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In the sentence below, the main clause (subject: patients) is followed by an infinitival that I understand to be a purpose infinitive. However, the logical subject of the infinitival seems to be the doctor. Is this conflict justified or what? I consulted A Student's Introduction to English Grammar, but found nothing to indicate its correctness.

All patients must have a preanesthesia evaluation by an anesthesia clinician to assess the patient's perioperative risk and readiness for the planned procedure.

I appreciate your comments.

  • It's strange that you start the sentence with all patients (plural) but then use the patient's (singular) later on. It would be more consistent if you used their later on. Also, perhaps, any planned procedure, since there isn't a single, specific procedure that's been identified. – Jason Bassford Dec 15 '18 at 10:55
  • @JasonBassford Thank you for your input. I didn't write the sentence. What bothers me with that sentence is that the second part (the assessment) is done by the doctor, while the subject of the sentence is "the patients." – Vahid Farajivafa Dec 15 '18 at 12:22
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Such utterances are frequently made by native speakers:

All student drivers must take an exam to assess their readiness for the road.

It's not abundantly clear who the assessor is there, the drivers (by submitting to the exam they can assess whether they are ready), an unnamed entity who gives the exam, or the exam.

You could restate it so that the drivers are the implied grammatical subject of the infinitive clause:

All student drivers must take an exam to have their readiness for the road assessed.

And you could do the same with the original sentence, making a stylistic modification to avoid have appearing twice:

All patients must be evaluated by an anesthesia clinician to have their readiness for the planned procedure assessed along with their perioperative risk.

If we don't care about using have in two different ways:

All patients must have a pre-anesthesia evaluation by an anesthesia clinician to have their readiness for the planned procedure assessed along with their perioperative risk.

That seems a little clumsy. You could reverse the order of the clauses and use the verb undergo:

To have their perioperative risk assessed along with their readiness for the planned procedure, all patients must undergo a pre-anesthesia evaluation by an anesthesia clinician.

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Let's simplify the sentence, hopefully without modifying or destroying the meaning:

All patients must have an evaluation to assess the patient's risk.

or

All patients must have an evaluation assessing the patient's risk.

The infinitive "to assess the patient's risk" seems to function as an adjective, modifying "evaluation". In this way, if there were any "subject" for the infinitive, it would be "evaluation". At the same time, there doesn't seem to be any reason to require the subject of the whole sentence (the patients) to also be the target of adjectives which happen to appear later on in the sentence. Thus, no grammatical conflict is occurring.

  • I am afraid your quick search does not answer my question as the verb in the sentence is not one of those "certain verbs." – Vahid Farajivafa Dec 15 '18 at 11:39
  • @VahidFarajivafa , rewrote the answer... What do you think? – Sam Dec 15 '18 at 12:09
  • Thank you. This makes more sense now. With "by the clinician" removed, it becomes clear to me that "to assess ..." functions as an adjective modifying "evaluation." Maybe we should try removing all clinicians! – Vahid Farajivafa Dec 15 '18 at 12:43

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