The task
Assume that today's date is 5 November 2026. This is original independent practice material. All patient details and individual care arrangements are fictional.
You are Dr Olivia Ntim, a general practitioner. Using the case notes, write to Ms Afia Nkrumah, your patient's agreed adult daughter, explaining the uncertainty about his memory difficulties and the practical home support agreed today. Respect his preferences about sharing information. Address the letter to Ms Afia Nkrumah, 24 Station Road, SW1V 2AB, United Kingdom. Allow 5 minutes for reading and 40 minutes for writing. 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?
Mild cognitive impairment under investigation: advice
You are Dr Olivia Ntim, a general practitioner. Using the case notes, write to Ms Afia Nkrumah, your patient's agreed adult daughter, explaining the uncertainty about his memory difficulties and the practical home support agreed today. Respect his preferences about sharing information. Address the letter to Ms Afia Nkrumah, 24 Station Road, SW1V 2AB, United Kingdom. Allow 5 minutes for reading and 40 minutes for writing. 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
- Mr Danny Lavery; DOB 16/03/1954 (72 yrs)
- GP: Dr Olivia Ntim; consultation 05/11/26
- Daughter: Ms Afia Nkrumah, 42; attended with permission
- Daughter's address: 24 Station Road, SW1V 2AB, United Kingdom
Social background
- Lives alone; daughter nearby, visits weekly
- Independent washing, dressing, cooking and paying bills
- Retired printer; collects postcards
- Prefers paper reminders; dislikes smartphone applications
- Stopped driving voluntarily 5 yrs ago; uses buses
Medical history
- Remote appendicectomy; no current abdominal symptoms
- Complained receptionist sounded impatient during booking
- No regular medicines; medication review completed today
Assessment
- 6/12 gradual forgetfulness: misplaced keys, repeated questions
- Mild cognitive impairment; cause under investigation, dementia NOT diagnosed
- Brief cognitive assessment: memory difficulty; other abilities relatively preserved
- No sudden confusion, focal neurological symptoms or acute illness
- No reported wandering, cooking incidents or unpaid bills
- Blood investigations requested; results pending
- Memory clinic assessment booked 19/11/26
Information preferences
- Consent: tell daughter mild cognitive impairment, cause still under investigation, dementia NOT diagnosed; share support plan + assessment arrangements; detailed results to pt first, NOT authorised for daughter
- Ask pt before sharing letter with other relatives
- Understands options; wishes to retain decisions and independence
- Private dispute with son about inheritance; explicitly not for daughter
- Requested written explanation for daughter within agreed limits
Agreed support and plan
- Agreed: one appointments calendar + reminders notebook; daughter helps establish use
- Weekly visit: review appointments together, prepare shopping list; prompt, avoid taking over
- Pt welcomes daughter accompanying him to memory clinic
- GP review booked 03/12/26 to discuss assessment and support
- Contact surgery earlier if everyday functioning worsens
- Safety advice: sudden confusion → call 999; stay with him
Who is reading, and what do they need?
Afia Nkrumah attended Danny Lavery’s consultation with permission; he requested this written explanation within agreed limits. He expressly authorised disclosure of mild cognitive impairment, its unresolved cause and the absence of a dementia diagnosis, alongside the support plan and assessment arrangements. She needs plain language about uncertainty, her practical role and follow-up. Keep patient identifiers and Dr Ntim’s consultation details brief. His living arrangements and retained everyday independence can provide context, but detailed assessment results are not authorised for disclosure to her.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Mild cognitive impairment; cause under investigation; dementia not diagnosed. | He expressly authorised this broad explanation, which clarifies uncertainty without implying confirmed dementia. |
| Consent covers mild cognitive impairment, its unresolved cause, no dementia diagnosis, the support plan and assessment arrangements; detailed results to patient first, not authorised for daughter. | This defines what Afia may be told and distinguishes the permitted explanation from confidential detailed results. |
| One appointments calendar and reminders notebook; daughter helps establish use. | These are the concrete memory aids Afia has agreed to help introduce. |
| Weekly appointment review and shopping list; prompt without taking over. | This defines her practical contribution while preserving her father’s control over everyday tasks. |
| GP review 3 December 2026; earlier surgery contact if everyday functioning worsens. | The booked review provides continuity; the earlier-contact option usefully distinguishes functional concerns from the emergency instruction. |
| Sudden confusion: call 999 and stay with him. | Both recorded actions are essential so Afia can respond to an acute change. |
| Blood results pending; memory clinic 19 November; daughter welcome to accompany him. | These useful process details explain the next assessment step and her permitted involvement without disclosing detailed findings. |
| Retains decisions and independence; ask him before sharing the letter with other relatives. | These preferences guide how Afia provides support and handles any further family disclosure. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Retired printer, postcard collector; stopped driving voluntarily five years ago and uses buses. | These established lifestyle details do not change the agreed support; the driving history does not justify a new restriction. |
| Remote appendicectomy; no current abdominal symptoms. | This resolved surgical history does not help Afia understand the memory investigation or implement home support. |
| Receptionist sounded impatient during booking. | The booking complaint has no bearing on the requested explanation or her practical responsibilities. |
| Private inheritance dispute with son; explicitly not for daughter. | Disclosure would directly breach his express confidentiality instruction. |
| Brief cognitive assessment: memory difficulty; other abilities relatively preserved. | These are detailed assessment findings whose disclosure is not authorised; use the expressly permitted broad explanation instead. |
| No regular medicines; medication review completed today. | Routine medication-review detail adds little to this family advice letter and does not explain the unresolved cause. |
A paragraph plan for this case
Use the supplied recipient address, then organise the opening around the authorised explanation, diagnostic uncertainty and useful pending-investigation or clinic details. In the middle paragraph, prioritise the calendar, notebook and weekly help; optional context includes six months of gradual forgetfulness, living arrangements, everyday independence, paper preferences, no sudden confusion, focal neurological symptoms or acute illness, and no reported wandering, cooking incidents or unpaid bills. Close with the December review, optional earlier contact for declining everyday function, both recorded sudden-confusion actions and the limits on further family sharing.
Where candidates slip on this task
- Do not relabel mild cognitive impairment as dementia or imply that pending blood tests establish a cause; the letter must explain that investigation remains incomplete.
- His consent expressly covers mild cognitive impairment, its unresolved cause and no dementia diagnosis, plus support and assessment arrangements. Detailed cognitive results go to Mr Lavery first and are not authorised for disclosure to Afia; exclude the inheritance dispute entirely and seek permission before wider sharing.
- Retain both actions for sudden confusion: calling 999 and staying with him. This UK case requires its recorded emergency number; distinguish sudden confusion from non-emergency deterioration in everyday functioning.
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
Must every reassuring negative or historical detail appear?
No. The absence of sudden confusion, focal neurological symptoms or acute illness, and the absence of reported wandering, cooking incidents or unpaid bills, may provide context. They need not all appear if the uncertainty and support plan remain clear. None establishes that living alone is risk-free.
How much may Afia be told about the assessment?
Her father expressly agreed that she may be told he has mild cognitive impairment, its cause remains under investigation and dementia has not been diagnosed. She may also receive the support plan and assessment arrangements. Detailed results go to her father first and are not authorised for disclosure to her. Exclude his inheritance dispute, and ask him before wider sharing.
Sources
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