Past Simple vs Present Perfect in OET Letters: Getting Patient History Tenses Right

Past simple vs present perfect in OET writing isn’t a rule you memorise once and apply mechanically — it’s a judgement call the case notes force on you every single time you write a patient history, and getting it wrong doesn’t just sound slightly off. It changes what the receiving clinician believes about the timeline. “She was admitted with chest pain” and “she has been admitted with chest pain” are not stylistic variants of the same fact. They report two different situations, and an examiner marking against the Language criterion knows exactly which one your case notes described.

Watch the full breakdown: Tenses in Patient History works through this same decision using real referral and discharge letter case notes.

Why does tense choice matter this much in a patient history?

A patient history is a timeline, and tense is the only grammatical tool English gives you to signal where each event sits on that timeline relative to now. Get the tense wrong, and you haven’t made a small grammar error — you’ve reported the timeline incorrectly. If a receiving GP reads “she has had abdominal pain” but the case notes actually describe pain that resolved two weeks ago after a single episode, that GP now believes the pain is ongoing when it isn’t. That’s a factual error that happens to be encoded in a verb form, which is exactly why tense selection in OET writing gets marked hard under Language and can drag down Content at the same time.

This matters more in OET letters than in general English writing because the entire genre exists to compress a case-notes timeline into prose a stranger has to act on immediately. There’s no room for the reader to ask a follow-up question. The tense you choose has to carry the timeline information on its own, correctly, the first time.

Past simple: a completed event, a closed time reference

Past simple is the right choice whenever the case notes attach a specific point in time to an event, whether that point is a date, a named day, or a clearly bounded period that has ended.

“Mr Osei was diagnosed with type 2 diabetes in 2015.”

“She presented to the emergency department on Tuesday with acute chest pain.”

“He underwent an appendectomy last year.”

In every one of these, a closed time reference is doing the work — “in 2015,” “on Tuesday,” “last year.” The event happened, it’s finished, and English marks that with past simple regardless of whether the consequences of the event are still relevant. Mr Osei’s diabetes from 2015 is almost certainly still present today, but the sentence isn’t reporting his current diabetes status — it’s reporting when the diagnosis was made, which is a dated, closed fact.

This is the detail that catches candidates who over-apply the “if it’s still relevant, use present perfect” shortcut. Relevance to today doesn’t decide the tense. The shape of the time reference in the case notes does.

Present perfect: no finished time reference, ongoing relevance to now

Present perfect is the right choice when the case notes give you an open time frame — a starting point that continues to the present, or a duration with no endpoint specified — and the result of that event matters to the current presentation.

“She has experienced increasing shortness of breath over the past week.”

“He has taken metformin 500mg twice daily for the past three years.”

“The patient has reported intermittent lower back pain since her last visit.”

Notice the markers doing the grammatical work here: “over the past week,” “for the past three years,” “since her last visit.” None of these closes off a specific finished point. They describe a span that runs right up to the moment of writing, and the reason the letter mentions them at all is that they bear directly on today’s presentation. That combination — open time frame, current relevance — is exactly what present perfect exists to signal.

The two words that almost always tell you which tense to use

“Since” and “for” are the strongest signals in patient-history writing, and they resolve most of the ambiguity candidates struggle with:

The pattern worth internalising: “since” and “for” both describe duration that has not stopped. A finished date or a completed episode, however recent, takes past simple. This single distinction resolves the majority of tense errors in OET patient-history writing, because most of the ambiguity candidates feel comes from treating recency as the deciding factor rather than whether the time frame is open or closed.

Where candidates actually go wrong: mixing tenses mid-timeline

The error that costs the most marks isn’t choosing the wrong single tense in isolation — it’s inconsistency across a patient history that should be internally coherent. Compare:

Incorrect: “Mrs Chen was a 58-year-old woman who has been diagnosed with hypertension in 2018. She has presented today with a two-day history of headache and blurred vision.”

Correct: “Mrs Chen is a 58-year-old woman who was diagnosed with hypertension in 2018. She has presented today with a two-day history of headache and blurred vision.”

The first sentence mixes present perfect (“has been diagnosed”) with a dated, closed time reference (“in 2018”) — the two don’t belong together, because “in 2018” already tells you the event is closed. The second sentence fixes it: past simple for the dated diagnosis, present perfect correctly reserved for “has presented today,” which genuinely does connect a recent event to the current moment of the letter.

This kind of internal contradiction is what an examiner notices fastest, because it isn’t one error buried in a long sentence — it’s two tenses in adjoining clauses that can’t both be right given the same time reference. That reads as a genuine misunderstanding of the timeline, not a slip, and it’s marked accordingly under Language.

Why this error survives self-proofreading

Many languages don’t split this distinction into two separate verb forms the way English does. A single past-tense form in the writer’s first language can cover both “a dated, finished event” and “an ongoing situation with a starting point,” which means the English sentence you produce under exam pressure often defaults to whichever tense feels more natural to translate, not whichever tense the time reference in the case notes actually requires. That’s why this error is so resistant to a normal proofreading pass: the sentence sounds complete to the writer, because in their first language it would be.

The fix isn’t to memorise more vocabulary — it’s to build the habit of checking every time-related phrase in your patient history against the closed/open test before you finalise the tense: does this time reference give me a dated, finished point, or does it describe something running up to now? That one question, applied consistently, resolves almost every past simple vs present perfect decision in a typical OET letter.

A worked self-check for your next letter

Before you submit, go through every sentence describing patient history and case-note timeline information and ask two things:

1. Does this event have a closed, dated time reference (a date, a named day, a completed episode)? If yes, past simple.
2. Does this event or state have an open time frame — marked by “since,” “for,” or an unspecified ongoing duration — that connects directly to today’s presentation? If yes, present perfect.

Run this check specifically, separate from a general grammar reread, because tense consistency doesn’t jump out the way a missing word does. It requires tracing each sentence back to the time reference it’s actually describing, which is exactly the kind of detail a fast proofreading pass skips.

This pairs directly with the other tense-adjacent Language errors covered in our 8 grammar errors guide, and with subject-verb agreement in long clinical noun phrases, which shows up in the same patient-history sentences for a related reason — English grammar drifting further from intuition the longer and more information-dense the sentence gets. If your letters also need a pass on when to hedge an uncertain finding versus stating it plainly, our modals and hedging guide covers that adjacent Language skill. For the Language criterion itself, our Language criterion breakdown explains exactly how grammatical accuracy and range are scored.

The honest limit of self-editing here

Tense selection in patient history is one of the hardest Language errors to catch in your own writing, because the sentence you produce always sounds grammatically complete — it’s rarely broken English, just the wrong tense for the timeline the case notes actually describe. That gap between “grammatically fine” and “factually accurate about the timeline” is invisible from the inside. Our free OET Grammar Checker catches a useful first layer of these errors, though tense choice this context-dependent often needs a human reader who can check your sentence against the actual case notes. Our OET writing correction service reviews your letters against all six criteria, including exactly this kind of timeline-accuracy error that a spelling-and-grammar pass alone won’t reliably surface.