The Polished Letter: Cohesion, Punctuation and Formal Tone

Problem: clinically accurate letters lose marks on cohesion gaps, comma splices, inconsistent dates and chatty tone — polish failures, not knowledge failures. Answer in brief: signpost with restrained connectors, punctuate commas/semicolons/dates/lists by rule, revise every sentence for formal tone, and proofread with a last-minute checklist. Method, models and 12 tasks below.

Learning outcomes

By the end you will be able to: signpost letter structure with varied connectors without overuse; place commas, semicolons, colons, date and list punctuation by rule; punctuate letter format (greetings, closings, headings) consistently; revise informal phrasing to formal tone; and run a last-minute proofreading checklist covering pitfalls. All guidance follows the source book, OET Letter Writing Grammar for Doctors (OET GRA DOC 15) (Jobin Thomas) — ten chapters from sentences through pitfalls with exercises and explained answers, verified by full-structure scan with chapter and answer-key sampling. Language-learning examples with fictional scenarios only; never clinical guidance.

Signposting with connector restraint

Signposts orient busy readers: history (“Previously…; In March…”), turns (“However, his condition…; Despite treatment…”), additions (“Moreover, she reports…; In addition…”), purpose (“I am writing to refer…; This letter requests…”), closure (“I would be grateful…; Please do not hesitate…”). Restraint rules: one connector per sentence maximum; never stack (“However, moreover”); vary across the letter (however → although-clause → despite-phrase); prefer built-in joints (subordination, participles) over added adverbs in every third sentence. Over-connection signals trainee prose — confident letters connect half their sentences explicitly and let sequence carry the rest.

Punctuation: commas, semicolons, dates, lists

Commas: after introductory phrases (“On examination, …”), around non-defining relatives (“Mr Bell, who is 72, …”), between independent clauses with conjunctions — never splicing two (“…rose, costs followed” ✗ → “…rose; costs followed” or “…rose as costs followed” ✓). Semicolons join related independents without conjunctions (“He is stable; discharge is planned”); colons introduce lists and explanations (“Findings: …”). Dates/times: consistent format throughout (“4 May 2026”, never mixed with “May 4th”); no commas inside (“on 4 May 2026”); times with colon (“08:30”). Lists: parallel structure (“…review, monitor and adjust” — all base verbs); colon before, consistent punctuation after.

Letter-format punctuation and capitalisation

Greetings (“Dear Dr Patel,” — comma), closings (“Yours sincerely,” + name/title block), headings (patient name, DOB, date — consistently punctuated). Capitalise titles and names (Dr, Mr, St Thomas’s), months and days, but not conditions generically (“diabetes”, “hypertension” lowercase; acronyms — ECG, COPD — uppercase). No contractions anywhere (“did not”, never “didn’t” — formality error as the answer key itself corrects). Addresses and reference lines aligned every letter; inconsistent formatting reads as carelessness before content is even assessed.

Formal tone revision, sentence by sentence

Revision sweep converts spoken habits: “got better” → “improved/recovered”; “a lot of pain” → “significant pain”; “kids” never appears — “children”; “check his sugar” → “monitor his glucose”; “tell me if worse” → “please contact us should symptoms worsen”. Addressing patients and others stays respectful (“Mr Bell” after first full naming; “the patient” where appropriate, never familiar first-names in referrals). Professionalism extends to content relevance — the pitfalls chapter’s final warning: irrelevant or overloaded content fails purpose criteria regardless of polish. Tone revision is the last pass, never the first: facts and structure precede style.

Worked models: polish applied

Labelling: all extracts below are newly written in the book’s exercise patterns. The book’s content is not reproduced. Fictional scenarios; language examples only.

Model 1 — Unpolished letter, revised (newly written)

Draft: “Dear Dr Patel I am writing about Mr King who is admitted two days ago, he have asthma since childhood, and he didn’t took his meds properly, his sugar is very high, please see him soon thanks.” Revised: “Dear Dr Patel, (greeting comma). I am writing to refer Mr King, who was admitted two days ago (past tense). He has had asthma since childhood (agreement + perfect). However, he did not take his medication regularly (connector + no contraction + base form). Additionally, his glucose remains significantly elevated (formal lexis). I would be grateful if you could see him urgently (polite request). Yours sincerely, (closing).” Fix classes: punctuation, tense, agreement, contraction, base form, lexis, request — seven in eight lines.

Model 2 — Signpost variety demo (newly written)

Stacked: “However, he improved. Moreover, his appetite returned. Furthermore, discharge is planned.” Varied: “He has improved steadily (clean opening). Although appetite was poor initially, it has now returned (subordination instead of moreover). Discharge is therefore planned for Friday (single precise connector).” Note: three joints, three different mechanisms — variety is the restraint.

Model 3 — Date/list consistency (newly written)

Inconsistent: “Seen May 4th, reviewed on 06/05/2026, next: Friday. Plan: review, to monitor, adjustment.” Consistent: “Seen on 4 May 2026 and reviewed on 6 May 2026; next review Friday 9 May 2026 (uniform dates). Plan: review symptoms, monitor glucose and adjust medication (parallel base verbs).” Note: consistency checked in one dedicated pass — mixed formats signal haste.

Model 4 — Last-minute checklist run (newly written)

Checklist: greeting/closing punctuation → contractions (zero allowed) → date formats uniform → commas in complex sentences → semicolon splices fixed → capitals (names/titles/months) → tone sweep (spoken words formalised) → relevance (every sentence earns its place). Demo find: “didn’t” in paragraph 3 → “did not”; “May 4th” → “4 May 2026”; “very high sugar” → “significantly elevated glucose”. Note: fixed order, five minutes, every letter — polish as procedure.

Proofreading checklist card (five minutes, fixed order)

Practice bank: 12 tasks with answers

Attempt on paper (letters are written, not thought) before opening each answer. All items are newly written; fictional scenarios; language examples only.

Common errors and corrections

• Connector stacks: however-moreover-furthermore. Correction: vary mechanisms; one per sentence.
• Comma splices: commas joining independents. Correction: semicolons or joints.
• Mixed date formats: three styles per letter. Correction: one dedicated consistency pass.
• Non-parallel lists: mixed verb forms. Correction: parallelise in one check.
• Chatty tone: got-better prose. Correction: sentence-by-sentence formal revision.
• Polish-before-facts: styled irrelevance. Correction: relevance first; tone last.

Independent task and self-check

Task (newly written): polish-pass two letters weekly with the checklist; log fixes by class; rewrite flagged lines same-day.

Self-check: are connectors varied and single? Is punctuation rule-clean? Is tone contraction-free and formal? Is every sentence relevant? Four yeses = polish procedural.

Study sequence with the book

1. Read sentence/tense/voice/modal/article/preposition chapters as foundations.
2. Study linking with restraint; vary mechanisms deliberately.
3. Master punctuation rules with fix-the-error exercises.
4. Revise tone sentence-by-sentence; ban contractions.
5. Run pitfalls with the proofreading checklist on every letter.
6. Final review: full letters polished in five-minute passes.

FAQs

How many connectors per letter? Roughly one per two sentences, varied — half explicit, half structural. Count in review.

Semicolons risky? Only misused ones. Correct semicolons display control; when unsure, use a joint instead.

British or American dates? Match your test centre’s convention consistently — “4 May 2026” is the safe international form.

Does polish really move marks? Yes across Language, organisation and genre/style criteria — polish failures read as carelessness in all three.

How does this fit the tenses/voice volumes? Those build sentence accuracy; this volume finishes letters — cohesion, punctuation, tone, proofreading. Accuracy first, polish always last.

The matching book

OET Letter Writing Grammar for Doctors (OET GRA DOC 15) contains ten chapters from clear sentences to pitfalls with exercises and explained answers — the finishing school for doctors’ letters. If procedural polish helped here, the book is where you practise it end to end. Product page link to be added when the authenticated staging catalogue mapping is available — no URL is invented here.

Continue your practice with OET Letter Writing Grammar for Doctors (OET GRA DOC 15)

Want more practice? This article introduces the key principles, but OET Letter Writing Grammar for Doctors (OET GRA DOC 15) provides additional practice, worked examples and structured preparation. View the book →

Sources and editorial note

Teaching follows the verified source EPUB (233 content files; ten chapters with exercises and explained answers; confirmed by structural scan with chapter and answer sampling). All extracts in this article are newly written; no book content or sentence is reproduced. Fictional scenarios; language examples only, never clinical guidance.