ROS Student Grammar Guide

As you know, there are thousands of grammar and punctuation rules. I will try to cover some of the more important ones here (I'll be adding as we go along). If you have any questions, please feel free to . Thanks!

Compound-complex sentences usually consist of two independent clauses (joined by and, but, or, or nor) and one or more dependent clauses. First, use a comma before the conjunction that joins the two main clauses. Then provide punctuation as necessary. NOTE: You may also drop the conjunction (and, but, or, or nor) and change the comma to a semicolon (think of it as a "soft period") if a stronger break is desired. Examples:

	The patient exercises very infrequently, but when he does, it may be fairly heavy.
	This is a worrisome lesion due to its firmness and persistence in size; however, now with the new presence of aphthous ulcers, I question whether this could be viral.

Semicolons. Use a semicolon to separate two independent (yet closely related) clauses.  Examples:

	Subsequently, he was seen by Dr. Little and placed on antibiotics with some decrease in size; however, the mass persisted.
	Father died at age 27; he had type I diabetes.

Noun modifiers. Hyphenate the elements of a compound adjective that occurs before a noun. Examples:

	The patient is a 64-year-old male.
	The patient does have some pelvic prolapse on exam with a second-degree cystocele and a second-degree rectocele.
	Shortly after last visit, she began to have more intense right-sided mid-back pain.
	Guaiac-negative brown stool.
	The patient has had low-grade fevers all week.
	Her only complaint is of tension-type headaches at the nape of the neck.

Commas (a headache for us all!). Commas are used to separate two independent clauses joined by a conjunction. Examples:

	She saw no formal consultant, and all treatments were given at the physician's home.
	She has had a bowel movement once today, and it was normal.
	Her creatine clearance was 71, and her creatine was 0.6.

TIP: When debating whether or not to set off clauses with a comma, read the sentence aloud, without the clause, to see if it makes sense. Examples:

	Her corneal and pupillary reflexes, which had been present on admission, were lost.
	As there was no chance of functional recovery, the decision was made to withdraw ventilatory support.
	However, on the second postoperative day, her pain and nausea had improved.

Do not use a comma in the following examples (the clause following the conjunction is referring to the subject):

	She has had some nose stuffiness and is pregnant.
	She has never had any evaluation for this but has been treated in various emergency rooms for those events.

Which is used to introduce nonessential clauses, and that is typically used to introduce essential clauses (necessary to the meaning of the sentence). A nonessential clause should be set apart with commas. Examples:

	He is now on Lescol 20 mg per day, which he is tolerating well.
	He did have an exercise treadmill test in 1996, which was negative.
	The patient has substernal chest discomfort that sounds like GE reflux.
	She had a full pelvic exam that revealed atrophic external genitalia, cystocele, and rectocele.

Here is what The Gregg Reference Manual says:

"Who" and "that" are used when referring to persons. Select "who" when the individual person or the individuality of a group is meant and "that" when a class, species, or type is meant. Examples: "She is the only one of my patients who can speak Spanish fluently." "He is the kind of patient that requires a lot of encouragement."

"Which" and "that" are used when referring to places, objects, and animals. "Which" is always used to introduce NONESSENTIAL clauses, and "that" is ordinarily used to introduce ESSENTIAL clauses. Examples: "The patient's lab tests, which I sent you last week, were all reportedly normal." The reports that I sent you last week should be of some help."

"Whose" is the possessive form of "who." The contraction "who's" means "who is" or "who has." Now, who's on first? <g>

Apostrophes.

Apostrophes are used to indicate omitted letters in contractions, form some plural words, or show possession.

Contractions. You should only use contractions in medical reports when in direct quotes, e.g., “The patient stated, ‘I don’t think I can tolerate much more.’”  Otherwise, write out the words.

Note:  Remember to watch for the following contractions and possessives to make sure they are used properly: it’s (meaning it is) and its (a singular possessive pronoun); whose and who’s; there, they’re, and their.

Plurals. Use ‘s to form plurals on single letters or numbers, e.g., “My kid got all A’s and B’s on her report card.”

You should also use an apostrophe with lower case abbreviations with and without periods, e.g., “rbc’s and wbc’s.”

Do not use an apostrophe to form the plural of capital letter abbreviations or numbers with two or more digits, e.g., “Her diastolic pressures have been running in the low 90s.”  “She had CPKs done, which were negative.”

Possessives. When a noun is singular, add an apostrophe s to create the possessive. Example: “The patient should return in 1 day’s time.”

If a noun ends in s, simply add an apostrophe to the end of the word, e.g., “I gave her 2 weeks’ worth of medicine.”

Note: The AAMT Book of Style tells us that we should not use ‘s with eponymic terms, e.g., “She has a negative Tinel sign.”

If you want to express joint ownership, only the lasts-named member is made possessive, e.g., “I met with Evan and Abbey’s mother.”

If you wish to indicate separate ownership, each of the names will be made possessive, e.g., “I will review Evan’s, Abbey’s, and Tommy’s test scores.”

Style note: While an apostrophe is sometimes used a symbol for feet, it is preferable to type out the word feet, e.g., “The patient’s height is 5 feet 9 inches.”