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How to interpret the question mark in OET Writing case notes

A symbol commonly used in OET case notes is the question mark (?), which is placed next to another word. Is this question mark relevant? How do you interpret this and transform it into a full, accurate sentence?

What does the question mark (?) symbol mean in the OET Writing case notes?

What is the difference between these two lines in a set of case notes? 



A question mark, or query in the case notes represents a possibility, or a doubt about a medical observation. It is important to take note of it, and understand that only an observation has been made, a diagnosis is not yet definitive. It should be described carefully and accurately in your letter when practising for the OET Writing sub-test. An example:

? depression...  means: Mr X may have depression. 

You can probably guess the medical meaning of such a short form, as you will have used such notes in your own training and workplace.  However, it can be challenging to translate the meaning appropriately in a formal English sentence, which will not lose accuracy to the reader.  

It is important to notice where the question mark occurs in the case notes, and look around it to understand the meaning in the right context. It can appear in any section.

Examples in the case notes:

You may see a question mark near the beginning of the notes, for example, linked to the background details for admission.  The medical issue may include a question mark. If so, here are some ways to describe this from case notes: 

Case notes example 1:

  • Admission23/1/20 
  • Diagnosis? L hip fracture (road traffic accident)

Description: "Mr X was admitted on 23.1.20 with a suspected left hip fracture, following a car accident."

If the question mark appears under the heading:

Case notes example 2:

  • Presenting ComplaintAlopecia (6 mths). ? depression.

Description: "Mr X presented with a 6-month history of alopecia.  He may also be experiencing depression associated with this."

Case notes example 3:

  • Presenting Complaint lower abdominal pain (2wks). Pt concerned. ? hernia 

Description: "Mr X presented with a 2-week history of pain in his lower abdomen. He expressed concern about the possibility of a hernia."

It could also appear towards the end of the case notes under Assessment or Plan– this often represents a possible diagnosis of a health condition, or a suggested plan of action for you to consider as found in the examples below:

Case notes example 4:

  • 18/1/20 Assessment:  Pt unwell. ? relapse / possible complications of pericarditis. 

Description: "Mr X appeared unwell today.  I suspect a relapse of pericarditis, perhaps with complications.  I am referring him to you for further assessment and management."

Case notes example 5:

  • Assessment: Deteriorating CCF ?  

Description: "He may have congestive cardiac failure."

Case notes example 6:

  • Treatment Plan: ? social worker appt. re: future accommodation 

Description: "An appointment with a social worker may be required to discuss future living arrangements."

Case notes example 7:

  • Treatment Plan: ? TKR (right) 

Description: "He may possibly require a right knee replacement."

Case notes example 8:

  • Assessment: ? pancreatic malignancy. Urgent referral for assessment + endoscopy. 

Description: "I am concerned about the possibility of a pancreatic cancer.  I would be grateful for an assessment and an endoscopy."

More polite ways to begin your sentence

Here are some polite ways for you to begin the sentences in your letter:

  • "It is possible that..."
  • "My provisional diagnosis is…"
  • "He has a suspected..."
  • "It is likely that…"
  • "Mr X may benefit from..."
  • "His symptoms are suggestive of..."

Choosing this language suggests your medical opinion to the reader, and you can be confident that you are interpreting the case notes accurately. 

Remember:  The assessors will expect you to take note of any question mark in the case notes, and interpret the information using appropriate language. 

Now you practice... 

Try to interpret these notes with a question mark. How would you create a formal sentence to describe their meaning? Remember to use the correct verb tense.

  1. Sore L knee – pain intermittent, no identified trigger ? osteoarthritis 
  2. ? pt not taking meds regularly 
  3. ? suspected ectopic pregnancy 
  4. Pt checks own glucose levels often (? worried)