The task
Assume that today's date is 5 November 2026. This is original independent practice material. All patient details, appointments and individual care arrangements are fictional.
You are Dr Etha Sykes, a doctor in the neurology outpatient service. Using the case notes, write to Mr Justin Gathoni, the patient's spouse, with her consent. Explain their agreed practical fatigue-support plan, address his concerns about future disability and clarify contact arrangements. Address the letter to Mr Justin Gathoni, Flat 2, 14 Willow Road, SW1V 2QP, United Kingdom. Allow 45 minutes: 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?
Multiple sclerosis: advice
You are Dr Etha Sykes, a doctor in the neurology outpatient service. Using the case notes, write to Mr Justin Gathoni, the patient's spouse, with her consent. Explain their agreed practical fatigue-support plan, address his concerns about future disability and clarify contact arrangements. Address the letter to Mr Justin Gathoni, Flat 2, 14 Willow Road, SW1V 2QP, United Kingdom. Allow 45 minutes: 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
- Patient: Ms Saumu Gedi
- DOB: 18/04/1988 (38 yrs)
- Address: Flat 2, 14 Willow Road, SW1V 2QP, United Kingdom
- Spouse: Mr Justin Gathoni; same address
- 05/11/26: patient consents to spouse receiving this advice
Social background
- Lives with spouse; works part-time in payroll
- Independent personal care; wishes to retain household decisions
- Spouse available evenings; can manage heavier chores
- Enjoys collecting postcards
- Spouse complained receptionist sounded unfriendly
- Private disagreement with brother over borrowed money
Medical history
- 29/10/26: neurologist confirmed multiple sclerosis after investigations
- Previous sensory episode improved; walking independently
- Fatigue 3/12; afternoon exhaustion limits cooking/housework
- Sister has MS, uses wheelchair; spouse fears identical course
- Explain: individual course unpredictable; no fixed timetable for disability
- Appendicectomy aged 17; uncomplicated
Assessment/visit notes
- 05/11: no new neurological symptoms or infection symptoms
- Patient wants help conserving energy without spouse taking over
Agreed individual fatigue-support plan
- Patient chooses priorities; divide tasks; planned breaks before exhaustion
- Spouse agrees shopping/vacuuming; ask before helping with other tasks
- Continue comfortable walks; adjust activity to energy
- Occupational therapy booked 12/11: practical fatigue strategies
- Keep brief activity/fatigue diary for review
Contact and follow-up plan
- Fatigue advice: MS nurse via neurology reception weekdays; GP if unavailable
- Other new/worsening symptoms or marked ↑ fatigue → prompt nurse/GP advice; not automatically MS; emergency signs below → 999
- Sudden weakness, numbness in 1 arm, vision loss/blurring or balance/coordination problems → call 999 immediately; possible stroke; do not await clinic
- Neurology review 19/11; discuss treatment options
- Bring questions about treatment/future support
- Spouse welcome at review with patient's agreement
Who is reading, and what do they need?
The reader is Ms Gedi’s spouse, receiving advice with her consent. He needs practical help with afternoon exhaustion and a response to fears prompted by her sister’s wheelchair use. A brief diagnosis reference can orient him; independent walking, personal care and part-time payroll work provide optional context. Use plain language, prioritising her control over tasks, agreed help and clearly separated contact routes.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| 5 November: patient consents to her spouse receiving this advice. | Permission is already established in the case notes and task; a brief acknowledgement is optional in the letter. |
| Sister uses wheelchair; individual MS course unpredictable, with no fixed disability timetable. | Addresses his specific fear without treating a relative’s experience as a prediction or promising freedom from disability. |
| Patient chooses priorities; divide tasks; planned breaks before exhaustion. | Makes energy conservation practical while preserving the patient’s authority over household decisions. |
| Spouse agrees shopping/vacuuming; ask before other help; available evenings for heavier chores. | Defines the agreed contribution and boundaries, reducing ambiguity about how he should help. |
| Fatigue advice: MS nurse through neurology reception weekdays; GP if unavailable. | Provides an actionable routine contact route and its fallback. |
| Other new/worsening symptoms or markedly increased fatigue: prompt nurse/GP advice; not automatically MS. Emergency signs require 999. | Gives a prompt assessment route for other changes without diverting possible stroke symptoms to the nurse or GP. |
| Sudden weakness, numbness in one arm, lost or blurred vision, or balance or coordination problems: call 999 immediately; do not await clinic. | These may indicate a stroke; any one requires immediate emergency help in this UK case. |
| OT 12 November; activity/fatigue diary; neurology review 19 November to discuss treatment options. | Connects home support with practical professional input and the next opportunity to review management. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Enjoys collecting postcards. | This hobby does not inform the agreed fatigue measures or the spouse’s questions. |
| Spouse complained receptionist sounded unfriendly. | The complaint does not change the contact arrangements and would distract from clear access instructions. |
| Private disagreement with brother over borrowed money. | This private family matter has no stated connection to fatigue support or future care. |
| Uncomplicated appendicectomy aged 17. | Remote, resolved surgery does not help the spouse implement the current plan. |
| 5 November: no new neurological symptoms or infection symptoms. | This relevant assessment detail can be omitted or compressed; recognising future changes matters more for this reader. |
| DOB 18 April 1988; age 38. | These demographics add little to spouse-facing advice once the patient is identified. |
A paragraph plan for this case
Use the supplied spouse name and shared address in the heading; open with brief patient identification and the advice purpose, optionally acknowledging her consent, then address the disability concern. Group patient-led task sharing and practical fatigue measures together, explicitly retaining the agreement to ask before other help. Comfortable walks, activity adjustment, the diary and occupational therapy are optional additions. Close with distinct routine, prompt and emergency contact routes; make clear that sudden neurological warning signs require 999 immediately. Review details, treatment/future-support questions and spouse attendance subject to the patient’s agreement may follow.
Where candidates slip on this task
- Do not turn the sister’s wheelchair use into a forecast for Ms Gedi, or use current independent walking to promise that future disability will not occur.
- Keep the weekday MS nurse route through neurology reception and the GP fallback together. Prompt nurse/GP advice applies to other new or worsening symptoms or markedly increased fatigue, excluding the emergency signs.
- Preserve the UK emergency instruction: sudden weakness, numbness in one arm, lost or blurred vision, or balance or coordination problems require 999 immediately without awaiting clinic; do not substitute 000 or route these through reception.
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 Medicine letter tasks
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Your profession's guide: OET Medicine. Layout and structure: OET letter format.
Questions about this task
Must the letter mention her sister’s wheelchair use?
It can briefly explain the spouse’s concern, but repeating that family detail is optional if the response clearly addresses his fear. The important message is the unpredictable individual course and absence of a fixed disability timetable, without predicting either disability or continued independence.
How much follow-up detail belongs in this advice letter?
The occupational therapy appointment, diary and neurology review help connect the home plan with further support, but each is optional if space is tight. Contact instructions take precedence. If spouse attendance is mentioned, retain the condition that Ms Gedi agrees.
Sources
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