Learning outcome: Distinguish a usual routine from a temporary situation when taking a history and agreeing advice. This OET Speaking for Doctors lesson applies present-tense grammar to an original consultation about sleep difficulty during a temporary night-shift rota. It includes paired five-task cards, condition teaching, task coaching, a doctor model and a repeat exercise in which daytime sleepiness changes the priority.
The course's source workbook explains present simple, present continuous and the connection between past and present. The clinical scenario below is an original application of those language points, not a case reproduced from the workbook. The purpose is practical: advice based on a patient's usual day may be unsuitable for the temporary pattern they are living through now.
1. Original paired cards: the usual day and the current rota
These original Jobins Training cards are independent practice material, not official OET exam cards. Partners should reveal the history through the conversation rather than reading every detail aloud at the start.
Doctor card
Setting: General practice.
Situation: Ms Reed, 36, works at a hotel and reports three weeks of difficulty obtaining restful sleep. She normally works daytime reception, but is temporarily covering night shifts. Her current sleep opportunity and usual routine differ. No sleep-disorder diagnosis or medicine plan has been established. In the first attempt she reports tiredness but no unintended sleep episodes or near misses; she has travelled by bus. Clarify the actual timetable, explore other contributors and agree realistic next steps without prescribing a universal bedtime.
Tasks:
- Explore the sleep difficulty, duration, daytime effect and any immediate safety concerns.
- Separate Ms Reed's usual working and sleeping routine from the temporary pattern she is following now.
- Ask about sleep opportunity, environment, caffeine, medicines and other relevant symptoms before explaining possible contributors.
- Discuss practical sleep support suited to the current rota and respond to her request for a quick sleeping-tablet solution.
- Summarise the usual and current patterns accurately, agree review and check what she will do if sleepiness creates a safety risk.
Patient card
Setting: An appointment about poor sleep.
Situation: You are Ms Reed, 36, a hotel receptionist. You usually work from 8 am to 4 pm and sleep at night. For the last three weeks you have been covering four night shifts a week, from 9 pm to 7 am. The cover is currently expected to last another three weeks, although the rota could change. You try to sleep around 9 am after work, but deliveries and phone calls often wake you. You drink coffee late in the shift and feel frustrated by advice to go to bed at 10 pm. In the first attempt you are tired but have not fallen asleep unexpectedly and have come by bus.
Tasks:
- Describe the poor sleep and its effect on concentration and mood during the day.
- Initially say “I work nights,” then explain that this is temporary cover when asked about the usual routine.
- Describe the current sleep period, interruptions and late-shift coffee, and explain why a standard night-time bedtime does not fit.
- Ask whether a sleeping tablet would solve the problem quickly, and discuss which practical changes are feasible.
- Explain the agreed next step in your own words and ask what to do if you become too sleepy to travel or work safely.
Preparation prompt: Make three brief notes: “usually,” “at the moment” and “since the change.” Use these to organise the history. They are prompts to clarify meaning, not labels to impose on the patient's language.
2. Understand the sleep problem before giving routine advice
What sleep difficulty can involve
Insomnia describes recurring difficulty sleeping, such as trouble getting to sleep, waking repeatedly or not feeling rested. It can affect concentration, mood and daytime functioning. A short history is still worth assessing when it disrupts daily life. The learner should not dismiss three weeks of symptoms merely because it is not a long-standing problem.
The card does not establish a final diagnosis. A person may have too little opportunity to sleep, difficulty sleeping despite adequate opportunity, another sleep disorder or several factors together. Asking only “How many hours do you sleep?” can miss why the available sleep period is short or interrupted.
Why a temporary rota matters
Night work can put the desired sleep period at odds with the body's usual sleep–wake rhythm and with daytime noise and responsibilities. Daytime sleep may be interrupted even when the person makes a serious effort to rest. This is a reason to investigate the pattern, not evidence that the patient lacks discipline.
In the original case, usual daytime work and current night cover are different facts. The expected end of the cover is also a plan, not a guarantee of recovery. The doctor should not promise that sleep will immediately return to normal when the rota changes.
Explore the whole day, not just the bedtime
Ask when the shift ends, what happens before bed, when the person actually sleeps and what interrupts them. Consider the room, noise, light and responsibilities. Ask about caffeine in relation to the intended sleep period rather than assuming that “morning coffee” always occurs near the beginning of someone's waking day.
A diary of shifts, sleep periods, interruptions and relevant drinks or medicines can help clarify a pattern. It should be manageable and used to support review, not presented as a test the patient must complete perfectly. It cannot replace assessment of significant daytime sleepiness or other concerning symptoms.
Other contributors still need consideration
Stress, mood problems, pain, medicines and substances can affect sleep. Ask what is being taken, including over-the-counter products and anything borrowed from someone else. Do not assume that the shift change explains everything simply because it occurred around the same time.
Loud snoring, witnessed pauses in breathing or waking with gasping can suggest a different sleep problem, such as sleep apnoea, and require assessment. These features are not supplied as present in the first card. The learner asks about them where relevant rather than inventing an additional diagnosis.
Make practical advice fit the current situation
Useful discussion may include protecting an appropriate sleep period, reducing avoidable interruptions and making the room dark, quiet and comfortable. Explore which change the patient can actually make. A hotel worker who must be awake at 10 pm cannot follow a routine designed around sleeping at that time.
Caffeine late in the waking period can interfere with subsequent sleep. Discuss timing against Ms Reed's real rota. Alcohol is not a reliable sleep treatment, and increasing stimulants to cover worsening sleepiness does not resolve the cause. The lesson does not prescribe an exact sleep schedule or a stimulant dose.
Sleeping tablets are not an automatic shortcut
The cause and impact of the sleep problem should guide treatment. Some sleeping medicines can cause next-day drowsiness and dependence, and pharmacy sleep aids can also impair alertness. Do not promise that a tablet will make night work easy or restore safe driving after inadequate sleep.
For some people, treatment includes cognitive behavioural therapy for insomnia, which addresses thoughts and behaviours that maintain sleep difficulty. The appropriate approach depends on assessment. Explain this as a possible form of help, not a guaranteed referral, immediate appointment or universal answer to a rota problem.
Sleepiness changes safety decisions
Tiredness and unintended sleep episodes are not interchangeable descriptions. Ask whether the patient is struggling to stay awake, falling asleep without intending to or having near misses during travel or tasks. Someone who is sleepy should not drive. An episode of nodding off at the wheel needs prompt clinical attention and a safe transport plan, not encouragement to use more coffee and continue.
The repeat exercise introduces that new information. It changes the immediate priority even though the grammar point remains the same. Accurate language matters because it reveals what is happening; finishing a tense exercise must never become more important than responding to a safety concern.
Clinical reading: The original case was checked against NHS insomnia information, HSE guidance for shift workers and NHS sleep-apnoea information, alongside NHLBI explanations of insomnia and treatment approaches. Advice in the model is a starting point for an individual discussion, not a diagnosis or a prescribed sleeping schedule.
3. Use grammar to clarify the clinical meaning
Task 1: establish duration and current effect
“How long has this been happening?” connects the problem's onset with the present. Follow it with what the person means by poor sleep and how it affects them. A statement such as “I don't sleep” usually needs clarification rather than literal acceptance that no sleep has occurred at all.
Ask about safety in clear everyday language: “Have you found yourself falling asleep when you did not mean to?” Do not hide the question behind the term somnolence. The patient's answer affects what should happen next.
Task 2: separate usual and temporary patterns
“What hours do you usually work?” invites a routine. “What hours are you working at the moment?” invites the current arrangement. Together they help expose the difference that a single question might miss.
The patient may use present simple for a temporary arrangement. Do not correct their grammar during the consultation. Ask, “Is that your regular pattern, or are you covering these shifts for a while?” Meaning is established by clarification and context, not by tense alone.
Task 3: put habits on the right timetable
If the patient says they drink coffee in the morning, ask when that is relative to work and planned sleep. For a night worker, a 6 am coffee may be near bedtime. Advice based only on the word morning may therefore be poorly targeted.
Likewise, distinguish “I take this every day” from “I'm taking this during the cover period,” while checking the actual product, reason and instructions. Temporary use does not automatically mean a medicine is safe or can be stopped without advice.
Task 4: negotiate a feasible change
Explore the patient's current obstacle before offering a suggestion. If repeated calls wake her, discuss how she might protect the sleep period while retaining any essential contact. If the room is noisy, ask what changes are possible. Avoid assuming money, control over housing or complete flexibility at work.
When she requests a tablet, ask what she hopes it will do. Acknowledge the wish for relief, explain the need to assess the cause and discuss the risks relevant to alertness. Do not turn the conversation into a moral judgement about wanting medicine.
Task 5: summarise time accurately
A useful summary says, “You usually work days, but you have been covering nights for three weeks.” It preserves both the baseline and the current duration. Follow with the agreed action and the review plan, not a prediction that the problem will certainly end with the cover.
Ask how the patient will use the advice on the next working day. This checks whether the plan fits the actual timetable. If the answer reveals a practical barrier or a safety concern, change the plan before closing.
4. Extended doctor-viewpoint model with listening pauses
This model gives the doctor's side of an interactive consultation. The patient supplies answers at the pauses. The full model provides more material than a single timed attempt needs; practise choosing the relevant parts.
“Hello, Ms Reed. I'm Dr Patel. Could you tell me what has been happening with your sleep?”
“When you say you are not sleeping, is the main difficulty getting to sleep, staying asleep, or feeling rested afterwards?”
Listen for the pattern and duration before summarising. Do not replace the patient's account with an assumed diagnosis.
“How is this affecting you when you are awake? Have you found yourself falling asleep when you did not intend to, or struggling to stay awake during travel or at work?”
“How did you get here today?”
The first card supplies no unintended sleep episodes and travel by bus. The repeat version changes this answer and therefore changes the immediate plan.
“You said you work nights. Is that your usual pattern, or are you covering these shifts temporarily?”
“What hours do you normally work when you are not doing this cover?”
“So you usually work from eight in the morning until four in the afternoon, but at the moment you are working from nine at night until seven in the morning. Have I got that right?”
“How long have you been doing those shifts, and how long is the cover currently expected to last?”
Keep the expected end date separate from certainty. The patient says the rota could change.
“Talk me through what happens after you finish a night shift. When do you try to sleep, and what tends to wake you?”
“You are trying to sleep during the morning, but calls and deliveries interrupt you. That sounds frustrating, especially when you have made time to rest.”
“What happens on your days off? And before the night cover began, did you have similar trouble sleeping?”
These answers help distinguish a new pattern from an older problem that has become more noticeable. Do not assume the chronology proves a single cause.
“Could we also go through coffee or energy drinks, alcohol and any medicines or sleep products you are using? The timing can matter as well as the amount.”
“When you have that last coffee, how long is it before you are trying to sleep?”
“Has anyone noticed loud snoring or pauses in your breathing while you sleep? Have you had pain, a change in mood or another symptom that is affecting your rest?”
Explore relevant positive answers rather than reading a fixed checklist. A possible separate sleep disorder needs its own assessment.
“The shift change and interrupted daytime sleep may be contributing, but I do not want to assume they explain everything. It is useful to look at both the opportunity you have to sleep and what makes sleep difficult once you have that opportunity.”
“You were told to go to bed at ten every night. That advice does not fit a shift where you need to be awake at work then. We need to discuss a pattern that fits your current situation.”
“Would it be manageable to keep a brief record of the shifts, when you sleep, what wakes you and the timing of caffeine? We can use that to review what is happening. It does not have to be a perfect record.”
“For the interruptions, what might you be able to change? For example, is there a way to reduce non-essential calls or arrange deliveries outside the period when you are trying to sleep?”
Wait for what is feasible. Do not assume the patient can switch off every contact or control all noise in the home.
“A darker, quieter room and protecting an appropriate sleep period may help. We can also look at the late-shift coffee in relation to your planned sleep, rather than applying a rule based only on the clock saying morning.”
“You asked whether a sleeping tablet would fix this quickly. What are you hoping it would help you do?”
“I understand wanting relief when the tiredness is affecting your day. A tablet is not automatically the right answer to this pattern, and some sleep medicines can leave people drowsy afterwards or cause other problems. We should assess the cause and decide on suitable care rather than use a medicine to push through an unsafe level of sleepiness.”
“There are other approaches to persistent sleep difficulty, including treatment that works on the thoughts and habits that maintain it. We can discuss what is appropriate after the assessment. I cannot promise that one change will restore your sleep by a particular date.”
“To check my summary: your usual routine is daytime work and night-time sleep. You have been covering nights for three weeks, and the sleep you are trying to get after work is being interrupted. We are going to look at those practical barriers and any other contributors, then review how you are doing. What have I missed?”
“Which of the changes we discussed feels realistic before the next shift?”
“If you become sleepy enough that you might nod off, do not drive or continue a task that would be unsafe. Seek advice promptly, and arrange a safe way to travel. What would you do if that happened before the review?”
“Let's confirm the review arrangements and how to contact the practice if things worsen. Is there anything in the plan that does not fit the rota you are working now?”
5. Speaking and grammar tips: choose forms for meaning
Present simple: a usual pattern
“What time do you usually finish?” asks about a routine. “You normally sleep at night” summarises the baseline. The word usually helps make the intended time frame explicit. Present simple does not guarantee that a situation is permanent; a follow-up may still be needed.
Present continuous: a current arrangement
“What hours are you working this month?” draws attention to the present period. The form is am, is or are followed by the -ing form. In this case, “You are covering nights” helps distinguish temporary cover from the ordinary job pattern.
Present perfect continuous: duration up to now
“How long have you been working these shifts?” connects the start of the cover to the present. “For three weeks” gives a duration; “since the beginning of the month” gives a starting point. Choose the expression that matches the information rather than forcing every answer into the same form.
Past simple: a completed event
“When did the rota change?” asks about the point when the new pattern began. This question can sit naturally alongside present-tense questions about what is happening now. Good communication often needs several forms because the history itself contains several time relationships.
Keep the patient out of the grammar lesson. These explanations are for the learner's preparation and review. In the consultation, clarify the history respectfully. Do not tell a distressed patient to change a tense before you will accept the answer.
Use time markers when a tense is ambiguous. Usually, currently, before the cover, on days off and since the change can make the history clearer. Accurate meaning is more important than displaying the most complex available verb form.
6. Useful sentences and what they clarify
| Meaning to establish | Possible question or summary | Listen for |
|---|---|---|
| Usual routine | “What hours do you normally work?” | The baseline before the current change. |
| Temporary arrangement | “What hours are you working at the moment?” | The present rota and whether it is expected to change. |
| Duration | “How long have you been covering nights?” | How the current pattern connects with symptom onset. |
| Sleep opportunity | “What happens between finishing work and trying to sleep?” | Travel, responsibilities and interruptions. |
| Timing of a habit | “How long before your planned sleep is the last coffee?” | The practical relationship, not just a clock label. |
| Current safety | “Have you nodded off when you did not mean to?” | A change that needs prompt attention. |
Practise changing the time marker while keeping the question natural. Compare “on most working days,” “during this cover period” and “before the rota changed.” Ask a partner whether each question makes the intended period clear.
7. Common mistakes and practical repairs
Assuming “I work nights” means permanent night work. Ask whether this is usual or temporary. Patient grammar alone is not a reliable clinical classification.
Giving a 10 pm bedtime to a night worker. Establish the current rota and sleep opportunity before discussing a suitable routine.
“The shifts caused all of this.” Timing suggests a possible contributor, not a complete diagnosis. Explore other relevant symptoms and factors.
“It will resolve when the cover ends.” The expected rota change is not a guaranteed clinical outcome. Agree review and respond to persistent or worsening difficulty.
“A tablet will make you safe to drive tomorrow.” Do not promise alertness or use medicine as a shortcut around assessment. Some sleep products can worsen drowsiness.
Correcting the patient's English instead of the summary. Clarify meaning with a respectful question and repeat the history accurately in your own words.
8. Second attempt: a near miss while driving
Keep the temporary night cover, but change the daytime effect. Ms Reed now reveals, “Yesterday I nodded off for a moment driving home and drifted towards the next lane. I thought another coffee would make it safe today.” She has not yet started today's journey home.
Your task: Stop treating the problem as routine sleep advice alone. Clarify the episode and current alertness, advise against driving while sleepy, arrange safe transport and assess the cause and immediate risks promptly. Ask about relevant medicines and other symptoms. Do not reassure her that coffee, an open window or the short length of the journey makes driving safe.
Reveal the teaching response and reasoning
“Nodding off at the wheel changes what we need to deal with now. Please do not drive while you are sleepy. We need to assess the episode and work out a safe way for you to get home. Can you tell me exactly what happened, how alert you feel now and whether you have taken any medicines or sleep products?”
This response uses the new information to change the priority. The exact cause is still unconfirmed, but the immediate risk is clear enough to act on. A sleep diary and a discussion of the rota may remain useful later; they are not an adequate response to the near miss by themselves.
A weaker response corrects “I nodded” to another tense or continues discussing curtains. Another recommends extra caffeine as clearance to drive. The stronger response connects accurate history-taking with an immediate, practical safety plan.
Recording review
Find where the doctor distinguished usual work from current cover. Check that the summary preserved the duration and did not turn an expected end date into a promise. Then listen for the patient's daytime-sleepiness answer and the next clinical action.
For a final attempt, ask the partner to change just one fact: permanent nights instead of cover, an older sleep problem instead of a new one, or daytime sleepiness instead of tiredness alone. Keep the questions natural and let the changed meaning alter the plan.
Continue with OET Speaking for Doctors — Course 13 for the matching grammar and integrated speaking practice.
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OET Speaking for Doctors — Course 13
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Source: OET SP doctors 28.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.