Contractions in OET Writing: Why They Don't Belong in a Clinical Letter

“The patient doesn’t report any known drug allergies and hasn’t had any previous admissions for this condition.” Nothing in that sentence is ungrammatical. Every contraction is used correctly. It still reads as the wrong register for OET writing, because contractions belong to spoken and informal English, and a referral or discharge letter is neither — it is formal written correspondence between two healthcare professionals, and that genre doesn’t use “doesn’t.”

Why do contractions cost you Genre & Style marks in OET writing?

Genre & Style is the criterion that checks whether your letter reads as genuine written clinical correspondence — one healthcare professional writing a formal document to another — rather than the way that same professional would speak the information out loud on a ward round. It sits alongside Purpose, Content, Conciseness & Clarity, Organisation & Layout, and Language as one of the six official criteria an OET Writing script is marked against, and it is where register slips like contractions get caught.

Contractions are the clearest marker of spoken register in written English. Native and highly fluent speakers use them constantly in conversation and in informal writing — texts, emails to friends, casual notes — and almost never in formal written documents: contracts, academic papers, official reports, and clinical correspondence. A referral letter that reads “the patient hasn’t responded to the first course of antibiotics” has borrowed the voice of a spoken handover, not a written letter, and an examiner trained to read for genre notices the shift immediately, even though the sentence is perfectly correct English.

This pattern sits alongside the broader over-formality and under-formality issues in our professional tone guide, and follows the same shape as other single-point register errors covered in our unwell vs sick guide and our “kindly note” phrases guide: a choice that is grammatically blameless and still the wrong genre for a clinical letter.

Contractions in OET writing: the full list to search for

Below is the set of contractions that appear most often in OET Writing scripts, with the full form each one needs to expand to before submission.

That last row is the one candidates miss most often, because an apostrophe followed by “s” usually signals possession in clinical writing — “the patient’s chart,” “the patient’s history” — and a quick read-through can skip past “patient’s been referred” without registering that this particular apostrophe-s is a contraction of “has,” not a possessive at all.

Why contractions feel invisible while you’re writing

Contractions are hard to self-edit for the same reason “sick” and “kindly note” are: nothing about them sounds wrong to the person who wrote them. Under 40-minute exam pressure, you are composing sentences close to how you would say them aloud, and spoken English runs on contractions. “The patient doesn’t have a history of asthma” is exactly how a nurse would say that sentence to a colleague on a ward. It is not how that same nurse would write it in a discharge letter, and the gap between those two registers is precisely what Genre & Style is designed to catch.

This also means contraction use tends to cluster rather than appear as an isolated slip. A candidate who writes “doesn’t” in the opening paragraph is statistically likely to write “can’t,” “it’s,” or “wasn’t” again later in the same letter, because the register has shifted for the whole piece, not just one sentence. Examiners read for that pattern across the full script, which is why a single missed contraction rarely sinks a letter on its own — a letter with five or six is a different story.

How does this connect to the Genre & Style criterion?

Genre & Style sits alongside Purpose, Content, Conciseness & Clarity, Organisation & Layout, and Language as one of the six official OET Writing criteria, and our Genre & Style score guide covers how the 0–7 band is assigned in full. Contractions are one of the most reliable signals this criterion is built to catch, precisely because they are so mechanical to produce and so easy to overlook: there is no judgement call about meaning, no ambiguity about tone — only a binary check of whether the full form or the short form was used. That mechanical quality is exactly why it is worth a dedicated proofreading pass rather than relying on the same read-through you use to check content and structure.

A letter that is otherwise strong — accurate content, clear organisation, correct clinical terminology — can still sit at a lower Genre & Style band than it should because of a habit that has nothing to do with how well the candidate understands the case notes. That makes contractions one of the cheaper wins available in the whole marking scheme: fixing them changes no content, restructures nothing, and takes under a minute once you know what to search for.

The one place contractions are correct: direct quotation

Contractions are not banned outright. If you are quoting the patient’s own spoken words inside your letter, keep the contraction exactly as spoken, because you are reporting speech, not writing in your own clinical voice: “The patient stated, ‘I can’t manage the stairs anymore since the surgery.’” The quotation marks signal to the reader that this is reported speech, so the register shift is expected and correct there. The error is using a contraction in your own narrative sentences outside quoted speech — which is, in practice, the vast majority of an OET letter.

A 60-second contraction check before you submit

Because contractions are grammatically invisible to a standard proofread, search for them specifically rather than hoping you’ll notice them on a normal read-through:

1. Search your letter for every apostrophe. This is the fastest way to surface contractions, since full written English rarely needs an apostrophe outside genuine possessives.
2. Classify each apostrophe you find. If it is attached to a verb form (don’t, isn’t, he’s, they’re, patient’s been), it is a contraction and needs expanding. If it shows ownership (the patient’s chart, the GP’s referral), it is correct and should stay.
3. Check your opening and closing lines specifically. Candidates often relax register at the very start and end of a letter — “I’m writing to refer…” or “Please don’t hesitate to contact me” — precisely where a first and last impression is formed.
4. Leave quoted speech untouched. Any contraction inside quotation marks reporting the patient’s exact words is correct as spoken and should not be expanded.

This takes under a minute once you know to search for the apostrophe character specifically, and it catches a category of error that a standard grammar checker will not flag, since every contraction it sees is spelled and used correctly. For the wider set of register errors beyond contractions, our Genre and Style mistakes guide covers the other common patterns examiners mark against.

The honest limit of self-editing for register

Register errors like contractions are hard to catch in your own writing because the sentence never sounds wrong to the person who wrote it — “the patient doesn’t have any allergies” is completely natural, correct English, which is exactly why it survives multiple rounds of self-proofreading unchanged. The mismatch only becomes visible when someone reads the letter the way the intended reader — a receiving clinician — would read it, and that is a different skill from checking grammar or spelling.

The free Writing Checker is a useful first pass for spelling and basic grammar, but register judgement calls like contraction use are exactly what a full criterion-by-criterion review is built to catch. Our OET writing correction service reviews your actual letter against all six official criteria, including the spoken-register habits that feel entirely natural to the writer and read as a Genre & Style flag to the examiner. View OET correction packages →