The task
Original independent practice. Assume that today is 6 November 2026. Mr Hamisi Wangare is being discharged home today. Patient details, clinical events and individual device-team arrangements are fictional case facts. Allow 45 minutes: 5 minutes for reading and 40 minutes for writing.
You are the doctor discharging Mr Hamisi Wangare from the cardiology ward. Using the case notes, write to his agreed brother, Mr Njagi Abdinoor, explaining how to support his recovery at home, the device team's temporary activity restrictions, warning signs and follow-up arrangements. Address the letter to Mr Njagi Abdinoor, Flat 2, 24 Willow Road, SW1V 2AB, 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?
Pacemaker implantation: advice
You are the doctor discharging Mr Hamisi Wangare from the cardiology ward. Using the case notes, write to his agreed brother, Mr Njagi Abdinoor, explaining how to support his recovery at home, the device team's temporary activity restrictions, warning signs and follow-up arrangements. Address the letter to Mr Njagi Abdinoor, Flat 2, 24 Willow Road, SW1V 2AB, 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: Mr Hamisi Wangare
- DOB: 12/04/1958 (68 yrs)
- Discharge home: 06/11/26
- Agreed support contact: brother, Mr Njagi Abdinoor
Social background
- Patient consents to written advice being shared with brother
- Lives alone; brother staying for first week
- Regular swimmer; asks when swimming can restart
- Brother believes pacemaker means permanent ban on exercise
- Brother disclosed private disagreement about another relative's inheritance
Medical history
- Symptomatic heart block; recurrent dizziness before admission
- Hypertension; established treatment unchanged
- Appendicectomy 1996; uncomplicated
- Does not drive; usually travels by bus
Treatment/Progress
- Admission MRSA screen: negative
- 05/11: pacemaker implanted beneath skin, L upper chest
- 06/11: device check satisfactory; discharge approved
- Wound clean, dry; dressing intact
- Walking independently; no further dizziness
- Mild local soreness; otherwise comfortable
Plan
- Device team: keep wound clean
- Individual team instruction: no heavy lifting, vigorous exercise or L elbow above shoulder height for 6/52 after implantation
- Team: gentle arm movements encouraged; restrictions temporary; discuss swimming at review
- Brother to help with shopping, heavy chores and appointment transport
- Safety advice: increasing wound redness/swelling/pain, leakage, feverishness/shivering → pacemaker clinic or NHS 111 same day
- Safety advice: previous dizziness returns → contact clinic or NHS 111 promptly
- Emergency advice: severe breathing difficulty, tight/heavy chest or sudden confusion → call 999 immediately
- Booked device review: pacemaker clinic, 17/12/26, 10:00; check device and review activities
- Pacemaker ID card issued; carry and show healthcare professionals before treatment
- Clinic contact details given to patient and brother
- Brother requests plain written instructions; unfamiliar with medical terminology
Who is reading, and what do they need?
Mr Njagi Abdinoor is Mr Hamisi Wangare’s brother and agreed support contact, with consent to receive written advice. The patient’s name can identify whose recovery the letter concerns, without repeated naming in the body. He will stay for the first week, fears a permanent exercise ban, and requests plain language. He needs practical home-care instructions, clear escalation routes and the booked review details; swimming questions need an explicit link to that review.
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 2026: pacemaker implanted beneath skin of left upper chest. | Anchors the advice to the recent procedure and identifies the side affected by the team’s movement restriction. |
| For six weeks following implantation, follow his device team's instruction: no heavy lifting, vigorous exercise or raising the left elbow above shoulder height. | Defines the team’s individual limits and duration so the brother can support recovery without imposing a permanent exercise ban. |
| Gentle arm movements encouraged; restrictions temporary; discuss swimming at review. | Prevents unnecessary immobility and addresses the exercise concern without inventing clearance to resume swimming. |
| Increasing wound redness/swelling/pain, leakage, feverishness/shivering: pacemaker clinic or NHS 111 same day. | Makes potential wound complications actionable at the specified urgency; retain every listed sign. |
| Previous dizziness returns: contact clinic or NHS 111 promptly. | Distinguishes recurrence of the presenting symptom from the separate emergency pathway. |
| Severe breathing difficulty, tight/heavy chest or sudden confusion: call 999 immediately. | Identifies the specified symptoms requiring immediate emergency help rather than routine clinic contact. |
| Pacemaker clinic: 17 December 2026, 10:00; device check and activity review. | Provides an actionable appointment and connects the swimming question to the planned assessment. |
| Keep wound clean; brother helps with shopping, heavy chores and appointment transport. | Offers useful practical guidance for the brother’s support role; these details can be compressed if space is limited. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Admission MRSA screen: negative. | This routine admission result gives the brother no home-care action and does not rule out later wound complications. |
| Private disagreement about another relative’s inheritance. | This private family disclosure has no stated connection to the requested recovery advice. |
| Uncomplicated appendicectomy in 1996. | The remote operation does not affect the recorded pacemaker restrictions or follow-up arrangements. |
| Hypertension; established treatment unchanged. | Although medical, this unchanged background condition adds no specific action for the brother in this task. |
| Does not drive; usually travels by bus. | Driving advice may look relevant after implantation, but he does not drive; appointment transport can be addressed directly. |
| Date of birth and age. | Detailed demographic identification is optional when writing to his agreed brother and should not displace practical advice. |
A paragraph plan for this case
Open with the discharge purpose and implantation details; heart block and a brief recovery update are optional context, covering the satisfactory check, clean and dry wound with intact dressing, independent walking without further dizziness, and mild local soreness only as space permits. Group wound care, practical support and temporary activity guidance next, followed by all three warning-sign pathways together with their respective urgency and contact routes. Close with the booked device and activity review; carrying the issued pacemaker ID card and showing healthcare professionals before treatment is an optional brief reminder.
Where candidates slip on this task
- Count the six weeks from implantation on 5 November, not discharge on 6 November; the 17 December review coincides with six weeks but does not automatically authorise swimming.
- Keep every wound warning and all three emergency symptoms, preserving same-day, prompt and immediate escalation; retain the UK numbers supplied for this UK discharge scenario.
- Avoid inventing medicines, dressing schedules, exercise clearance or clinic telephone numbers; contact details were already supplied, and the brother’s exercise misconception calls for reassurance about temporary restrictions.
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 discharge finding be included?
No. The satisfactory device check and brief recovery findings can provide context, but the brother chiefly needs usable instructions. Select or compress these observations according to space, without treating them as proof that complications cannot occur or allowing them to displace warning signs.
How should the swimming question and warning signs be handled?
Treat swimming as a question for the booked review, rather than a permitted activity after a calculated date. Keep all the listed criteria within each of the three escalation groups, paired with its recorded urgency and contact route. Preserve the supplied UK numbers for this UK case.
Sources
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