OET Writing for Dietitians: Identify and Address the “Problematic Point”

A lot of OET Writing Test prep focuses on learning the letter format, understanding how to identify important information, but what test takers really need to know is how to find and address the “problematic point”. This post helps you identify the issue(s) the patient is facing and gives suggested language you can use to communicate clearly with your colleagues on the healthcare team.

Every OET writing prompt contains what the test designers call a “problematic point”. The problematic point is designed to add clinical complexity to the task. In the dietetics context, this frequently takes the form of a patient who isn't fully following the advice they've been given: they've made some changes but not others, they believe they're compliant but have misunderstood the recommendation, or they're eager to discontinue a treatment. But it can also appear as a clinical concern the letter recipient needs to act on, like a patient intent on stopping medication without medical guidance. You experience these challenges on a daily basis as a dietitian. The OET Writing sub-test isn’t testing whether you recognize these challenges; it's testing whether you can communicate them professionally.

Why OET Dietetics Writing Tasks Are Challenging 

The challenge is: you need to tell the letter recipient, often a referring physician or other dietitian, exactly what's happening with the patient but in a professional manner. You can't minimize the problem or leave it out because the reader needs the full clinical picture to continue care. But you also can't write something that sounds judgmental. In real clinical practice, most dietitians develop a feel for this over time. But having a general instinct for professional communication isn't quite the same as producing precise, polished language under time pressure in an exam setting. That's where preparation makes a real difference.

Let’s look at two scenarios that illustrate the kinds of problematic points that come up in OET dietetics tasks.

Scenario 1: Incomplete Adoption of Dietary Advice

A patient with hypertension has been advised to significantly reduce sodium intake to help manage their blood pressure. At follow-up, they report that they've stopped adding salt at the table. However, they're still eating fast food and canned soups and vegetables several times a week.

The problematic point here is that the patient has not been able to fully implement the dietary advice they were given. The patient has made a genuine change, but it's incomplete and falls well short of what's clinically needed. The referring physician needs to know this, including what the patient has done well and where the gap is.

The following sample communicates the problem but struggles with professionalism:

"The patient did not follow the dietary advice they received and continues to eat fast food and canned goods despite being told to reduce sodium."

That sentence is accurate, but "did not follow" and "despite being told" carry a critical tone that has no place in a professional referral letter. Now here's a better version:

"The patient reports reduced sodium intake by eliminating added salt. Dietary counseling re-emphasized the sodium content in processed and fast foods, and the patient agrees that this is an area they will work to address."

This is great if they are making strides, but you might have a patient who is not as motivated. Something like this would be appropriate:

"The patient reports reduced sodium intake by eliminating added salt. Dietary counseling re-emphasized the sodium content in processed and fast foods. The patient acknowledges that these foods should be reduced but expresses uncertainty about whether they will change these behaviors."

You present the same clinical facts but without judgment.

Scenario 2: Incomplete Understanding of Dietary Advice

A patient with type 2 diabetes received initial dietary counseling that included carbohydrate counting. At follow-up, they report that they've been eating well and have cut out sugar. When discussing their diet, it becomes clear they don't recognize that foods like bread, rice, and pasta raise blood glucose even though they aren't sweet.

This is a different kind of problematic point. It isn't that the patient has chosen not to follow the advice; it's that they believe they are following it. The patient is motivated but lacks understanding. That distinction matters when you're writing the letter, because you need to communicate the misunderstanding to the physician without making the patient sound uninformed or making the original counseling sound inadequate.

A less careful version might look like this:

"The patient claims to be following dietary advice but is not counting carbohydrates and does not understand that non-sweet foods can raise blood glucose."

"Claims to be following" implies the patient is being dishonest. "Does not understand" is condescending. Compare that to:

"The patient reports avoiding sugar; however, carbohydrate counting has not been implemented. Education regarding the glycemic impact of non-sweet carbohydrate sources was provided and reinforced at this visit."

The physician now understands exactly what happened and what was done about it, and the patient's dignity is intact.

The Grammar Behind the Professional Phrasing

You've probably noticed that the stronger versions of both examples use passive voice. That’s because passive constructions are one of the most effective tools for communicating compliance issues professionally, and the OET prep materials emphasize them for good reason.

Active voice puts the patient in the driver's seat of the action: "The patient refused the meal plan." That frames the patient as actively defiant. Passive voice shifts the focus to the situation: "The meal plan was refused." Same clinical fact, entirely different tone.

Here are some passive and passive-adjacent constructions that work well when you're documenting compliance issues:

• "Dietary modifications were discussed; however, full implementation has not yet been achieved."

• "The recommended changes have been partially adopted."

• "Further education regarding [specific topic] has been provided."

• "Ongoing support with carbohydrate counting is recommended."

• "Compliance with the meal plan has been limited to date."

Notice that none of these constructions require you to say the patient is doing something wrong. They report the clinical reality clearly and completely while keeping the tone neutral and professional.

What to Look For When You Practice

When you're working through OET writing practice tasks, make a habit of identifying the problematic point before you start writing. It won't always be a compliance issue. Sometimes it's a patient who misunderstands their treatment. Or, it could be a clinical concern; for example, a patient who wants to stop a medication. The recipient needs to know about that to continue care. Ask yourself: what is the complexity in this case, and what does the recipient of your letter need to know to handle it? That framing will guide your language choices. Once you've identified the problematic point, you can build the rest of your letter around it.

Working on your OET Writing sub-test preparation? I offer one-on-one sessions for dietitians and other healthcare professionals that combine clinical content expertise with targeted English language coaching. Book a free 15-minute consultation to find out if we're a good fit. If you’re also preparing for the Speaking sub-test, check out our free OET Clinical Scenario Coach here.

Back to the Blog