can have adverse effects on your health.

If you do not take your medication on time, it can lead to unfavorable outcomes.
You must consider the repercussions that this can have on your health
You must think of the long-term effects that it can have on your health
Of course, at the end of the day, it’s your decision to comply with the advice, but I would advise….
Here, you could use phrases like “I am afraid” or “unfortunately” for emphasis.
I am afraid if you do not cut down on your smoking, it can exacerbate your condition
Unfortunately, it is imperative that you cut down on processed foods to control your hypertension.
 Chapter 4
OET Speaking Course – Pocketbook
Beginning the conversation

Thanks for coming in. (not to be used when the patient is admitted in the hospital or
during a home visit).

Next, state your name and clarify your role.

Get permission to have the discussion

Set goals for the discussion – seek the patient’s permission before asking questions
or introducing a discussion.

“I’d like to go over your test reports, would that be ok?” “Today I plan to discuss…is
that okay?”

“Before, proceeding further, I’d like to ask you some questions. It will help me in
getting a clearer picture of your condition. Is that okay?”

“The doctor is worried about your weight. Is it okay if I ask you some questions
about your eating habits and lifestyle?”

“I’m concerned about your uncontrolled sugar levels. Would it be alright if I asked
you some questions first?”

“I’m wondering if you mind answering some questions about your medical history.
It will help me to understand the situation much better.”

Questioning techniques for information gathering and Active Listening skills.

Open-Ended Questions

“What brings you here today?”

“Can you tell me about your concerns?”

“How have you been feeling?”

“What seems to be bothering you?”

“Could you tell me something about your eating habits?” (Focused question – open
question but limits the scope)
 Closed-Ended Questions

“Do you have any ongoing medical illnesses?” “Do you drink alcohol?”

“Have you had any similar problems in the past?”

“Does anyone in your family suffer from this condition too?” “Did you take any
medication before coming here?”

Use an empathizing statement to show that you recognize the patient’s emotion and
understand it.

“I’m sorry this has happened, and I understand how it would make you feel that
way.”

“I hear what you’re saying. That must have been very difficult.”

“I get your point. It is obviously very upsetting.”

“I can see it’s really difficult for you to talk about this.” “I can appreciate that it isn’t
easy to talk about this”

“I do understand that it’s stressful to talk about this.” “It must be hard to talk about
this”

“I can see how difficult it is for you.”

“It sounds frustrating.”

Facilitating

• Do not interrupt the patient, but use back-channeling (Okay, uh-huh, hmmm, I see,
Alright, go on…etc.) to facilitate the conversation.

• A nod to let the patient know you are following them.

Use “Tell me more” statements

“Tell me more about that.”

“I can see that you sound/seem anxious. Could you tell me more about what’s
bothering you?”
Clarifying

“So, if I understand you correctly, you are saying…”

“Tell me more about that.”

“From what I have understood………,”

“So, let me see if I understand….…”

“What I hear you saying is…”

Explaining medical advice

Do not use medical jargon and explain the facts in a manner that the patient will
understand.

Present the information in small “chunks” to facilitate the patient’s understanding.

Use signposting or discourse markers to make the conversation easier to follow. After
each chunk, verify the patient’s understanding.

“Are you with me so far?”

“Do you have any questions that I can answer at this stage?” “Are you clear with
what I have just explained?”

“Would you like to ask any questions about what I have just explained?”

Elicit patient’s ideas, feelings, or concerns

“Can you tell me about how you feel?”

“Could you tell me how this makes you feel?”

“Can you tell me what you are thinking at the moment?”

“I can see that you seem anxious.”

“I can see that this has made you anxious. Would you like to share what’s on your
mind?”
Checking the patient’s understanding

Before explanation, assess the patient’s understanding of their condition.

Ask what the patient already knows and take note of the discrepancies in the patient’s
understanding and what is actually true.

“Tell me what you know about your condition so far.”

“Please tell me what you understand about your condition until now.”

“Could you tell me what you know about your condition so far?”

“To ensure we are on the same page with understanding your condition, so can you
tell me…”

Acknowledgement, Validation, and Empathizing

You may not agree with the patient’s feeling or way of thinking but respond
empathetically to show that you respect the patient’s perspective.

“That must have felt terrible when...” “Most people would be upset about this.”

“I do understand your concern.”

“I know it’s upsetting for you”

“I can appreciate that it is difficult for you.”

“I do understand how challenging it must be for you.”

Negotiating

3- step approach

1. Empathize to validate the patient’s feelings

(Use a normalizing statement like: “Most people would feel that way.”)

“I can understand your perspective.” “I get your point.”

2. Outline the benefits associated with your advice

3. Explain the risks associated with non-compliance

(Use “unfortunately” or “I am afraid” )

Use persuading statements like

“It’s really important that we resolve this.”

“Given the risks associated with non-adherence, I strongly advise you to consider
my advice.”

“I can understand your reluctance, but it’s important that you prioritize your health.”

“I strongly urge you to comply with this advice; otherwise, the repercussions could
be harmful to your health.”
More examples:

“I understand your resistance and many people would think the same, but I’m
afraid, there’s no other option at the moment. You need to priorities your health.”

“It’s never easy making lifestyle changes, but it’s imperative for your health
currently; not doing so would put you at risk of serious harm.”

“I can understand your perspective, but if you do not comply with my advice, it
could lead to adverse effects on your health.”

Then, check the patient’s agreement by asking clarifying questions. E.g.

Is that okay with you?

How does that sound?

Does that seem plausible to you?

Does that sound realistic to you?

Wrapping up the conversation

Ask if the patient has any questions or concerns

“Do you have any other questions or concerns?”

Reiterate/Summarize the discussion or the advice provided or clarify with the patient
their expectations of treatment and outcome.

“So, this is what we’ve decided.”

Ask the patient to repeat back to you their understanding of the plan.

“To check your understanding, could you please repeat back to me what we have
discussed today?”

“Do you mind repeating back to me what we have discussed? I want to

ensure that we are both clear about what we have discussed.”
Useful Vocabulary practice for Speaking and
Writing
• As well as –also/and- He is a drinker as well as a smoker.

• As well as this –also- As well as this, she also consumes a fat-rich diet.

• Overwhelming-emotionally difficult- I can understand this must be overwhelming

for you. Please let me explain why this is important. If you do not stop
smoking/drinking………

• Adverse-harmful-If you do not follow my advice; it will have adverse effects on

your health.

• Reiterate –repeat- to reiterate what we discussed today, you will have to make
changes…../To reiterate what you just said, you have a stressful job, and you barely
get time to exercise, is that correct?

• Cornerstone- foundation-good diet/Regular exercise is a cornerstone for leading a

healthy life.

• Perhaps- used to express uncertainty- Perhaps, you could consider cutting down on
smoking/drinking one day at a time.

• Probably- used to express uncertainty- Probably, you can join a support group like
Alcoholics anonymous to meet people who are in the same condition.

• Incorporate preventative/precautionary measures- You must incorporate these

changes into your lifestyle to get your health on track. You must incorporate
preventative measures into your lifestyle to…….

• Aww, it’s a pity to hear that!

• I am sorry to hear that!

• Mitigate- make something less severe or painful- Painkillers will help to mitigate
the pain.
Synonyms: reduce/ease/relieve

• Alleviate – Painkillers will help to alleviate the pain. Is there anything that alleviates
your pain?

• Susceptible- likely/prone/sensitive/vulnerable- Patients with liver disease may be

susceptible to infection. If you do not lose weight, you are susceptible to……

• Compliance- please ensure compliance with the suggested medication regimen

• To begin with - used for enumeration- To begin with, I will explain... after that.......
then.....following that......Finally.......

• Significant- Important - Adopting a low-fat diet will improve your health

significantly

Remarkable - note-worthy- Adopting a healthy lifestyle will improve your health

remarkably.

• Vital Please do not underestimate how vitally important this is.

Synonyms- crucial/essential/critical

• The importance of this treatment cannot be emphasized strongly enough.

• Detrimental- tending to be harmful, negative, adverse- If you continue to

smoke/drink, it will have detrimental effects on your health

• You seem distressed, is there anything on your mind that you would like to discuss
with me?

• Adherence-compliance - Please ensure adherence to the recommended exercise

program/medication regime and so on.