READING SUB-TEST – TEXT BOOKLET: PART A

CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:
MIDDLE NAMES: Passport Photo

PROFESSION: Candidate details and photo will be printed here.

VENUE:
TEST DATE:

CANDIDATE DECLARATION
By signing this, you agree not to disclose or use in any way (other than to take the test) or assist any other person to disclose or use any OET
test or sub-test content. If you cheat or assist in any cheating, use any unfair practice, break any of the rules or regulations, or ignore any advice
or information, you may be disqualified and your results may not be issued at the sole discretion of CBLA. CBLA also reserves its right to take
further disciplinary action against you and to pursue any other remedies permitted by law. If a candidate is suspected of and investigated for
malpractice, their personal details and details of the investigation may be passed to a third party where required.

CANDIDATE SIGNATURE:

INSTRUCTIONS TO CANDIDATES
You must NOT remove OET material from the test room.

SAMPLE
www.occupationalenglishtest.org
© Cambridge Boxhill Language Assessment – ABN 51 988 559 414

[CANDIDATE NO.] READING TEXT BOOKLET PART A 01/04

PRACTICE  TEST   1 25
 The use of feeding tubes in paediatrics: Texts
Text A
Paediatric nasogastric tube use
Nasogastric is the most common route for enteral feeding. It is particularly useful in the short term, and
when it is necessary to avoid a surgical procedure to insert a gastrostomy device. However, in the long
term, gastrostomy feeding may be more suitable.
Issues associated with paediatric nasogastric tube feeding include:
• The procedure for inserting the tube is traumatic for the majority of children.
• The tube is very noticeable.
• Patients are likely to pull out the tube making regular re-insertion necessary.
• Aspiration, if the tube is incorrectly placed.
• Increased risk of gastro-esophageal reflux with prolonged use.
• Damage to the skin on the face.

Text B
Inserting the nasogastric tube
All tubes must be radio opaque throughout their length and have externally visible markings.

1. Wide bore:
–– for short-term use only.
–– should be changed every seven days.
–– range of sizes for paediatric use is 6 Fr to 10 Fr.

2. Fine bore:
–– for long-term use.
–– should be changed every 30 days.
In general, tube sizes of 6 Fr are used for standard feeds, and 7-10 Fr for higher density and fibre feeds.
Tubes come in a range of lengths, usually 55cm, 75cm or 85cm.
Wash and dry hands thoroughly. Place all the equipment needed on a clean tray.
• Find the most appropriate position for the child, depending on age and/or ability to co-operate.
Older children may be able to sit upright with head support. Younger children may sit on a parent’s
lap. Infants may be wrapped in a sheet or blanket.
• Check the tube is intact then stretch it to remove any shape retained from being packaged. 
• Measure from the tip of the nose to the bottom of the ear lobe, then from the ear lobe to
xiphisternum. The length of tube can be marked with indelible pen or a note taken of the
measurement marks on the tube (for neonates: measure from the nose to ear and then to the
halfway point between xiphisternum and umbilicus).
• Lubricate the end of the tube using a water-based lubricant.
• Gently pass the tube into the child’s nostril, advancing it along the floor of the nasopharynx to the
oropharynx. Ask the child to swallow a little water, or offer a younger child their soother, to assist
passage of the tube down the oesophagus. Never advance the tube against resistance.
• If the child shows signs of breathlessness or severe coughing, remove the tube immediately.
• Lightly secure the tube with tape until the position has been checked.

26 PRACTICE  TEST   1
Text C

• Estimate NEX measurement (Place exit port of tube at tio of nose. Extend tube to earlobe, and then to
xiphistemum)
• Insert fully radio-opaque nasogastric tube for feeding (follow manufacturer’s instructions for insertion)
• Confirm and document secured NEX measurement
• Aspirate with a syringe using gentle suction

YES Aspirate obtained? NO

Try each of these techniques to help gain aspirate:

• If possible, turn child/infant onto left side
• Inject 1-5ml air into a tube using a syringe
• Wait for 15-30 minutes before aspirating again
• Advance or withdraw tube by 1-2cm
• Give mouth care to patients who are nil by mouth
(stimulates gastric secretion of acid)
• Do not use water to flush
Test aspirate on CE marked
pH indicator paper for use on
human gastric aspirate Aspirate obtained?
YES
NO

Proceed to x-ray, ensure reason for x-ray documented

pH between pH NOT between on request form
1 and 5.5 1 and 5.5

Competent clinician (with evidence of training) to

PROCEED TO FEED or USE TUBE document confirmation of nasogastric tube position
Record result in notes and YES in stomach
subsequently on bedside NO
documentation before each
feed/medication/flush DO NOT FEED or USE TUBE
Consider re-siting tube or call for senior advice

A pH of between 1 and 5.5 is reliable confirmation that the tube is not in the lung, however, it does not confirm
gastric placement. If this is any concern, the patient should proceed to x-ray in order to confirm tube position.
Where pH readings fall between 5 and 6 it is recommended that a second competent person checks the
reading or retests.

Text D
Administering feeds/fluid via a feeding tube
Feeds are ordered through a referral to the dietitian.
When feeding directly into the small bowel, feeds must be delivered continuously via a feeding
pump. The small bowel cannot hold large volumes of feed.
Feed bottles must be changed every six hours, or every four hours for expressed breast milk.
Under no circumstances should the feed be decanted from the container in which it is sent
up from the special feeds unit.
All feeds should be monitored and recorded hourly using a fluid balance chart.
If oral feeding is appropriate, this must also be recorded.
The child should be measured and weighed before feeding commences and then twice weekly.
The use of this feeding method should be re-assessed, evaluated and recorded daily.

END OF PART A
THIS TEXT BOOKLET WILL BE COLLECTED

PRACTICE  TEST   1 27
 READING SUB-TEST – QUESTION PAPER: PART A
CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:
MIDDLE NAMES: Passport Photo
PROFESSION: Candidate details and photo will be printed here.
VENUE:
TEST DATE:

CANDIDATE DECLARATION
By signing this, you agree not to disclose or use in any way (other than to take the test) or assist any other person to disclose or use any OET
test or sub-test content. If you cheat or assist in any cheating, use any unfair practice, break any of the rules or regulations, or ignore any advice
or information, you may be disqualified and your results may not be issued at the sole discretion of CBLA. CBLA also reserves its right to take
further disciplinary action against you and to pursue any other remedies permitted by law. If a candidate is suspected of and investigated for
malpractice, their personal details and details of the investigation may be passed to a third party where required.

CANDIDATE SIGNATURE:

TIME: 15 MINUTES

INSTRUCTIONS TO CANDIDATES
DO NOT open this Question Paper or the Text Booklet until you are told to do so.
Write your answers on the spaces provided on this Question Paper.
You must answer the questions within the 15-minute time limit.
One mark will be granted for each correct answer.
Answer ALL questions. Marks are NOT deducted for incorrect answers.
At the end of the 15 minutes, hand in this Question Paper and the Text Booklet.
DO NOT remove OET material from the test room.

SAMPLE
www.occupationalenglishtest.org
© Cambridge Boxhill Language Assessment – ABN 51 988 559 414

[CANDIDATE NO.] READING QUESTION PAPER PART A 01/04

28 PRACTICE  TEST   1
 Part A
TIME: 15 minutes

• Look at the four texts, A-D, in the separate Text Booklet.

• For each question, 1-20, look through the texts, A-D, to find the relevant information.

• Write your answers on the spaces provided in this Question Paper.

• Answer all the questions within the 15-minute time limit.

• Your answers should be correctly spelt.

The use of feeding tubes in paediatrics: Questions

Questions 1-7

For each question, 1-7, decide which text (A, B, C or D) the information comes from.
You may use any letter more than once.

In which text can you find information about

1 the risks of feeding a child via a nasogastric tube?

2 calculating the length of tube that will be required for

a patient?

3 when alternative forms of feeding may be more

appropriate than nasogastric?

4 who to consult over a patient’s liquid food

requirements?

5 the outward appearance of the tubes?

6 knowing when it is safe to go ahead with the use of a

tube for feeding?

7 how regularly different kinds of tubes need replacing?

PRACTICE  TEST   1 29
Questions 8-15

Answer each of the questions, 8-15, with a word or short phrase from one of the texts. Each
answer may include words, numbers or both.

8 What type of tube should you use for patients who need nasogastric feeding
for an
extended period?

9 What should you apply to a feeding tube to make it easier to insert?

10 What should you use to keep the tube in place temporarily?

11 What equipment should you use initially to aspirate a feeding tube?

12 If initial aspiration of the feeding tube is unsuccessful, how long should you
wait before trying again?

13 How should you position a patient during a second attempt to obtain aspirate?

14 If aspirate exceeds pH 5.5, where should you take the patient to confirm the
position of the tube?

15 What device allows for the delivery of feeds via the small bowel?

30 PRACTICE  TEST   1
Questions 16-20

Complete each of the sentences, 16-20, with a word or short phrase from one of the texts.
Each answer may include words, numbers or both.

16 If a feeding tube isn’t straight when you unwrap it, you should
it.

17 Patients are more likely to experience if they need

long-term feeding via a tube.

18 If you need to give the patient a standard liquid feed, the tube to use is

in size.

19 You must take out the feeding tube at once if the patient is coughing badly or is

experiencing .

20 If a child is receiving via a feeding tube, you

should replace the feed bottle after four hours.

END OF PART A
THIS QUESTION PAPER WILL BE COLLECTED

PRACTICE  TEST   1 31
 READING SUB-TEST – QUESTION PAPER: PARTS B & C
CANDIDATE NUMBER:
LAST NAME:
FIRST NAME:
MIDDLE NAMES: Passport Photo

PROFESSION: Candidate details and photo will be printed here.

VENUE:
TEST DATE:

CANDIDATE DECLARATION
By signing this, you agree not to disclose or use in any way (other than to take the test) or assist any other person to disclose or use any OET
test or sub-test content. If you cheat or assist in any cheating, use any unfair practice, break any of the rules or regulations, or ignore any advice
or information, you may be disqualified and your results may not be issued at the sole discretion of CBLA. CBLA also reserves its right to take
further disciplinary action against you and to pursue any other remedies permitted by law. If a candidate is suspected of and investigated for
malpractice, their personal details and details of the investigation may be passed to a third party where required.

CANDIDATE SIGNATURE:

TIME: 45 MINUTES

INSTRUCTIONS TO CANDIDATES
DO NOT open this Question Paper until you are told to do so.
One mark will be granted for each correct answer.
Answer ALL questions. Marks are NOT deducted for incorrect answers.
At the end of the test, hand in this Question Paper.

HOW TO ANSWER THE QUESTIONS:

Mark your answers on this Question Paper by filling in the circle using a 2B pencil. Example: A
B
C

SAMPLE
www.occupationalenglishtest.org
© Cambridge Boxhill Language Assessment – ABN 51 988 559 414
[CANDIDATE NO.] READING QUESTION PAPER PARTS B & C 01/16

32 PRACTICE  TEST   1
 Part B
In this part of the test, there are six short extracts relating to the work of health professionals.
For questions 1-6, choose answer (A, B or C) which you think fits best according to the text.

1. If vaccines have been stored incorrectly,

A this should be reported.

B staff should dispose of them securely.

C they should be sent back to the supplier.

Manual extract: effective cold chain

The cold chain is the system of transporting and storing vaccines within the
temperature range of +2°C to +8°C from the place of manufacture to the point of
administration. Maintenance of the cold chain is essential for maintaining vaccine
potency and, in turn, vaccine effectiveness.
Purpose-built vaccine refrigerators (PBVR) are the preferred means of storage for
vaccines. Domestic refrigerators are not designed for the special temperature needs of
vaccine storage.
Despite best practices, cold chain breaches sometimes occur. Do not discard or use any
vaccines exposed to temperatures below +2°C or above +8°C without obtaining further
advice. Isolate vaccines and contact the state or territory public health bodies for advice
on the National Immunisation Program vaccines and the manufacturer for privately
purchased vaccines.

PRACTICE  TEST   1 33
2. According to the extract, prior to making a home visit, nurses must

A record the time they leave the practice.

B refill their bag with necessary items.

C communicate their intentions to others.

Nurse home visit guidelines

When the nurse is ready to depart, he/she must advise a minimum of two
staff members that he/she is commencing home visits, with one staff member
responsible for logging the nurse’s movements. More than one person must
be made aware of the nurse’s movements; failure to do so could result in the
breakdown of communication and increased risk to the nurse and/or practice.
On return to the practice, the nurse will immediately advise staff members of his/
her return. This time will be documented on the patient visit list, and then scanned
and filed by administration staff. The nurse will then attend to any specimens, cold
chain requirements, restocking of the nurse kit and biohazardous waste.

34 PRACTICE  TEST   1
3. What is being described in this section of the guidelines?

A changes in procedures

B best practice procedures

C exceptions to the procedures

Guidelines for dealing with hospital waste

All biological waste must be carefully stored and disposed of safely. Contaminated
materials such as blood bags, dirty dressings and disposable needles are also
potentially hazardous and must be treated accordingly. If biological waste and
contaminated materials are not disposed of properly, staff and members of the
community could be exposed to infectious material and become infected. It is
essential for the hospital to have protocols for dealing with biological waste and
contaminated materials. All staff must be familiar with them and follow them.
The disposal of biohazardous materials is time-consuming and expensive, so it is
important to separate out non-contaminated waste such as paper, packaging and
non-sterile materials. Make separate disposal containers available where waste is
created so that staff can sort the waste as it is being discarded.

PRACTICE  TEST   1 35
4. When is it acceptable for a health professional to pass on confidential
information given by a patient?

A if non-disclosure could adversely affect those involved

B if the patient’s treatment might otherwise be compromised

C if the health professional would otherwise be breaking the law

Extract from guidelines: Patient Confidentiality

Where a patient objects to information being shared with other health professionals
involved in their care, you should explain how disclosure would benefit the continuity
and quality of care. If their decision has implications for the proposed treatment, it
will be necessary to inform the patient of this. Ultimately if they refuse, you must
respect their decision, even if it means that for reasons of safety you must limit your
treatment options. You should record their decision within their clinical notes.
It may be in the public interest to disclose information received in confidence
without consent, for example, information about a serious crime. It is important that
confidentiality may only be broken in this way in exceptional circumstances and then
only after careful consideration. This means you can justify your actions and point out
the possible harm to the patient or other interested parties if you hadn’t disclosed the
information. Theft, fraud or damage to property would generally not warrant a breach
of confidence.

36 PRACTICE  TEST   1
5. The purpose of the email to practitioners about infection control obligations
is to

A act as a reminder of their obligations.

B respond to a specific query they have raised.

C announce a change in regulations affecting them.

Email from Dental Board of Australia

Dear Practitioner,
You may be aware of the recent media and public interest in standards of infection
control in dental practice. As regulators of the profession, we are concerned that
there has been doubt among registered dental practitioners about these essential
standards.
Registered dental practitioners must comply with the National Board’s Guidelines
on infection control. The guidelines list the reference material that you must have
access to and comply with, including the National Health and Medical Research
Council’s (NHMRC) Guidelines for the prevention and control of infection in
healthcare.
We believe that most dental practitioners consistently comply with these guidelines
and implement appropriate infection control protocols. However, the consequences
for non-compliance with appropriate infection control measures will be significant for
you and also for your patients and the community.

PRACTICE  TEST   1 37
6. The results of the study described in the memo may explain why

A superior communication skills may protect women from dementia.

B female dementia sufferers have better verbal skills.

C mild dementia in women can remain undiagnosed.

Memo to staff: Women and Dementia

Please read this extract from a recent research paper

Women’s superior verbal skills could work against them when it comes to recognizing
Alzheimer’s disease. A new study looked at more than 1300 men and women
divided into three groups: one group comprised patients with amnestic mild cognitive
impairment; the second group included patients with Alzheimer’s dementia; and the final
group included healthy controls. The researchers measured glucose metabolic rates
with PET scans. Participants were then given immediate and delayed verbal recall tests.
Women with either no, mild or moderate problems performed better than men on the
verbal memory tests. There was no difference in those with advanced Alzheimer’s.
Because verbal memory scores are used for diagnosing Alzheimer’s, some women may
be further along in their disease before they are diagnosed. This suggests the need to
have an increased index of suspicion when evaluating women with memory problems.

Part C

38 PRACTICE  TEST   1
In this part of the test, there are two texts about different aspects of healthcare. For questions
7-22, choose the answer (A, B, C or D) which you think fits best according to the text.

Text 1: Asbestosis

Asbestos is a naturally occurring mineral that has been linked to human lung disease. It has
been used in a huge number of products due to its high tensile strength, relative resistance
to acid and temperature, and its varying textures and degrees of flexibility. It does not
evaporate, dissolve, burn or undergo significant reactions with other chemicals. Because
of the widespread use of asbestos, its fibres are ubiquitous in the environment. Building
insulation materials manufactured since 1975 should no longer contain asbestos; however,
products made or stockpiled before this time remain in many homes. Indoor air may become
contaminated with fibres released from building materials, especially if they are damaged or
crumbling.

One of the three types of asbestos-related diseases is asbestosis, a process of lung

tissue scarring caused by asbestos fibres. The symptoms of asbestosis usually include
slowly progressing shortness of breath and cough, often 20 to 40 years after exposure.
Breathlessness advances throughout the disease, even without further asbestos inhalation.
This fact is highlighted in the case of a 67-year-old retired plumber. He was on ramipril to
treat his hypertension and developed a persistent dry cough, which his doctor presumed to
be an ACE inhibitor induced cough. The ramipril was changed to losartan. The patient had
never smoked and did not have a history of asthma or COPD. His cough worsened and he
complained of breathlessness on exertion. In view of this history and the fact that he was
a non-smoker, he was referred for a chest X-ray and to the local respiratory physician. His
doctor was surprised to learn that the patient had asbestosis, diagnosed by a high-resolution
CT scan. The patient then began legal proceedings to claim compensation as he had worked
in a dockyard 25 years previously, during which time he was exposed to asbestos.

There are two major groups of asbestos fibres, the amphibole and chrysotile fibres. The
amphiboles are much more likely to cause cancer of the lining of the lung (mesothelioma) and
scarring of the lining of the lung (pleural fibrosis). Either group of fibres can cause disease
of the lung, such as asbestosis. The risk of developing asbestos-related lung cancer varies
between fibre types. Studies of groups of patients exposed to chrysotile fibres show only a
moderate increase in risk. On the other hand, exposure to amphibole fibres or to both types
of fibres increases the risk of lung cancer two-fold. Although the Occupational Safety and
Health Administration (OSHA) has a standard for workplace exposure to asbestos (0.2 fibres/
millilitre of air), there is debate over what constitutes a safe level of exposure. While some
believe asbestos-related disease is a ‘threshold phenomenon’, which requires a certain level
of exposure for disease to occur, others believe there is no safe level of asbestos.

PRACTICE  TEST   1 39
Depending on their shape and size, asbestos fibres deposit in different areas of the
lung. Fibres less than 3mm easily move into the lung tissue and the lining surrounding
the lung. Long fibres, greater than 5mm cannot be completely broken down by
scavenger cells (macrophages) and become lodged in the lung tissue, causing
inflammation. Substances damaging to the lungs are then released by cells that are
responding to the foreign asbestos material. The persistence of these long fibres in
the lung tissue and the resulting inflammation seem to initiate the process of cancer
formation. As inflammation and damage to tissue around the asbestos fibres continues,
the resulting scarring can extend from the small airways to the larger airways and the
tiny air sacs (alveoli) at the end of the airways.

There is no cure for asbestosis. Treatments focus on a patient’s ability to breathe.

Medications like bronchodilators, aspirin and antibiotics are often prescribed and
such treatments as oxygen therapy and postural drainage may be recommended. If
symptoms are so severe that medications don’t work, surgery may be recommended to
remove scar tissue. Patients with asbestosis, like others with chronic lung disease, are
at a higher risk of serious infections that take advantage of diseased or scarred lung
tissue, so prevention and rapid treatment is vital. Flu and pneumococcal vaccinations
are a part of routine care for these patients. Patients with progressive disease may be
given corticosteroids and cyclophosphamide with limited improvement.

Chrysotile is the only form of asbestos that is currently in production today. Despite
their association with lung cancer, chrysotile products are still used in 60 countries,
according to the industry-sponsored Asbestos Institute. Although the asbestos industry
proclaims the ‘safety’ of chrysotile fibres, which are now imbedded in less friable and
‘dusty’ products, little is known about the long term effects of these products because of
the long delay in the development of disease. In spite of their potential health risks, the
durability and cheapness of these products continue to attract commercial applications.
Asbestosis remains a significant clinical problem even after marked reductions in on-
the-job exposure to asbestos. Again, this is due to the long period of time between
exposure and the onset of disease.

40 PRACTICE  TEST   1
Text 1: Questions 7-14

7. The writer suggests that the potential for harm from asbestos is increased by

A a change in the method of manufacture.

B the way it reacts with other substances.

C the fact that it is used so extensively.

D its presence in recently constructed buildings.

8. The word ‘ubiquitous’ in paragraph one suggests that asbestos fibres

A can be found everywhere.

B may last for a long time.

C have an unchanging nature.

D are a natural substance.

9. The case study of the 67-year-old man is given to show that

A smoking is unrelated to a diagnosis of asbestosis.

B doctors should be able to diagnose asbestosis earlier.

C the time from exposure to disease may cause delayed diagnosis.

D patients must provide full employment history details to their doctors.

10. In the third paragraph, the writer highlights the disagreement about

A the relative safety of the two types of asbestos fibres.

B the impact of types of fibres on disease development.

C the results of studies into the levels of risk of fibre types.

D the degree of contact with asbestos fibres considered harmful.

PRACTICE  TEST   1 41
11. In the fourth paragraph, the writer points out that longer asbestos fibres

A can travel as far as the alveoli.

B tend to remain in the pulmonary tissue.

C release substances causing inflammation.

D mount a defence against the body’s macrophages.

12. What is highlighted as an important component of patient management?

A the use of corticosteroids

B infection control

C early intervention

D excision of scarred tissue

13. The writer states that products made from chrysotile

A have restricted application.

B may pose a future health threat.

C enjoy approval by the regulatory bodies.

D are safer than earlier asbestos-containing products.

14. In the final paragraph, the word ‘this’ refers to

A the interval from asbestos exposure to disease.

B the decreased use of asbestos in workplaces.

C asbestosis as an ongoing medical issue.

D occupational exposure to asbestos.

42 PRACTICE  TEST   1
Text 2: Medication non-compliance

A US doctor gives his views on a new program

An important component of a patient’s history and physical examination is the question of

‘medication compliance,’ the term used by physicians to designate whether, or not, a patient is
taking his or her medications. Many a hospital chart bears the notorious comment ‘Patient has
a history of non-compliance.’ Now, under a new experimental program in Philadelphia, USA,
patients are being paid to take their medications. The concept makes sense in theory - failure to
comply is one of the most common reasons that patients are readmitted to hospital shortly after
being discharged.

Compliant patients take their medications because they want to live as long as possible; some
simply do so because they’re responsible, conscientious individuals by nature. But the hustle and
bustle of daily life and employment often get in the way of taking medications, especially those
that are timed inconveniently or in frequent doses, even for such well-intentioned patients. For the
elderly and the mentally or physically impaired, US insurance companies will often pay for a daily
visit by a nurse, to ensure a patient gets at least one set of the most vital pills. But other patients
are left to fend for themselves, and it is not uncommon these days for patients to be taking a
considerable number of vital pills daily.

Some patients have not been properly educated about the importance of their medications
in layman’s terms. They have told me, for instance, that they don’t have high blood pressure
because they were once prescribed a high blood pressure pill – in essence, they view an
antihypertensive as an antibiotic that can be used as short-term treatment for a short-term
problem. Others have told me that they never had a heart attack because they were taken to the
cardiac catheterization lab and ‘fixed.’ As physicians we are responsible for making sure patients
understand their own medical history and their own medications.

Not uncommonly patients will say, ‘I googled it the other day, and there was a long list of side
effects.’ But a simple conversation with the patient at this juncture can easily change their
perspective. As with many things in medicine, it’s all about risks versus benefits – that’s what
we as physicians are trained to analyse. And patients can rest assured that we’ll monitor them
closely for side effects and address any that are unpleasant, either by treating them or by trying a
different medication.

But to return to the program in Philadelphia, my firm belief is that if patients don’t have strong
enough incentives to take their medications so they can live longer, healthier lives, then the long-
term benefits of providing a financial incentive are likely to be minimal. At the outset, the rewards
may be substantial enough to elicit a response. But one isolated system or patient study is not an
accurate depiction of the real-life scenario: patients will have to be taking these medications for
decades.

Although a simple financial incentives program has its appeal, its complications abound. What’s
worse, it seems to be saying to society: as physicians, we tell our patients that not only do we

PRACTICE  TEST   1 43
work to care for them, but we’ll now pay them to take better care of themselves. And by the way,
for all you medication-compliant patients out there, you can have the inherent reward of a longer,
healthier life, but we’re not going to bother sending you money. This seems like some sort of implied
punishment.

But more generally, what advice can be given to doctors with non-compliant patients? Dr John
Steiner has written a paper on the matter: ‘Be compassionate,’ he urges doctors. ‘Understand what
a complicated balancing act it is for patients.’ He’s surely right on that score. Doctors and patients
need to work together to figure out what is reasonable and realistic, prioritizing which measures
are most important. For one patient, taking the diabetes pills might be more crucial than trying to
quit smoking. For another, treating depression is more critical than treating cholesterol. ‘Improving
compliance is a team sport,’ Dr Steiner adds. ‘Input from nurses, care managers, social workers and
pharmacists is critical.’

When discussing the complicated nuances of compliance with my students, I give the example of
my grandmother. A thrifty, no-nonsense woman, she routinely sliced all the cholesterol and heart
disease pills her doctor prescribed in half, taking only half the dose. If I questioned this, she’d wave
me off with, ‘What do those doctors know, anyway?’ Sadly, she died suddenly, aged 87, most likely
of a massive heart attack. Had she taken her medicines at the appropriate doses, she might have
survived it. But then maybe she’d have died a more painful death from some other ailment. Her
biggest fear had always been ending up dependent in a nursing home, and by luck or design, she
was able to avoid that. Perhaps there was some wisdom in her ‘non-compliance.’

44 PRACTICE  TEST   1
Text 2: Questions 15-22

15. In the first paragraph, what is the writer’s attitude towards the new programme?

A He doubts that it is correctly named.

B He appreciates the reasons behind it.

C He is sceptical about whether it can work.

D He is more enthusiastic than some other doctors.

16. In the second paragraph, the writer suggests that one category of non-compliance is

A elderly patients who are given occasional assistance.

B patients who are over-prescribed with a certain drug.

C busy working people who mean to be compliant.

D people who are by nature wary of taking pills.

17. What problem with some patients is described in the third paragraph?

A They forget which prescribed medication is for which of their conditions.

B They fail to recognise that some medical conditions require ongoing treatment.

C They don’t understand their treatment even when it’s explained in simple terms.

D They believe that taking some prescribed pills means they don’t need to take others.

18. What does the writer say about side effects to medication?

A Doctors need to have better plans in place if they develop.

B There is too much misleading information about them online.

C Fear of them can waste a lot of unnecessary consultation time.

D Patients need to be informed about the likelihood of them occurring.

PRACTICE  TEST   1 45
 19. In the fifth paragraph, what is the writer’s reservation about the Philadelphia program?

A the long-term feasibility of the central idea

B the size of the financial incentives offered

C the types of medication that were targeted

D the particular sample chosen to participate

20. What objection to the program does the writer make in the sixth paragraph?

A It will be counter-productive.

B It will place heavy demands on doctors.

C It sends the wrong message to patients.

D It is a simplistic idea that falls down on its details.

21. The expression ‘on that score’ in the seventh paragraph refers to

A a complex solution to patients’ problems.

B a co-operative attitude amongst medical staff.

C a realistic assessment of why something happens.

D a recommended response to the concerns of patients.

22. The writer suggests that his grandmother

A may ultimately have benefited from her non-compliance.

B would have appreciated closer medical supervision.

C might have underestimated how ill she was.

D should have followed her doctor’s advice.

END OF READING TEST

THIS BOOKLET WILL BE COLLECTED

46 PRACTICE  TEST   1