Learning outcome: Build an explanation around the patient's replies instead of delivering a prepared lecture. This OET Speaking for Doctors lesson uses possible asthma to practise short explanations, meaningful pauses and follow-up questions that change what happens next. It includes original five-task cards, condition teaching, an extended doctor model and a second attempt with new information about work.
A doctor can provide accurate information and still miss the patient's question. If the person fears becoming addicted to an inhaler, a long explanation of breathing tests may not resolve the hesitation. If the concern changes to symptoms after cleaning duties, repeating reassurance about medicines misses new clinical information. The skill is to listen, select the next useful explanation and check what it means to this person.
1. Original paired cards: an inhaler concern behind the questions
These are original Jobins Training practice cards, not official OET examination material. Partners should read their own cards and reveal the details through natural answers.
Doctor card
Setting: General practice.
Situation: Ms Morgan, 29, works at a leisure centre. She has had intermittent cough, wheeze and breathlessness over several weeks, sometimes at night and during a dance class. She is comfortable at rest today and has no current severe breathing difficulty. Asthma is possible but has not been confirmed. No test result or individual inhaler prescription is supplied. She is concerned that starting an inhaler could make her lungs dependent on it. Explain assessment and management principles while allowing her answers to guide the conversation.
Tasks:
- Explore the symptoms, current breathing, timing, possible triggers and impact on sleep and activities.
- Identify what Ms Morgan understands about asthma and what concerns her most about possible treatment.
- Explain the airway changes and the purpose of appropriate tests in short sections, checking her response.
- Discuss inhaler treatment and safe activity in general terms, addressing the concern she actually describes and avoiding an invented prescription.
- Summarise the agreed assessment steps, check understanding and explain how worsening breathing changes the help plan.
Patient card
Setting: Your GP appointment.
Situation: You are Ms Morgan, 29. Coughing has interrupted your sleep, and wheezing during your weekly dance class has made you leave early. You are breathing comfortably now. You have heard that people become reliant on inhalers and worry that starting one could weaken your lungs. You have not been diagnosed with asthma and do not have a prescribed inhaler plan. In the first attempt you have not noticed a clear relationship with work.
Tasks:
- Describe the episodes and how they affect sleep and dance classes.
- Ask whether the symptoms definitely mean asthma, and explain what you have heard about inhalers.
- Say that “dependent” means your lungs might stop working properly without the medicine.
- Ask what the tests involve and whether you should give up dancing permanently.
- Explain your understanding of the next steps and ask what to do if breathing becomes much worse before review.
Preparation prompt: Prepare three possible questions rather than three long speeches: “What do you mean by dependent?”, “What happens during the class?” and “What have you noticed about the timing?” Each question should open a useful branch of the discussion.
2. Understand asthma before explaining the options
What happens in the airways
Asthma affects the breathing tubes inside the lungs. These airways can become inflamed and narrow, making it harder for air to move. Symptoms can include wheeze, cough, breathlessness and chest tightness. They may vary over time and be more noticeable at night, during exercise or around particular triggers.
This mechanism can be explained without a catalogue of technical terms. “Inflamed” can be followed by “swollen and sensitive.” If you use “airways,” explain that these are the tubes carrying air through the lungs. Avoid asking the patient to memorise terminology before addressing why the symptoms matter.
A possible diagnosis still needs assessment
The pattern in the card is compatible with asthma, but other conditions can also cause breathing symptoms. Being comfortable at the appointment does not make the earlier episodes imaginary. Equally, the history alone does not justify announcing a confirmed diagnosis. Ask about onset, variation, allergies, smoking or other exposures, existing conditions and medicines as relevant.
Assessment can include tests of airflow or airway inflammation. Examples are spirometry, peak-flow monitoring, a breath test called FeNO and blood tests in appropriate circumstances. Explain the purpose of the tests selected for the patient. Do not promise that one normal reading will settle every question or invent immediate access to every test.
Different tests answer different questions
Spirometry measures breathing out through a device, including how much air can be expelled and how quickly. Peak-flow readings can help show variation over time when recorded as instructed. FeNO measures nitric oxide in exhaled breath, which can provide evidence about a type of airway inflammation. Test selection and interpretation belong to the clinical assessment.
A patient does not need every test name at once. The learner should know enough to give an accurate answer if asked, then return to the agreed next step. If someone is acutely unwell, treatment and urgent assessment must not be delayed simply to complete routine diagnostic testing.
Explain inhalers by function, not colour alone
Inhalers deliver medicine into the lungs. Asthma treatment addresses airway inflammation as well as symptoms. Current UK advice includes combination inhaler approaches: an anti-inflammatory reliever, often called AIR, or maintenance and reliever therapy, called MART. Some people have separate preventer and reliever inhalers. A blue reliever inhaler alone is not an adequate ongoing asthma treatment plan.
The names describe different treatment arrangements, and the prescribed product matters. Do not assume every combination inhaler can be used for immediate symptom relief. Explain the person's actual medicine, device and instructions when these are known. In this card they are not supplied, so the model discusses principles and the need for an individual plan.
Clarify what “dependent” means
The patient may mean addiction, fear of damage, anxiety about leaving home without medicine or simply disliking a daily routine. These are different concerns. Inhalers used for asthma are not addictive in the way the patient fears. Needing treatment to control an underlying condition is different from a medicine causing that condition.
Do not turn this correction into “there are no risks.” Side effects depend on the medicine and dose. For example, inhaled budesonide can cause a sore throat, a hoarse voice or oral thrush; higher doses can have additional risks. Correct technique and the relevant after-use advice can help, and troublesome effects should be discussed with the care team. This example is an explanation, not a prescription for Ms Morgan.
Activity and review have practical purposes
The aim is to control symptoms and support safe participation in valued activities. Breathing problems during exercise need assessment and an appropriate plan; they are not a reason to advise someone to push through an episode. Avoid a permanent ban on all exercise, and avoid promising that the patient can return to a demanding class on a particular date.
When treatment is prescribed, demonstration and a check of inhaler technique matter. A personalised action plan records how to use treatment and what to do if symptoms worsen. It should match the actual regimen. General statements such as “take extra puffs whenever you want” cannot replace that plan.
Work can be part of the history
Ask about tasks and substances, not just the job title. Someone employed at reception may also clean rooms or handle sprays. A pattern of symptoms during or after work, or improvement away from work, can warrant further assessment. It does not prove that a particular product caused asthma. The repeat exercise tests whether the doctor investigates this information instead of continuing the original inhaler explanation.
Recognise worsening breathing
Severe breathing difficulty, difficulty speaking because of breathlessness, collapse or rapidly worsening symptoms requires emergency help. In the UK, call 999 for a severe asthma attack, including an attack when no asthma inhaler is available. A patient with prescribed treatment should follow their individual emergency instructions while getting help. Do not invent a dose for an unidentified inhaler or tell someone with a severe episode to wait for routine testing.
Clinical reading: This lesson draws on NHS asthma information, Asthma + Lung UK's diagnosis guidance, NHS information on budesonide side effects and inhaler use, and NIOSH guidance on assessing work-related asthma. These sources inform safe teaching; the card does not provide an individual treatment regimen.
3. Use each answer to choose the next task
Task 1: explore the pattern before naming the problem
Begin with an invitation to describe an episode. Then clarify how often symptoms occur, whether they disturb sleep and what happens during activity. Ask about current breathing early. Someone who is now struggling needs a different response from the stable patient described in the first attempt.
Use one focused question at a time. A sentence containing six questions about pets, pollen, family, work, exercise and smoking is difficult to answer fully. Follow the initial account with relevant detail, and show that you heard the answer before moving on.
Task 2: discover the meaning of the worry
“What concerns you about using an inhaler?” is a starting point. If the answer is dependence, ask what the patient imagines would happen. Do not answer only the word while missing its meaning. Here the fear is that treatment itself will weaken the lungs.
Reflect this accurately: “You are worried that starting treatment could make your breathing rely on it.” Check that summary. A patient who feels correctly understood is more likely to reveal the remaining question.
Task 3: explain a small useful part
Describe the airway problem in a short section and pause. Ask what the person takes from it or which part needs clarification. Then explain why assessment is needed. This sequence connects the test to a question rather than presenting the test as another unexplained instruction.
The pause has a purpose only if you use the reply. If the patient asks whether a normal day rules asthma out, explain variation. If they ask about the procedure, describe that experience. Continuing your planned paragraph regardless of the answer is still a lecture.
Task 4: answer the concern without overpromising
Distinguish treating inflammation from causing dependency. Acknowledge possible side effects and explain that the suitable medicine and instructions are individual. The patient should not have to choose between “all medicines are dangerous” and “all inhalers are harmless.”
Use dance as a concrete goal. Ask what the person wants to return to, what currently stops them and what has happened during symptoms. Explain that assessment and an appropriate plan come before deciding how to manage those episodes during activity.
Task 5: summarise decisions, not every fact
End with the question being investigated, the next assessment step and the response to deterioration. Ask the patient to explain what they will do. This is more useful than reviewing every inhaler category mentioned during the lesson.
Confirm the practical arrangements that are actually known. Where a test date or contact route is missing, identify that it needs confirming. Do not manufacture a complete appointment schedule to make the ending sound confident.
4. Extended doctor-viewpoint model with listening pauses
The following is a teaching model from the doctor's viewpoint. The partner provides the patient's contributions. The pauses and branches show how to adapt; the whole text is not intended to fit into one timed role-play.
“Hello, Ms Morgan. I'm Dr Lewis. Before we talk through the episodes, how is your breathing right now?”
Establish current safety. The supplied first attempt is a stable consultation, not an active severe attack.
“Could you describe what happened the last time you noticed the wheeze?”
“You had to leave your dance class early. What did you feel at that point, and how long did it take to settle?”
“You also mentioned coughing at night. How often is that waking you, and have the episodes been getting more frequent?”
Use the answers to clarify the pattern. Ask about relevant triggers, work tasks, allergies, health history and current medicines without delivering them as a single list.
“What have you noticed about when it happens at work or on days away from work?”
“What worries you most about what these symptoms might mean?”
“You have been wondering about asthma, but the possibility of needing an inhaler is worrying you too. Could you tell me what you have heard about inhalers?”
“When you say dependent, do you mean you are afraid the medicine might make your lungs less able to work on their own?”
Pause for confirmation. If the patient means something else, use that meaning in the next response.
“That would be a worrying thought. Would it help if I explained what asthma does to the breathing tubes, and then how treatment is intended to help?”
“The airways are the tubes carrying air through your lungs. In asthma, they can become swollen and sensitive, and they can narrow. That can cause the wheeze, cough or tight feeling people describe. The symptoms can come and go.”
“What does that explanation make you think about the times you feel completely well?”
Allow the patient to explain. If she thinks a comfortable day rules asthma out, discuss variation before moving to tests.
“Feeling well between episodes does not by itself rule asthma out. It also does not prove that asthma is the cause. We need to consider the history and the appropriate tests so that we treat the right problem.”
“A breathing test can give us information about how air moves out of your lungs. Depending on the assessment, we may also use tests looking for signs of inflammation or ask you to record measurements over time. I would explain the specific tests we arrange and how to prepare for them.”
“Which part of the testing would you like me to explain further?”
If asked about spirometry, describe blowing into the device and following the trained professional's instructions. Do not claim every patient receives the same sequence of tests or an immediate diagnosis.
“Coming back to the inhaler concern, asthma treatment is intended to control the underlying airway problem. It does not make the lungs addicted to the medicine. If someone needs treatment over time, that can reflect the condition needing continued control rather than the inhaler having weakened their lungs.”
“How does that compare with what you had heard?”
“There can be side effects, and I would not want to suggest otherwise. They depend on the medicine and the dose. If we prescribe an inhaler, we would discuss its benefits, possible effects and the right way to use that device. You can also tell us if anything about it worries you.”
Answer the actual question. A concern about voice changes needs a relevant medicine discussion; a concern about carrying an inhaler needs a practical discussion.
“There are different inhaler plans. Some inhalers combine medicines to treat inflammation and relieve symptoms. Other plans use separate inhalers. The important thing is that you know what your prescribed inhaler is for and when to use it. We should not choose instructions just from its colour.”
“You asked about giving up dancing. I can see why you would be disappointed about that. The aim would be to assess these episodes and help you be active safely. I cannot tell you to ignore wheezing and push through the class, or promise a return date before we have assessed the problem.”
“What is the part of the class you most want to get back to, and what currently makes you stop?”
Listen for the patient's goal and present limitation. Keep the activity discussion relevant rather than giving a general fitness lecture.
“If treatment is prescribed, we would show you how to use the inhaler and ask you to demonstrate it back. A personal action plan would explain the medicines and what to do if symptoms worsen. That plan needs to match your own treatment.”
“For today, we need to assess the symptoms and confirm the appropriate investigation and care while we work out the cause. What do you understand about why we are checking this rather than simply calling it asthma now?”
Repair an incorrect interpretation before closing. Do not take a polite nod as evidence that the uncertainty and next step are clear.
“Let's confirm how the tests and review will be arranged. If the breathing becomes severe, you struggle to speak because of it, or you are rapidly getting worse, seek emergency help immediately. In the UK, call 999 for a severe attack, particularly when you do not have an asthma inhaler. Do not wait for the routine appointment.”
“What would you do if that happened before the review? And what question have we not yet answered about the plan?”
5. Speaking tips: make the pauses change the conversation
Ask fewer questions and use the answers. Three relevant follow-ups can demonstrate more listening than ten unrelated questions. After the patient names an activity, ask about that activity. After they name a fear, clarify its meaning.
Link explanations to an expressed need. “You asked why it comes and goes” tells the patient why the next information matters. A long introduction to every possible treatment may be accurate but poorly timed.
Use a specific understanding check. Ask why tests are needed, what the inhaler is intended to do or how the patient would respond to worsening symptoms. A repeated “Okay?” often checks willingness to continue rather than meaning.
Leave room for correction. “Have I understood that?” allows the patient to change your summary. Do not follow it immediately with the answer you want them to give.
Keep signposting brief. A sentence such as “Let's look at the testing next” is enough. Repeated announcements about the consultation structure can use the time that should be available for the patient.
Distinguish hope from certainty. Supporting a return to dance is a useful goal. Guaranteeing unrestricted exercise after a particular treatment is a prediction. Explain the aim and what needs to be assessed.
6. Useful sentences and when to use them
| Purpose | Possible wording | What to listen for |
|---|---|---|
| Explore an episode | “Talk me through the last time it happened.” | Timing, severity, activity and how it settled. |
| Clarify a concern | “What does dependent mean to you here?” | Addiction, physical harm, routine or practical worries. |
| Explain uncertainty | “Asthma is possible, but we need to assess the cause.” | Whether the patient hears a possibility as a diagnosis. |
| Invite a response | “How does that fit with what you had heard?” | The belief that remains after the explanation. |
| Explore work | “What tasks are you doing when symptoms begin?” | Actual exposures that a job title may hide. |
| Check a plan | “What would make you seek help before the review?” | Whether the patient can recognise and act on deterioration. |
Practise responding to each possible answer with one follow-up, not a memorised paragraph. If your next sentence would be identical whatever the patient said, check whether you have actually used the answer.
7. Common mistakes and practical repairs
“You are young, so it must be asthma.” Age and a symptom pattern do not establish the diagnosis. Explain the possibility and the purpose of assessment.
“You only need the blue inhaler when symptoms occur.” Do not give an outdated reliever-only plan or assume a device from its colour. Use current, individual instructions when prescribed.
“All inhalers have minimal side effects.” Discuss the relevant medicine honestly. Correcting addiction fears does not remove the need to explain risks and technique.
“Any questions?” followed immediately by more information. Give the patient time to answer and let the answer affect the next step. A rhetorical question is not a listening pause.
“Just avoid exercise.” Explore the episode and arrange assessment and suitable advice. Neither a blanket ban nor encouragement to push through breathing difficulty is a useful individual plan.
“Your job has definitely caused it.” A work-related pattern needs investigation. Do not substitute a confident cause statement for clinical and exposure assessment.
8. Second attempt: new information about cleaning duties
Keep Ms Morgan comfortable at rest today. Change her main concern. She now says she is willing to discuss inhalers, but has noticed that wheezing often begins after cleaning rooms with sprays. It is less troublesome during several days away from work. She had not mentioned this because she thought her job title, receptionist, meant the work was irrelevant.
Your task: Explore the actual tasks, substances and timing, including symptoms after leaving work and on days off. Explain why the pattern deserves assessment without declaring the cause proven. Discuss appropriate clinical and occupational assessment and safe next steps. Do not advise deliberate re-exposure as a home experiment or make unsupported promises about employment arrangements.
Reveal the teaching response and reasoning
“That is useful information, and it changes what we need to explore. Could you describe the cleaning tasks and what you use? When do the symptoms start, and what happens on days away from work? The pattern may be relevant, but it does not by itself prove that a particular product has caused asthma. We should include it in the assessment and consider the appropriate specialist or occupational advice.”
This response moves from a medicine concern to a possible exposure pattern. It uses the patient's information to change the history and next step. It does not diagnose occupational asthma from one answer or instruct the patient to resign.
If the patient reports current severe symptoms, urgent care takes priority over obtaining a detailed product history. In the stable version, ask about practical concerns and explain what needs confirming. Avoid telling the patient to reproduce symptoms to prove the connection.
Recording review
Mark one place where the doctor invited a reply. Write down what the patient added and what the doctor did with it. If the next contribution simply resumes a prepared lecture, repeat that section with a shorter explanation and a relevant follow-up.
Then check for three distinct outcomes: the concern was understood, the medical uncertainty was preserved and the next action was clear. Fluency supports these outcomes; it cannot replace them.
Continue with OET Speaking for Doctors — Course 11 for the matching course lessons and further patient-centred practice.
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OET Speaking for Doctors — Course 11
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Source: OET SP DOCTORS &&&.epub, Jobins Training. Examples labelled original or illustrative were written for this article. Independent exam preparation; no affiliation with or endorsement by the examining body. Practice does not predict an official score.