The task
Assume that today's date is 10 November 2026. Mr Lealaiauloto attended his eight-week dietetic review this morning.
You are a dietitian in the hospital Outpatient Dietetics Department. Using the information in the case notes, write a letter to Mr Lealaiauloto's GP, Dr Maricel Fischer, updating her on his progress and requesting a change to his supplement prescription. Address the letter to Dr Maricel Fischer, General Practitioner, Main Road Medical Practice, 25 Main Road. In your answer: expand the relevant notes into complete sentences; do not use note form; use letter format. The body of the letter should be approximately 180–200 words.
Length: the body of the letter should be about 180–200 words. You have 45 minutes in the test: 5 minutes to read, 40 to write. Letter type: Update letter.
Case notes
Patient details
- Name: Mr Dinesh Lealaiauloto
- DOB: 03/05/1958 (68 yrs)
- Height: 1.75 m
- Referred by GP 08/26 for unintentional wt loss; first dietetic appt 15/09/26
Social background
- Lives with wife (66), who does cooking & shopping
- Retired bus driver; keeps racing pigeons
- Ex-smoker (quit 2019, 40 pack-yrs)
- Wife says daughter's marriage 'falling apart' - pt worried about her
- Drives to appts; complained about lack of parking at clinic
Medical history
- COPD (severe), dx 2014; home O2 not required
- 2 exacerbations in past 12/12; last 07/26 (oral prednisolone course)
- Inhalers: tiotropium/olodaterol daily; salbutamol PRN
- Hypertension - amlodipine
- Appendicectomy 1979
- Osteoarthritis R knee
- Allergies: nil known
Initial assessment (15/09/26)
- Wt 61.2 kg (BMI 20.0); usual wt 70 kg 6/12 ago → 12.6% unintentional loss
- MUST score: high risk
- Poor appetite; early satiety; SOB when eating large meals
- Intake approx. 2 small meals/day; often skipping lunch
Treatment
- Food fortification (full-cream milk, extra butter/cheese/oil); small frequent meals + snacks (approx. 6 eating occasions/day)
- ONS: energy- & protein-dense, 2 × 200 mL/day between meals (prescribed by GP)
- Advised to rest before meals & have main meal when least breathless
Progress (10/11/26)
- Wt 64.0 kg (BMI 20.9) → ↑2.8 kg over 8/52
- Appetite ↑; now 3 meals + 2–3 snacks daily; wife continuing fortification
- Taking ONS consistently 2/day; tired of vanilla flavour
- Est. intake from food alone now ≈85% of requirements
- Grip strength ↑; reports more energy, walking to letterbox daily
- Commenced pulmonary rehab 20/10/26 (2/wk)
- Pt asked about 'detox tea' seen online - advised no evidence of benefit
Plan
- Wean ONS: ↓ to 1 × 200 mL/day from today until dietetic review 08/12/26; consider ceasing only if food intake adequate & nutritional recovery sustained, otherwise continue ONS
- GP: please amend ONS script to 1/day; weigh monthly at practice
- If wt ↓ or COPD exacerbation → restart ONS 2/day & re-refer to dietetics
- Dietetic review 08/12/26 (4/52); continue fortification & small frequent meals
Who is reading, and what do they need?
Dr Fischer is the GP who referred Mr Lealaiauloto and prescribed his supplement. She knows his COPD and needs to see the weight change, what has improved, why the supplement can be reduced and what she is asked to do. She must also know when to restart it, so the conditions need to be explicit.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| First appt 15/09/26: 61.2 kg, BMI 20.0; usual 70 kg; 12.6% loss; MUST high risk | Baseline for judging progress; she referred him for weight loss and needs the starting point. |
| 10/11/26: 64.0 kg, BMI 20.9, up 2.8 kg over 8/52 | Objective progress measure that supports the request to reduce the supplement. |
| Appetite improved; now 3 meals + 2–3 snacks daily; wife continuing fortification | Shows the change in eating pattern from about two small meals a day and who supports it. |
| Food intake alone now about 85% of requirements | Explains why the supplement is reduced rather than stopped: intake is not yet full, so be careful not to imply it is. |
| ONS taken consistently 2/day; commenced pulmonary rehab 20/10/26; grip strength up, more energy | Shows adherence and functional progress, supporting the plan; compress to the key points. |
| Request: amend ONS script to 1 × 200 mL/day; weigh monthly at practice | The specific action required from the GP, including the monitoring she is asked to do. |
| Restart ONS 2/day and re-refer if weight falls or COPD exacerbation | Safety trigger that tells her when to reverse the reduction; both conditions must be stated. |
| Continue 1/day until dietetic review 08/12/26; cease only if intake adequate and recovery sustained | Makes clear this is a reduction, not cessation, and gives the date of the next review. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Wife says daughter's marriage 'falling apart'; patient worried | Family matter not part of the nutritional plan; sharing it is unnecessary. |
| Complained about lack of parking at clinic | Administrative complaint, irrelevant to the GP's actions. |
| Asked about 'detox tea' online; advised no evidence of benefit | Trap: it looks like a nutrition issue but is minor and resolved, and the GP does not need it. |
| Tired of vanilla flavour | Trap: could suggest a flavour change, but the plan reduces the supplement, so this is not needed. |
| Racing pigeons; retired bus driver; appendicectomy 1979; knee osteoarthritis; hypertension | Background that has no effect on the supplement change; the GP already holds his history. |
| Detailed fortification list (full-cream milk, butter, cheese, oil) | Compress to the fact that fortification and small frequent meals continue; the GP does not need the food list. |
A paragraph plan for this case
Open with the purpose of the letter and the review date, then give weight, BMI and dietary progress compared with the first appointment. Use a final paragraph for the supplement request, monthly weights, restart criteria and the next dietetic review.
Where candidates slip on this task
- Do not write that the supplement is being stopped; it is reduced to once daily until 08/12/26, and ceasing is considered only if intake is adequate and recovery is sustained.
- Report weights and the change accurately: 61.2 kg at 15/09/26, 64.0 kg on 10/11/26, up 2.8 kg over 8 weeks. Do not describe the food intake as meeting full requirements.
- State both restart triggers (weight loss or a COPD exacerbation) and what follows: ONS back to twice daily and re-referral to dietetics. Omitting either leaves the GP without a clear safety net.
No model letter is published here. Write for the named reader from the case notes in the timed editor, then get it marked.
Write it in the timed editor and get marked on the 6 criteria
More Dietetics letter tasks
- Update to the treating paediatrician: infant with cow's milk protein allergy and faltering growth update letter
- Gestational diabetes - patient relocating referral letter
- Home jejunostomy feeding after oesophagectomy referral letter
Your profession's guide: OET Dietetics. Layout and structure: OET letter format.
Questions about this task
Why is the supplement reduced instead of stopped?
Because food alone provides about 85% of his requirements, so recovery is not yet complete. The plan weans to once daily to the 08/12/26 review and considers stopping only under the stated conditions.
Should I include the patient's progress outside nutrition?
Include only what supports the plan, briefly: grip strength, more energy and the start of pulmonary rehab. Leave out family worries, parking and the detox tea question, because they do not affect the GP's actions.
Sources
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