Writing a good OET letter is not about filling every sentence with sophisticated vocabulary. It is about helping another healthcare professional understand the patient’s situation quickly, accurately and clearly. This is particularly important when using connectors.
Connectors are words and phrases that show how one idea relates to another. They can help you add information, show a contrast, explain a reason, describe a consequence, establish a timeline or indicate what should happen under a particular condition. However, there is an important point to remember: using more connectors does not automatically make your OET Writing better. In fact, adding a connector when the relationship between two ideas is already clear can make your letter sound unnatural or unnecessarily wordy.
The better approach is to ask yourself: What is the relationship between these two ideas, and does the reader need a connector to understand it? Once you identify the relationship, choosing the appropriate connector becomes much easier.
What does OET expect from your use of connectors?
The OET Writing sub-test is designed around professional healthcare communication. You have 45 minutes to write one profession-specific letter, usually to another healthcare professional.
This means your writing should resemble the kind of communication used in a clinical setting. A referral letter, discharge letter, transfer letter or letter requesting an urgent review needs to communicate relevant information efficiently. It does not need to sound like an academic essay. OET’s guidance on sentence connectors emphasises that assessors do not count how many connectors you use. Instead, they consider whether your language is clear, concise and appropriately linked. This makes connector selection a question of purpose, rather than vocabulary.
For example: She has hypertension and type 2 diabetes. There is no need to replace and with a more complicated expression simply to demonstrate a wider vocabulary. The relationship between the two conditions is already clear.
Similarly: Her pain has improved; however, her mobility remains limited. Here, however has a clear purpose. It tells the reader that the second piece of information contrasts with the first. The key difference is that the connector is helping the reader understand the clinical relationship between the ideas.
Choose the connector according to the clinical relationship
Instead of trying to memorise long lists of connectors, organise them according to what you want to communicate.
| Clinical purpose | Useful connectors | Example |
| Add relevant information | and, additionally, as well as | She has hypertension and type 2 diabetes. |
| Show contrast | however, although, despite | Her pain has improved; however, her mobility remains limited. |
| Explain a reason | because, as, owing to | As he lives alone, he requires support with medication management. |
| Show a consequence | therefore, consequently, so | She remains at risk of falls; therefore, a home-safety assessment is recommended. |
| Give a condition or warning | if, unless, otherwise | Please review her urgently if her symptoms worsen. |
| Show time or sequence | following, subsequently, after, on admission, on discharge | Following surgery, she developed urinary retention. |
| Explain purpose | to, in order to, so that | I am referring Mr Ali to the physiotherapy team so that he can receive ongoing treatment. |
| Present an alternative | or, alternatively | He may require insulin adjustment or, alternatively, specialist review. |
The most appropriate option depends on the information in the case notes. A connector that works well in one letter may be unnecessary or inappropriate in another.
1. Adding relevant information
Sometimes you simply need to introduce another relevant piece of clinical information.
For closely connected information, and is often enough: She has hypertension and type 2 diabetes. There is no advantage in replacing a simple and accurate connection with an unnecessarily elaborate phrase.
When you are introducing an additional relevant point, additionally can be useful: Additionally, she reports reduced appetite.
You can also use as well as when you want to combine related information: He reports persistent lower back pain as well as difficulty walking.
The important word here is relevant. Do not use an additional connector merely because you are moving to the next sentence. The information should contribute to the purpose of the letter. For example, if you are writing a referral letter about a patient’s worsening mobility, adding another relevant symptom may help the receiving professional understand the case. An unrelated piece of information does not become useful simply because it is introduced with additionally.
2. Showing contrast or an unexpected result
Clinical information does not always move in the same direction.
A patient may improve in one area while continuing to experience problems in another. This is when connectors such as however, although and despite can make the relationship much clearer.For example : Her pain has improved; however, her mobility remains limited. The first statement suggests improvement, while the second introduces a continuing problem.
You can also use although: Although she is clinically stable, she requires monitoring.
Or despite: Despite treatment, her symptoms persist.
These connectors are particularly useful when the second piece of information might otherwise appear surprising or contradictory.
Although vs despite
One common grammar problem is using these two connectors in the wrong structure.
Use: Although + subject + verb
Although she attended physiotherapy, her mobility did not improve.
Use: Despite + noun, pronoun or -ing form
Despite attending physiotherapy, her mobility did not improve.
Notice the difference:
Although she attended physiotherapy…
but: Despite attending physiotherapy…
This distinction is small, but grammatical accuracy matters in OET Writing.
3. Explaining a reason
Sometimes the reader needs to understand why a patient requires a particular intervention, referral or form of support. Connectors such as because, as and owing to can establish this relationship.
For example: As he lives alone, he requires support with medication management. Here, living alone explains why additional support is required.
You could also write: Because he lives alone, he requires support with medication management. Another useful distinction is between because and because of.
Use: because + subject + verb
Because she has recurrent falls, she needs supervision.
Use: because of + noun phrase
Because of recurrent falls, she needs supervision.
The meaning is similar, but the grammatical structure is different. When you are editing your letter, check what comes immediately after the connector. If you use because, you need a subject and verb. If you use because of, you need a noun phrase.
4. Showing a result or clinical consequence
Healthcare correspondence often moves from clinical information to a recommendation.
For example, you may describe a patient’s symptoms and then explain what action is required as a result. This is where therefore or consequently can be useful.
She remains at risk of falls; therefore, a home-safety assessment is recommended.
The connector makes the relationship clear: risk of falls → need for assessment
Similarly: Her condition has deteriorated. Therefore, urgent assessment is required.
The second sentence is not simply another piece of information. It is a consequence of what has already been described.
However, you should not automatically use therefore every time a recommendation follows a clinical finding. If the relationship is already clear from the sentence itself, the connector may not be necessary. The purpose is to make the reasoning easier to follow, not to make the sentence sound more advanced.
5. Giving a condition or warning
OET letters frequently need to communicate what should happen if a patient’s condition changes. This is especially relevant when providing safety-netting instructions. Useful connectors include if, unless and otherwise.
For example: Please review her urgently if her symptoms worsen. Here, if establishes the condition under which the action should be taken.
You can also use unless: Unless she improves within 48 hours, please arrange a review.
The structure is: unless + subject + verb
You can use otherwise when referring to an alternative consequence: Please monitor his blood glucose levels regularly; otherwise, further complications may occur.
These connectors can be particularly useful because they make contingency plans explicit. In healthcare communication, clarity about what should happen next can be more important than using sophisticated vocabulary.
6. Showing sequence and timing
Clinical letters often contain several events that happened at different points in a patient’s care. If the timeline is unclear, the reader may struggle to understand the patient’s history. Connectors and time expressions such as following, subsequently, after, on admission and on discharge can make the sequence easier to follow.
For example: Following surgery, she developed urinary retention. This immediately establishes when the complication occurred.
Similarly: On discharge, she was prescribed analgesia.
Or: Subsequently, her symptoms improved.
These expressions are particularly useful in transfer and discharge letters because they help the receiving professional understand what happened and when. However, avoid adding a time connector to every sentence. If the chronology is already obvious, repeating such expressions can make the letter unnecessarily heavy. The goal is to clarify the timeline where needed.
7. Clarifying the purpose of an action
Healthcare letters frequently explain why the writer is referring a patient or requesting a particular service. Structures such as to, in order to and so that can make the purpose clear.
For example: I am referring Mr Ali to the physiotherapy team so that he can receive ongoing treatment. Here, so that he can receive explains the purpose of the referral.
You can also write: The patient has been referred to physiotherapy to improve his mobility. Here, to improve explains the intended purpose.
There is no need to use in order to simply because it sounds more formal. In many situations, to is shorter and more natural:
‘She was referred to a dietitian to support weight management’ rather than ‘She was referred to a dietitian in order to support weight management’. Both are grammatically possible, but concise writing is generally preferable when the shorter structure communicates the same meaning.
8. Presenting an alternative
Sometimes the notes indicate that more than one option may need to be considered. In such situations, or and alternatively can be useful.
For example: He may require insulin adjustment or, alternatively, specialist review. The connector signals that the second option is an alternative to the first.
Again, the choice should reflect the information in the case notes. Do not add alternatively simply because you want to use a more formal word.
Should you use formal connectors in OET Writing?
Professional healthcare correspondence does require an appropriate tone, but formal does not mean complicated.
Connectors such as additionally, however, therefore, following and unless can work well because they are clear and appropriate in clinical communication. However, some candidates assume that the more academic a connector sounds, the better it must be. That is not the case.
OET guidance specifically distinguishes between natural connectors suitable for healthcare writing and expressions that may sound overly academic, informal or outdated. For example, candidates may be tempted to use:
- furthermore
- moreover
- hence
- thus
- thereafter
simply because they associate these words with formal writing. But healthcare correspondence does not need to imitate an academic essay. In many cases, a more straightforward connector communicates the same relationship more naturally. For example: ‘Her condition deteriorated. Therefore, urgent assessment was required,’ is direct and clinically appropriate. The objective is not to impress the reader with vocabulary. The objective is to communicate the patient’s situation and the required action efficiently.
What about “And”, “But”, “So” and “Also”?
Candidates are often taught to avoid beginning sentences with simple connectors such as and, but, so or also. For OET Writing, it is generally better to use professional alternatives where a sentence-opening connector is actually needed.
For example: ‘Additionally, she reports reduced appetite’, ,rather than, ‘Also, she reports reduced appetite’
Or: ‘However, her mobility remains limited’,rather than, ‘But her mobility remains limited’.
And: ‘Therefore, urgent assessment is required’, rather than, ‘So urgent assessment is required’.
The important point, however, is not to turn this into another rule about replacing every simple word with a longer one. If two pieces of information can be combined naturally, you may not need a sentence-opening connector at all.For example: She has hypertension and type 2 diabetes. There is no need to write: Additionally, she has hypertension. Additionally, she has type 2 diabetes. The second version adds unnecessary repetition instead of clarity.
Avoid “connector stuffing”
One of the easiest ways to make an OET letter sound unnatural is to place a connector at the beginning of almost every sentence. Consider this example: ‘Additionally, the patient was admitted. Furthermore, she was treated with intravenous antibiotics. Moreover, she improved over the next three days.’
There are several connectors, but they do not add much meaning. The reader already understands that the events are related. A more efficient version would be: ‘She was admitted for intravenous antibiotics and improved clinically over the next three days’. The second version communicates the same clinical information more directly. This is why simply counting connectors is not a useful way to improve your writing. More connectors do not mean a higher grade. If a connector does not clarify the relationship between ideas, it may be better to remove it.
A practical way to choose connectors during the exam
You do not need to stop for a long time and search through a mental vocabulary list during the 45-minute Writing sub-test. Instead, identify the relationship between the pieces of information.
If you are adding information:
Think: “I am giving another relevant point.”
Possible choices: and, additionally, as well as
If the information contrasts:
Think: “The second point is different from or unexpected based on the first.”
Possible choices: however, although, despite
If you are explaining why:
Think: “What is the reason?”
Possible choices: because, as, owing to
If one point leads to an action or consequence:
Think: “What happened as a result?”
Possible choices: therefore, consequently
If an action depends on a condition:
Think: “Under what circumstances should this happen?”
Possible choices: if, unless, otherwise
If you are explaining when something happened:
Think: “Where does this event fit in the patient’s timeline?”
Possible choices: following, subsequently, after, on admission, on discharge
If you are explaining why something is being done:
Think: “What is the purpose?”
Possible choices: to, in order to, so that
This approach is more useful than memorising dozens of connectors because it links vocabulary to meaning.
Connectors should support the clinical message, not compete with it
The most effective OET letters are easy for the receiving healthcare professional to follow. Imagine reading a referral letter while already managing several patients. You need to know:
- Why is this patient being referred?
- What has happened?
- What is relevant to the current problem?
- What has been done?
- What needs to happen next?
Connectors can help organise these relationships, but they should not become the main feature of the letter. For example:
Following her recent admission, Mrs Khan was commenced on antibiotics. However, she continues to experience intermittent fever. Therefore, I would appreciate your urgent review.
Each connector has a different function:
Following → establishes the timeline.
However → highlights an important contrast.
Therefore → connects the clinical situation to the requested action.
This is purposeful use of connectors. Each one helps the reader understand something that matters.
The key takeaway: choose the connection, not the “advanced” word
When preparing for OET Writing, it can be tempting to collect long lists of sophisticated connectors and try to include them in your letters. Instead, focus on understanding the relationship between your ideas.
Use however when you need to highlight a contrast.
Use therefore when a clinical finding leads to a consequence or recommendation.
Use additionally when you genuinely need to introduce another relevant point.
Use because or as when you need to explain a reason.
Use if or unless when an action depends on a condition.
Use following, subsequently or on discharge when the timing of an event needs to be clear.
Use to when you need to explain purpose.
And remember that sometimes the best connector is no connector at all.
Your aim in OET Writing is not to demonstrate how many linking words you know. It is to make the clinical information easy to understand and the required action easy to identify. So, before adding a connector, pause and ask: What relationship am I trying to show?
Then choose the simplest, most natural connection that communicates it clearly. That is a much more effective approach than trying to make every sentence sound more sophisticated.
Read our Recent Blog – “How to Adapt Your Introduction to Different OET Speaking Role Plays” – to ensure your journey stays on track.
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