Commas

[jolibutler]

#1. The patient states that he has had occipital headaches that are worse towards the evening.

#2. The patient says that they are occipital in nature and will again be worse in the evening.

#3. The patient states that the arm pain is rated 2-8/10 depending on the time of day and again worsens with activity towards the end of the day and are associated with his headaches.

This is exactly what the doctor dictates, without punctuation. He is repeating that the patient has already told him the pain will be worse in the evening. How do I punctuate to keep from reading like the patient's pain is happening for the second time.

[5jj]

#1. The patient states that he has had occipital headaches that are worse towards the evening.
#2. The patient says that they are occipital in nature and will again be worse in the evening.
#3. The patient states that the arm pain is rated 2-8/10 depending on the time of day and again worsens with activity towards the end of the day and are associated with his headaches.

This is exactly what the doctor dictates, without punctuation. He is repeating that the patient has already told him the pain will be worse in the evening. How do I punctuate to keep from reading like the patient's pain is happening for the second time.

I am not an expert on how commas are used in the United States, but I suggest that simply omitting 'again' in #2 and #3 helps.

[minnieuk]

I am not an expert on how commas are used in the United States, but I suggest that simply omitting 'again' in #2 and #3 helps.

Nor am I, but I was told by a previous tutor at university that in the US it is customary to put a comma before 'and'.
However, I don't read any of the sentences as meaning the pain is happening for the second time. It reads more as though the patient has spoken about the pain a second time.

[Rover_KE]

. . . but I suggest that simply omitting 'again' in #2 and #3 helps.

Unfortunately, omitting words from a doctor's dictated report is not an option most medical secretaries would dare to make.

Rover

[freezeframe]

#1. The patient states that he has had occipital headaches that are worse towards the evening.

#2. The patient says that they are occipital in nature and will again be worse in the evening.

#3. The patient states that the arm pain is rated 2-8/10 depending on the time of day and again worsens with activity towards the end of the day and are associated with his headaches.

This is exactly what the doctor dictates, without punctuation. He is repeating that the patient has already told him the pain will be worse in the evening. How do I punctuate to keep from reading like the patient's pain is happening for the second time.

If you read 1-3 as one paragraph, i.e. again keeps referring to sentence 1, just set off again with commas.

The patient states that he has had occipital headaches that are worse towards the evening. The patient says that they are occipital in nature and will, again, be worse in the evening. The patient states that the arm pain is rated 2-8/10 depending on the time of day and, again, worsens with activity towards the end of the day and are associated with his headaches.