OET Listening Part C practice test

Narrator: Part C. Extract one. You'll hear a radio interview with Dr Rohan Iyer, a geriatrician, about reducing medicines in older people. For questions thirty-one to thirty-six, choose the answer which corresponds most closely with what you hear. Now listen.

Radio presenter: Good morning, and welcome to Health Matters. Many older people take a long list of medicines, and there's growing interest in carefully reducing them, what's known as deprescribing. With me is Dr Rohan Iyer, a geriatrician who's been leading a local pilot programme on this. Dr Iyer, welcome.

Geriatrician: Thank you, Fiona. Good to be here.

Radio presenter: Let's start with the word everyone uses: polypharmacy. What does it actually mean?

Geriatrician: Well, the usual definition is five or more regular medicines, and by that measure a large proportion of people over seventy-five qualify. But I think the word has become a bit misleading, honestly. It makes it sound as if the number itself is the problem. Someone with heart failure, diabetes and kidney disease might genuinely need eight medicines, and each one is earning its place. The real question is whether every single medicine is still doing more good than harm for that person, at this point in their life. A tablet that made sense at sixty may not make sense at eighty-five.

Radio presenter: Can you give us an example?

Geriatrician: Sure. Take a statin started for prevention twenty years ago. If someone is now frail, with limited life expectancy, the benefit may simply not arrive in time, while the side effects and the sheer number of pills are very real today. Or sleeping tablets, benzodiazepines, which significantly increase the risk of falls in older people. Those are classic candidates for a conversation.

Radio presenter: And yet I imagine patients don't always welcome that conversation.

Geriatrician: No, and it's important to understand why. People often assume it's because patients are attached to their tablets, or worried their symptoms will come back. That's sometimes true. But what I hear far more often is something like, so you're giving up on me, then? Stopping a medicine can feel like a message that they're no longer worth treating. If you don't address that directly, the conversation goes nowhere.

Radio presenter: So how do you address it?

Geriatrician: By being clear that it's about treating them better, not less. I'll say, this tablet may be adding to your dizziness, and we'd like you to be steadier on your feet. That lands very differently.

Radio presenter: Many listeners will be thinking about GPs here. Aren't they the ones who should be doing this?

Geriatrician: In principle, yes. And I want to be careful, because GPs often get blamed for polypharmacy, and I don't think that's fair. Most GPs I work with know perfectly well which medicines could go. The problem is the structure. A standard consultation is fifteen minutes, the patient's come in with a new problem, and adding a medicine takes thirty seconds. Stopping one safely means a discussion, a plan, follow-up. The system rewards starting things, not stopping them.

Radio presenter: Which brings us to your pilot. Tell us about it.

Geriatrician: So for the past eighteen months we've run what we call the Westmere Medicines Partnership. Patients over seventy-five on ten or more medicines get a home visit from a pharmacist, who goes through everything, including whatever's in the kitchen drawer. Then the pharmacist, the GP and, where needed, someone from my team meet for a short case conference and agree a plan.

Radio presenter: And the results?

Geriatrician: We've seen about two hundred patients so far. On average we stopped or reduced just under two medicines per person, which is respectable, but not dramatic. What genuinely surprised us was something else. When the pharmacist asked, at home, is there anything you'd like to stop, nearly two-thirds of patients named a medicine straight away. They'd wanted to raise it for years but never felt there was room in a GP appointment.

Radio presenter: That's striking. What about technology? There are software tools now that flag potentially inappropriate medicines.

Geriatrician: They're helpful, and I use them. They're good at saying, have you thought about this one? But I've seen people treat the list as a set of instructions, and that worries me. The software doesn't know that a patient's antidepressant is the reason she's still going to her choir. The tool can start a conversation, but it can't have it for you.

Radio presenter: Finally, for health professionals listening who want to make a start, what's your advice?

Geriatrician: Don't try to fix the whole list in one go. Pick one medicine, explain why, agree what the patient should watch out for, and book a follow-up. If you stop three things at once and the patient feels unwell, you've no idea which change was responsible, and you may lose their trust for the next conversation.

Radio presenter: Dr Rohan Iyer, thank you.

Narrator: Extract two. You'll hear a presentation by Dr Hannah Whitcombe, an emergency physician, about recognising sepsis in rural hospitals. For questions thirty-seven to forty-two, choose the answer which corresponds most closely with what you hear. Now listen.

Conference chair: Our next speaker is Dr Hannah Whitcombe, an emergency physician who's spent the last ten years working across small rural hospitals. Her talk is called The Sixty-Minute Problem. Hannah.

Emergency physician: Thanks, Michael. Morning, everyone. I want to start with something that might sound odd from someone who's about to talk to you about sepsis. I don't think the nurses and doctors in our small hospitals lack knowledge about it. Every one of you could probably list the warning signs: a high or low temperature, a fast heart rate, fast breathing, low blood pressure, new confusion. The problem in a rural hospital is different. It's three in the morning, there's no doctor on site, the patient doesn't look that sick yet, and the person who has to decide whether to pick up the phone is often a nurse working on her own.

Emergency physician: Let me tell you about a patient I'll call Joan. This was early in my career. Joan was sixty-eight, she came in with her daughter, and she had a urinary tract infection. Her temperature was up a little, her heart rate was a bit fast, her blood pressure was okay. I did a urine test, prescribed oral antibiotics, and sent her home. As they were leaving, her daughter said to me, she's just not herself, she's usually so sharp. And I said something reassuring, and I meant it.

Emergency physician: Joan came back by ambulance at six the next morning in septic shock. She survived, after nine days in an intensive care unit three hundred kilometres away. For a long time I told myself the problem was that her observations were borderline. But that's not really true. The information that mattered most was standing right in front of me, and it came from her daughter. A family member telling you that someone is acting differently is a sign of new confusion, and I treated it as small talk.

Emergency physician: Now, that's one story. So last year we looked at the bigger picture. We audited every adult sepsis presentation over twelve months across eleven small hospitals in our district. That was three hundred and twelve patients. The national standard says antibiotics should be given within sixty minutes of sepsis being recognised. Before we started, I assumed the delay would be in the treatment itself, you know, finding the right antibiotic, getting a line in, that kind of thing. It wasn't. Once a doctor had been contacted, most patients got their antibiotics reasonably quickly. The big gap, a median of almost two hours, was between the first abnormal set of observations and anyone calling a doctor.

Emergency physician: So we asked the nurses why. And to be fair, a few did mention poor phone coverage. But overwhelmingly, the answer was the same. They didn't want to call out a doctor who might be forty minutes away for what might turn out to be nothing. They were afraid of the false alarm.

Emergency physician: Now, the usual response to an audit like this is a new tool. Another screening chart, another checklist, another sticker on the front of the notes. And I'll be honest, I've lost my enthusiasm for that. Our observation charts already have clear calling criteria, in red. The nurses could see the patient was in the red zone. A new tool wouldn't have changed what they knew. What they needed was permission. Permission to call early without apologising, and permission to act.

Emergency physician: So if I could change one thing tomorrow, it would be this. When a patient meets the sepsis criteria, the nurse should call the on-call doctor straight away, ideally by video, and at the same time be authorised under a standing order to start the pathway without waiting for the doctor to see the patient. Take blood cultures, start fluids, give the first dose of antibiotics. The call is never delayed. It just stops being the thing that everything else waits for. Some people have suggested we simply transfer everyone with suspected sepsis to the regional centre. But a two-hour transfer isn't a treatment plan. The first hour still happens with us. So give our nurses the authority to act in that hour, and back them when they do. Thank you.