English Writing & Speaking

A sentence should contain one main idea. When you put too many ideas into a single sentence, the reader loses track of your meaning — and in a clinical letter, that can matter enormously.

Three short sentences are almost always clearer than one long one. The reader absorbs information more easily when they can pause between ideas.

Active vs Passive Voice

In British medical writing, both active and passive voices are used — but the passive can become a trap when it creates ambiguity.

The active voice makes it clear who did what — important for medico-legal clarity as well as readability.

Punctuation guides the reader through your writing. Used well, it is invisible — the reader simply flows through the text. Used badly, it stops the reader mid-sentence, confused.

Apostrophes

Apostrophes do two jobs: they show possession, and they replace missing letters in contractions. They do NOT indicate a plural.

Colons and Semicolons

Question Marks and Full Stops

A direct question always ends with a question mark. An indirect question does not.

English spelling is wonderfully inconsistent. Even native speakers make predictable mistakes. Here are the ones that appear most often in medical writing.

Capitalisation: When to Use and When Not To

A common source of uncertainty in medical writing. The basic rules are simpler than they seem.

• Job titles only take a capital when used as a formal title before a name: Dr Mehay attended. But: a doctor attended the meeting.
• Conditions and diseases are generally lower case: hypertension, type 2 diabetes, rheumatoid arthritis. Exception: conditions named after people (Parkinson's disease, Crohn's disease).
• Drug names: generic names are lower case (metformin, amlodipine). Brand names take a capital (Glucophage®).
• Seasons, points of the compass used as directions (north, south), and general academic subjects do not take capitals. Specific titles of courses, departments, and proper nouns do.

Noun & Noun Phrase Errors

Many errors in medical writing involve how nouns are modified. Watch for these patterns:

• Dangling modifiers: "Having reviewed the notes, the diagnosis was clear." (Who reviewed the notes? The diagnosis? Rewrite: "Having reviewed the notes, I found the diagnosis clear.")
• Disagreement between noun and verb: "The team of doctors are reviewing…" is technically informal. Formally: "The team is reviewing…" (The team is singular.)
• Countable vs uncountable nouns: Fewer is used with countable nouns (fewer patients, fewer appointments). Less is used with uncountable quantities (less time, less pain).

Split Infinitives

The "rule" against split infinitives (to boldly go) is actually a style preference, not a grammatical law. In modern English, splitting an infinitive is frequently perfectly acceptable — and sometimes the clearest option. Don't be afraid of it, but don't overuse it either.

First Person: "I" or "We"?

"With regards to" — A Common Error

Italics and Dashes

• Italics in medical writing are used for: Latin terms (in situ, per os, ad hoc), titles of books and journals, and occasionally for emphasis. Avoid overuse for emphasis — if everything is emphasised, nothing is.
• En dash (–) is used between ranges (pages 12–18, ages 40–60) and in compound adjectives (evidence-based medicine).
• Em dash (—) is used as a strong parenthetical marker — like this — or to introduce a conclusion or surprise. Effective in moderation; avoid in formal letters.

If you are writing for a portfolio, a QI project, a journal, or an educational resource, you will need to reference correctly. In medical education and general academic writing in the UK, the Harvard system is the most widely used.

A cliché is a phrase that has been used so many times it has lost its power. In medical writing, clichés often appear as filler phrases — they add length without adding meaning.

The Plain English Campaign promotes writing that is clear, direct, and easy to understand. In medical writing aimed at patients — leaflets, outpatient letters, patient summaries — plain English is not optional. It is an ethical responsibility.

If you are writing something for publication — a journal article, an educational resource, a book chapter — you will need to approach writing differently from a clinical letter.

Apostrophes do exactly two jobs. That is all. Learn both jobs and you will get apostrophes right almost every time.

The possession rules in full

The "of" test — a simple way to find the right position

Not sure whether the apostrophe goes before or after the s? Turn the phrase around using the word of:

• Is it the dining room of the doctor or the dining room of the doctors? The possessing word goes right before the apostrophe → doctor's or doctors'.
• Is it the party of the children? Children doesn't end in s → children's party.

Many writers avoid colons and semicolons simply because they are not sure when to use them. Once you understand the logic, both become simple and useful tools.

The key distinction is between a direct question (the actual words of a question, as if spoken aloud) and an indirect question (reporting that a question was asked).

When a sentence contains a quoted question

If the quoted question is inside a longer sentence, the question mark goes inside the closing quotation mark. The full stop (if needed) goes outside:

Spell-checkers only check whether a word is spelled correctly — not whether it is the right word. Every one of the pairs below will pass a spell-check even when used incorrectly. You need to know these yourself.

English has a number of tricky noun rules — particularly around words that look plural but behave as singular, and collective nouns that can go either way. These errors appear frequently in clinical writing.

Nouns with no plural form

Some nouns cannot be made plural — they are always treated as singular. These are called uncountable nouns and they cause frequent errors, especially for non-native speakers.

Collective nouns — singular or plural verb?

In British English, collective nouns (team, committee, family, practice, staff) can take either a singular or plural verb — depending on whether you mean the group as a whole or the individuals within it.

Compound subjects that stay singular

Some compound expressions describe a single thing, not two separate things — and they take a singular verb:

• "Bacon and eggs was served." (It's one dish, not two separate foods.)
• "Fish and chips is popular in England."
• In clinical writing: "History and examination was unremarkable" — but most writers now prefer to split this: "The history was unremarkable. Examination revealed…"

Dangling modifiers — a common clinical writing trap

A participial phrase at the start of a sentence must refer to the subject of the sentence. When it doesn't, the result is confusing — or unintentionally funny.

Both words suggest something is possible — but they differ in how likely that possibility is.

Two common points of confusion — both worth knowing.

When to use "I" and when to use "We"

"Maggie and I" vs "Maggie and me" — the drop-test

Many people assume "Maggie and I" is always correct and "Maggie and me" is always wrong. This is not true. The right choice depends on the grammatical role in the sentence.

Split infinitives — "to boldly go"

An infinitive is the base form of a verb: to write, to refer, to sleep. A split infinitive puts a word between to and the verb: to clearly write, to boldly go.

The old rule said: never split an infinitive. Modern English grammar — including official guidance from bodies like the Oxford University Press — says this rule is a style preference, not a grammatical law. Splitting an infinitive is sometimes the clearest option. Do it if it reads better. Just don't overuse it.

"Shall" vs "Will" — a fading distinction

This distinction is now largely obsolete in everyday British English — most people use will for everything. But for completeness:

In modern clinical writing: just use will for everything. Nobody will notice — or object.

"Is comprised of" — a common irritant

The phrase "is comprised of" is grammatically incorrect, though widely used. The verb comprise means "to contain" — so the correct form does not need "of":

[sic] — what it means and when to use it

Sic is Latin for "thus" or "as written." It is placed in square brackets immediately after a word or phrase to signal that you are quoting something exactly as it was written — even though it appears to contain an error or unusual phrasing.

You will occasionally see [sic] used to draw the reader's attention to a deliberate pun or wordplay in the original text. In clinical writing, the main use is the former — indicating that a quoted error is not yours.

Hyphens

• Compound adjectives before a noun: Use a hyphen when two or more words act together as a single adjective before a noun. evidence-based medicine, patient-centred care, first-line treatment, long-term management. Without the hyphen, the meaning can change.
• Number ranges: Write ranges without spaces around the hyphen: ages 40–60, pages 12–18. (Note: purists use an en-dash — — for ranges, not a hyphen. Most word processors do this automatically.)
• Avoid breaking words with hyphens at line ends. Modern word processors wrap text automatically — there is no need to hyphenate at the end of a line in medical writing.
• Prefixes: pre-operative, post-natal, non-steroidal — hyphens are standard after these prefixes in UK medical writing, though some styles omit them.

Lists — when to use them and how to punctuate them

Acronyms — use carefully in clinical writing

• Never start a sentence with an acronym. Begin with the full word: "General practice training requires…" — not "GP training requires…" at the very start of a document where the abbreviation has not yet been introduced.
• Drug names: Generic names are lower case (metformin, amlodipine). Brand/trade names take a capital (Glucophage®).
• Bacteria: First letter of the genus is capitalised; the species name is lower case: Staphylococcus aureus, Escherichia coli, Candida albicans.

Brackets — which type, and when

Quotation marks — UK vs US convention

In UK English, the convention is to use single quotation marks for most purposes, and double quotes only for a quotation within a quotation:

American convention is the opposite — double quotes first, then single within. Since you are writing for a UK NHS context, use single quotes as your default.

This section draws on Dr Ramesh Mehay's own experience editing a major GP training textbook — and the hard-won lessons that came from that process. Whether you are writing an article, a portfolio piece, or a chapter, these principles apply.

1. Always start with purpose — Kipling's six honest serving men

Before you write a single word, ask yourself: what am I actually trying to achieve? The philosopher Brand Blanshard put it well: good style consists in having something to say and saying it clearly. If you are not clear on your purpose, your writing will drift.

2. Spend time at the foundations — don't rush into writing

Many writers rush into the action phase — they start typing before they have thought carefully about what they want to say. The more time you spend at the planning stage, the less time you will waste rewriting later. A solid structure built before you start is like a scaffold — it holds everything up while you build.

3. Good writing is rewriting

The first draft is for getting your ideas down. Do not try to write perfectly on the first pass — it slows you down and produces stilted prose. Write quickly, then edit ruthlessly. Every sentence should earn its place. If it does not add something, remove it.

4. Write in short chapters / sections

Readers — especially busy GP trainees — lose concentration in long unbroken sections. Short, focused sections with clear headings allow the reader to navigate, dip in and out, and return to specific points. If a section is growing beyond 400–500 words, consider splitting it.

A good referral letter is a work of clinical communication. It tells the specialist who they are about to see, why they're being referred, and what they need to know to help the patient. Too little information delays care. Too much obscures the point.

Your 14Fish ePortfolio is a living record of your development as a GP. The quality of your writing there matters — not just for ARCP (Annual Review of Competence Progression), but because good reflective writing actually accelerates learning.

What makes a good reflection?

• Describe briefly, reflect deeply. Keep the description of events short. Spend most of your words on what it meant, what you felt, and what you have changed as a result.
• Be honest. The best reflections acknowledge what went wrong or what you found difficult. Assessors are not looking for perfection — they are looking for insight and growth.
• Use a framework if it helps. Gibbs' Reflective Cycle, Driscoll's "What? So What? Now What?", or the BVTS reflective frameworks are all useful scaffolds when you're starting out.
• Link to learning. Always connect your reflection to future learning or a change in practice. "As a result, I plan to…" is essential.
• Keep language professional. Reflections are formal documents, even if they feel personal. Write in complete sentences. Avoid bullet points within the reflection itself.

Email has replaced formal letters in most day-to-day NHS communication — but that doesn't mean standards have dropped. A poorly written email to a colleague or specialist reflects on your professionalism.

• Subject line: Always include one. Be specific: "Re: Mrs Smith — cardiology query" rather than "Patient query."
• Opening: Use "Dear Dr…" or "Dear [first name]" depending on your relationship. "Hi" is fine for close colleagues in informal communication. Never begin with just a name and no greeting.
• Body: Keep it short and focused. State your purpose in the first sentence. Use short paragraphs. One topic per email whenever possible.
• Closing: "Kind regards," or "Best wishes," followed by your name and role. "Please do not hesitate to contact me" is a cliché — just say "Please do contact me if you have questions."
• Confidentiality: Never include patient-identifiable information in an email unless you are sure the system is secure and encrypted according to NHS data governance rules.

Yes — and here's why. In general practice, how you write and communicate is inseparable from how you are perceived professionally. Referral letters with errors, reflections that read as descriptions, and patient letters full of jargon all affect how colleagues and assessors perceive your competence. Clinical skill is essential, but communication is the medium through which clinical skill is expressed and evaluated.

Passing IELTS or OET demonstrates that your English meets the threshold for registration — which is an important achievement. But professional fluency in the UK NHS extends well beyond a test score. Understanding idiomatic British speech, cultural tone, consultation nuances, and the particular register of professional correspondence all develop over time through immersion and practice. This page — and the resources it contains — helps bridge that gap.

The most common structural problem is burying the reason for referral. The specialist needs to know immediately why you are referring — but many letters open with a lengthy medical history before eventually arriving at the point. State the reason in your opening sentence. Every time. The most common grammatical error is the misuse of apostrophes — specifically, using them to form plurals (GPs, not GP's).

This is a very common piece of feedback. The fix is to cut the description significantly and spend more words asking and answering three questions: (1) What did this situation make me feel, and why? (2) What does this tell me about how I currently practise? (3) What specific change will I make as a result? A reflection that clearly answers these three questions is almost always richer than one that spends three paragraphs recounting events. A practical exercise: write your reflection, then delete the first paragraph. You will often find it reads better — because the first paragraph is usually description.

This depends on what you most need to improve. For general grammar and vocabulary, start with Learn English with Gill or English Jade — both are British, clear, and well-organised. For pronunciation specifically, start with English School Online or ETJ English. Whatever you choose, work through it systematically rather than dipping between different channels. Consistency beats variety here.

Directly, writing quality is assessed through your WPBA (Workplace-Based Assessment) portfolio. Indirectly, communication skills — including clarity of verbal expression — are central to the SCA (Structured Clinical Assessment). The SCA is a spoken consultation assessment, but the same principles of clear, structured, warm communication apply equally to written and spoken language. Trainees with strong communication skills generally fare better in both.