In OET Speaking, we are expected to communicate with patients in a way that is clear, professional and patient-centred. However, many of us focus so heavily on remembering what to say that their communication can begin to sound rehearsed. This is particularly noticeable when they try to demonstrate empathy.
Many of us often prepare expressions such as “I understand how you feel,” “I can appreciate that this must be difficult,” or “Please don’t worry.” While these phrases can be useful, using them repeatedly does not necessarily demonstrate genuine empathy. In fact, when a phrase is used without considering what the patient has actually said, it can make the interaction sound mechanical.
So, what does effective empathy look like in an OET role play?
In this blog, we will look at empathy as part of the OET Speaking assessment, explain why memorised responses can sound unnatural, and show how you can develop a more responsive approach. We will first consider what OET assesses, then examine what makes communication sound robotic, before looking at how to respond to a patient’s emotions and concerns more naturally. Finally, we will discuss how we can use their preparation time and practice sessions to develop this skill.
The central idea is simple: Empathy in OET Speaking is not about memorising the right phrase. It is about recognising the patient’s perspective and responding appropriately.
Empathy Within the OET Speaking Assessment
The OET Speaking sub-test consists of two profession-specific role plays. We have three minutes to prepare for each role play and approximately five minutes to complete it.
Performance is assessed using four Linguistic Criteria and five Clinical Communication Criteria.
The Linguistic Criteria are:
- Intelligibility
- Fluency
- Appropriateness
- Resources of Grammar and Expression
The Clinical Communication Criteria are:
- Relationship-building
- Understanding and incorporating the patient’s perspective
- Providing structure
- Information-gathering
- Information-giving
The Linguistic Criteria are marked on a 0–6 scale, while the Clinical Communication Criteria are marked on a 0–3 scale. The resulting scores are combined and converted to the OET 0–500 scale.
Empathy and respect are specifically considered under Relationship-building. At the same time, we are assessed on the ability to understand and incorporate the patient’s perspective. This is important because it shows that empathy is not simply an additional quality that makes a role play sound pleasant. It forms part of the communication skills being assessed.
OET describes empathy as recognising and responding to a patient’s feelings, predicament or emotional state. Therefore, demonstrating empathy requires more than using an appropriate phrase.
The candidate must show that they have understood what the patient is experiencing and have adapted their response accordingly. For many of us aiming for Grade B, OET guidance indicates that performance is generally associated with predominantly 5/6 on the Linguistic Criteria and 2/3 on the Clinical Communication Criteria.
The question, therefore, is not simply “Which empathy phrases should I memorise?” , instead it is “How can I show the patient that I have understood their concern?”
That distinction is at the heart of sounding empathetic rather than robotic.
Why Memorised Responses Can Sound Robotic
Memorising useful expressions can be helpful when preparing for OET Speaking. It gives us a starting point when we are unsure how to respond. However, problems arise when these expressions become a fixed script.
Consider the following example:
Patient: “I’m really worried about this lump. My mother died of cancer, so I’m scared that it could be something serious.”
Candidate: “I understand how you feel. Please don’t worry. We will do some tests.”
The candidate has used an empathy expression, but the response does not fully acknowledge the patient’s specific circumstances.
A more responsive answer would be: “I can understand why you’re feeling worried, especially given your mother’s experience. Let’s talk through what you’ve noticed and discuss what we can do next.”
The second response works because it responds to the reason behind the patient’s concern. This is the difference between memorised empathy and responsive empathy.
Memorised empathy asks: “What phrase have I prepared for this situation?”
Responsive empathy asks: “What has the patient just told me, and what do they need from me now?”
The same problem can occur with reassurance.
For example, telling a worried patient: “Please don’t worry. Everything will be fine” may sound reassuring, but it may not be appropriate when the outcome is uncertain.
A better response might be: “I can understand why this is worrying for you. Let me explain what we know so far and what we can do next.”
This provides reassurance through support and action rather than through an unrealistic promise. The aim is therefore not to eliminate prepared phrases completely. Rather, you should learn to use them selectively and appropriately.
Developing a Responsive Approach to Empathy
A practical way to approach empathy during a role play is to follow three stages:
Listen → Recognise → Respond
Listen
Pay attention to what the patient is actually saying. Patients often reveal their emotional state through their words:
- “I’m frightened about having surgery.” → fear
- “I’ve been waiting for two weeks and nobody has called me.” → frustration
- “I feel terrible because I can’t look after my children.” → distress or guilt
- “I’m not sure whether I can manage this treatment.” → uncertainty or anxiety
The candidate does not need to identify the emotion aloud. The purpose is to recognise it so that the response is appropriate.
Recognise
Acknowledge the patient’s experience.
For example: “It sounds as though this has been quite difficult for you” , or “I can understand why you might be concerned.” The acknowledgement should reflect the situation rather than appear to be inserted automatically.
Respond
Once the concern has been acknowledged, consider what the patient needs next.
They may need:
- reassurance,
- clarification,
- further information,
- practical support,
- or an opportunity to explain their concern further.
For example:
Patient: “I’m worried about taking these tablets because I’ve heard they can cause side effects.”
Candidate: “I can understand why you’d be concerned about possible side effects. It’s important that you feel comfortable with the treatment. Let me explain which side effects you should look out for and what you should do if you experience them.”
Here, empathy leads naturally into information-giving. This is more effective than immediately explaining how the medication works without acknowledging the patient’s concern.
Adapting Empathy to the Patient and Situation
There is no single empathy response that is appropriate for every role play.
A patient who is frustrated about a delayed appointment may need acknowledgement: “I’m sorry this has been frustrating for you.”
A patient who is anxious about a procedure may need reassurance and information: “I can understand why you’re feeling nervous. Let me explain what the procedure involves and what you can expect.”
A patient who is struggling to manage their condition at home may need acknowledgement followed by practical support: “I can understand why you’re concerned about managing this at home. Let’s discuss which aspects you are finding most difficult.”
The intensity of your response should also reflect the patient’s emotional state. Not every concern requires an extended empathy statement.
If a patient says: “I’m a little nervous about the procedure”, a simple response such as “Of course. What would you like to know about it?” may be more natural than a lengthy statement about how difficult and stressful the situation must be.
Effective empathy is therefore context-dependent. It involves understanding the patient first and choosing your language second. This is also why candidates should avoid trying to sound overly sophisticated. A simple sentence such as “I can see that this has been really difficult for you.” is often more natural and appropriate than “I can appreciate the considerable emotional distress that this unfortunate circumstance may have occasioned.”
The objective is not to impress the patient with complex vocabulary. It is to communicate clearly, professionally and sensitively.
Integrating Empathy into the Role-Play Conversation
Empathy should not exist as a separate part of the role play that candidates “tick off”. It should be integrated into information-gathering, information-giving and relationship-building. This is particularly important when using the role-play card. The card provides the framework for the interaction, but it should not become a script.
Suppose the card asks you to ask about the patient’s concerns, explain a treatment and provide reassurance. A mechanical approach might be, “what are your concerns?” followed immediately by a prepared explanation.
A more patient-centred approach would allow the patient’s answer to influence the next part of the conversation.
For example: “Could you tell me what concerns you most about starting the treatment?”
If the patient responds, “I’m worried that I’ll become dependent on it ”, you could say, “I can understand why that would concern you. Let me explain how this medication works and address your concerns about dependence.”
The patient’s response has now shaped the conversation. This is particularly important because OET’s assessment framework focuses on communication skills rather than simply checking whether a candidate has mentioned every point on the role-play card.
A useful structure for combining empathy and clinical communication is:
Acknowledge → Address → Explain → Check
For example: “I can understand why you’re concerned. Let’s look at what has been happening. Some people can experience this when starting the medication. Does that explanation make sense?”
This structure helps maintain a two-way interaction rather than turning the role play into a long information-giving monologue.
Using Tone, Delivery and Preparation Time Effectively
Even appropriate language can sound robotic if it is delivered mechanically. Tone, pace, pauses and responsiveness all contribute to how natural the interaction sounds.
For example, repeating “I understand how you feel” in exactly the same tone after every concern can sound rehearsed. Allowing the patient to finish speaking, pausing briefly and responding calmly can make the same expression sound much more genuine.
Candidates should therefore use the three-minute preparation period to think about communication as well as content. Before beginning the role play, consider:
What is the patient’s main concern? : Look beyond the clinical problem. What are they actually worried about?
What might the patient be feeling? : Are they anxious, frustrated, embarrassed, confused or distressed?
What do they expect from this interaction? : What are they hoping to understand, resolve or receive?
What do they need from me now? : Do they need reassurance, information, clarification, support or further discussion?
These questions can help candidates enter the role play with a communication strategy rather than a fixed script. Candidates should also allow the patient to finish speaking where appropriate. If the patient explains a concern, respond to that concern rather than immediately moving to the next point on the card.
Using the patient’s preferred name appropriately can also contribute to relationship-building, but it should not be repeated in every sentence.
Developing Empathy Through Deliberate Practice
The most effective way to improve this skill is to practise responding, rather than simply memorising phrases.Take different patient statements and identify three things:
- What is the patient feeling?
- What is the concern?
- What would be an appropriate response?
For example;
Patient: “I’m really nervous about the operation.”
Emotion: Anxiety
Response: Acknowledge + reassure + provide information
“I can understand why you’re feeling nervous. Let me explain what the operation involves and what you can expect.”
Now consider;
Patient: “I’ve been waiting for weeks, and nobody seems to know what is happening.”
Emotion: Frustration
Response: Acknowledge + investigate + provide support
“I’m sorry this has been such a frustrating experience. Could you tell me what information you’ve received so far?”
The objective of this practice is not to memorise the two responses. It is to understand why each response is appropriate. Once candidates begin practising in this way, they become less dependent on a fixed collection of empathy phrases. They also become better prepared for role plays in which the patient’s response does not follow the pattern they expected.
Conclusion
Empathy is an important component of effective communication in OET Speaking, but it should not be treated as a collection of phrases to insert into a role play.
OET’s assessment criteria require candidates to build relationships, understand and incorporate the patient’s perspective, gather information effectively and provide appropriate information. Empathy and respect form part of Relationship-building, while the Linguistic Criterion of Appropriateness considers whether language and tone are suitable for the interaction. For this reason, the strongest approach is to move beyond scripted empathy.
Rather than asking: “Which empathy phrase should I use?”, ask: “What is this patient feeling, and how should I respond?” Listen to what the patient says. Recognise the concern behind their words. Acknowledge it appropriately. Then provide the information, reassurance or support they need.
The goal is not to sound empathetic. The goal is to communicate with empathy.
When candidates focus on the patient rather than the script, their communication becomes more natural, more flexible and more closely aligned with the patient-centred approach expected in OET Speaking.
Read our detailed blog – “Master OET Writing Tenses: The Complete Guide to Using Tenses Correctly” – to ensure your journey stays on track.
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