The task
Original independent practice material. Allow 45 minutes: 5 minutes for reading and 40 minutes for writing. Assume that today's date is 5 November 2026. Rian Lyden is returning home after his paediatric review.
You are Dr Hoa Luu, a doctor in the paediatric outpatient clinic. Using the case notes, write to Rian's mother, Ms Seaneen Weldon, explaining his constipation and soiling, and the clinician's written home-care and follow-up plan. The paediatrician has already counselled her directly about the prescribed laxative; do not add a regimen or change medicine instructions. Address the letter to Ms Seaneen Weldon, Flat 2, 14 Orchard Road, M14 6QL, United Kingdom. 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: Advice letter.
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Which case notes belong in this letter?
Functional constipation with overflow soiling: advice
You are Dr Hoa Luu, a doctor in the paediatric outpatient clinic. Using the case notes, write to Rian's mother, Ms Seaneen Weldon, explaining his constipation and soiling, and the clinician's written home-care and follow-up plan. The paediatrician has already counselled her directly about the prescribed laxative; do not add a regimen or change medicine instructions. Address the letter to Ms Seaneen Weldon, Flat 2, 14 Orchard Road, M14 6QL, United Kingdom. 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.
Mark every line: Include keeps the specific detail; Compress keeps the relevant gist in fewer words; Omit leaves it out. Then compare your choices with our reviewed analysis. Some choices are optional.
Download practice checklist (PDF)
One-page worksheet. Answers and reasons are on the linked webpage, so you can practise before checking.
Case notes
Patient details
- Name: Rian Lyden; DOB 12/04/2019 (7 yrs)
- Parent: Ms Seaneen Weldon; lives with Rian
- Home: Flat 2, 14 Orchard Road, M14 6QL, United Kingdom
- Paediatric review today: 05/11/2026; home afterwards
- Mother requests written explanation and practical home advice
Social background
- Enjoys drawing dinosaurs; collects toy cars
- Mother complained about the reception queue
- Mother disclosed private parental disagreement about money
Medical history
- Previously toilet-trained; hard, painful stools for 3/12
- Small underwear stains most days for 6/52
- Otitis media age 3; resolved
Assessment
- Growth tracking consistently; generally well
- Sometimes postpones toilet visits at school
- No vomiting or abdominal swelling today
- Intermittent tummy discomfort improves after passing stool
- Mother worried accidents mean deliberate misbehaviour
- Assessment: functional constipation; softer stool leaking around retained hard stool → overflow soiling
Treatment and explanation
- Explanation: accidents involuntary; reassure Rian; avoid blame/punishment
- General advice: improvement may take months
- Paediatrician counselled mother directly on prescribed laxative use
Written ongoing plan
- Prescribing remains with paediatrician; medicine questions → clinic; this letter changes no medicine instructions
- Home routine: sit on toilet after meals; feet supported on step
- Praise sitting/trying, regardless of whether stool passed
- Offer regular drinks and varied foods, including fruit/vegetables
- Encourage active play
- Ask about toilet worries, including school
- Mother to record bowel movements and accidents
- Clinic review booked 19/11/2026; bring record
- Contact clinic earlier if worsening or difficulty following plan
- Swollen tummy with vomiting → urgent medical assessment; do not await review
Who is reading, and what do they need?
Ms Weldon is Rian’s mother and has already received the paediatrician’s laxative counselling. She needs an accessible explanation of overflow soiling, reassurance about involuntary accidents, and practical steps for home care and follow-up. Use everyday language, prioritise actions she can carry out, and preserve the clinic’s responsibility for medicine questions.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Functional constipation; softer stool leaking around retained hard stool causes overflow soiling | Explaining the mechanism makes the diagnosis understandable and helps address the mother’s concern about deliberate accidents. |
| Accidents involuntary; reassure Rian; avoid blame or punishment | The mother needs guidance on responding to accidents without treating them as misconduct. |
| Paediatrician retains prescribing; medicine questions to clinic; letter changes no medicine instructions | Preserves the existing counselling and identifies who should resolve medicine queries without introducing an unsupported regimen. |
| Toilet after meals; feet supported on step; praise sitting/trying regardless of stool passed | Combines the practical toileting routine with the required approach to encouragement. |
| Record bowel movements and accidents; review 19 November 2026; bring record | Connects home monitoring with the booked appointment and what the mother should bring. |
| Regular drinks; varied foods including fruit/vegetables; active play; explore toilet worries, including school | Provides useful supporting home advice and prompts discussion of toilet difficulties without assuming their cause. |
| Contact clinic earlier if worsening or difficulty following plan | Gives the mother an earlier route to help when the routine cannot be followed or symptoms worsen. |
| Swollen tummy with vomiting: urgent medical assessment; do not await review | Preserves the clinician’s explicit urgent-assessment instruction and distinguishes it from routine follow-up. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Enjoys drawing dinosaurs; collects toy cars | These interests do not help the mother understand constipation or carry out the prescribed home plan. |
| Mother complained about the reception queue | The service complaint has no role in explaining Rian’s condition or continuing care. |
| Private parental disagreement about money | This disclosure does not establish a cause or change the documented constipation advice. |
| Otitis media at age three; resolved | The resolved ear infection has no documented connection with the current explanation or management. |
| No vomiting or abdominal swelling today | This apparently useful negative is optional; the mother’s future urgent-assessment instruction deserves priority within the word limit. |
| Growth tracking consistently; generally well | Brief reassurance is possible, but these observations need not occupy space required for actionable home advice. |
A paragraph plan for this case
Place identifying details and the supplied postal address in the appropriate letter fields, then open with the 5 November review purpose and a plain-language explanation of involuntary overflow soiling. Follow with the toileting routine, praise, medicine boundaries and useful supporting advice; optional brief context includes three months of painful stools, six weeks of staining, school toilet postponement, discomfort relieved by passing stool and improvement potentially taking months. Close with the bowel record, booked review, earlier clinic contact and the specific urgent-assessment instruction.
Where candidates slip on this task
- Address the mother’s concern about deliberate misbehaviour by explaining involuntary leakage and avoiding blame; explore toilet worries without assuming why Rian postpones school toilet visits.
- Preserve all three prescribing boundaries: the paediatrician remains responsible, medicine questions go to the clinic, and this advice changes no instructions; invent no laxative regimen.
- Keep the 19 November 2026 review distinct from urgent assessment for a swollen tummy with vomiting; current absence of these symptoms must not dilute that warning.
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
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Your profession's guide: OET Medicine. Layout and structure: OET letter format.
Questions about this task
How much symptom history belongs in this advice letter?
The hard, painful stools for three months and underwear staining for six weeks can briefly support the explanation. School postponement and discomfort relieved by passing stool are optional context. The mother mainly needs the meaning of overflow soiling and the practical plan, so these details need not all appear.
Should the letter repeat or reconstruct the laxative instructions?
Do not reconstruct a regimen from the fact that counselling occurred. Retain the paediatrician’s prescribing responsibility, direct medicine questions to the clinic, and make clear that the letter changes no medicine instructions. The notes provide no drug name or dose.
Sources
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