The task
Assume that today's date is 22 October 2026. Ms Eze is being discharged home this afternoon.
You are a resident medical officer in the General Surgery Unit of the hospital where Ms Eze has been treated. Using the information in the case notes, write a letter to her GP, Dr Hieu Dang, informing him of her admission, the advice she has been given and the warning signs that need urgent review while she waits for surgery. Address the letter to Dr Hieu Dang, General Practitioner, Family Medical Practice, 42 High Street. 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: Discharge letter.
Case notes
Patient details
- Name: Ms Funmilayo Eze
- DOB: 03/05/1979 (47 yrs)
- Address: 8 Hillcrest Road
- Admitted: 17/10/26; discharge: 22/10/26
Social background
- Married, lives with husband and 2 children (14, 17)
- Primary school teacher; sings in church choir
- Alcohol: 4–6 standard drinks/wk (social); non-smoker
- Husband asked staff not to tell pt's mother about admission — 'she worries too much'
Medical history
- Hypothyroidism — levothyroxine 100 micrograms mane
- Obesity — BMI 32
- Intermittent RUQ pain after fatty meals × 6/12 — not investigated
- Appendicectomy aged 12
- Allergies: nil known
Admission
- Presented: severe epigastric pain radiating to back, vomiting × 12 hrs
- Lipase > 3 × ULN; ALT and bilirubin mildly ↑ on admission
- US abdomen: multiple gallstones; CBD not dilated
- Dx: mild acute gallstone pancreatitis — no organ failure, no local complications
- Mx: IV fluids, analgesia, antiemetic; oral diet recommenced day 2
Progress
- Pain-free since 20/10; tolerating low-fat diet
- LFTs within normal range 21/10
- Afebrile throughout; obs stable
- Complained ward meals cold and served too late
- Sister had cholecystectomy 2020 — 'no problems afterwards'
Discharge plan
- Elective laparoscopic cholecystectomy booked 05/11/26; pre-admission clinic 30/10
- Diet: low-fat diet until surgery; small, regular meals
- Avoid alcohol until after surgery
- Analgesia: paracetamol 1 g QID PRN
- Pt educated re warning signs: severe/persistent abdo pain, fever/rigors, jaundice, dark urine/pale stools, persistent vomiting → attend ED immediately
- GP: review 1/52; refer urgently to ED if any warning signs
- Written low-fat diet sheet given to pt
Who is reading, and what do they need?
Dr Dang is the patient's GP. He has not seen the admission details but will see her for review in a week. He needs the diagnosis, key results, progress, the surgery dates, the advice she has received and exactly which warning signs require urgent review. Detail should be summarised, not a day-by-day account.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Admitted 17/10/26 with severe epigastric pain radiating to back and vomiting for 12 hrs | Gives the GP the reason for admission and dates in a form that identifies the episode. |
| Intermittent RUQ pain after fatty meals for 6/12, not previously investigated | Explains the likely background to the gallstone disease and why surgery is planned. |
| Lipase >3 × ULN; ALT and bilirubin mildly raised; ultrasound: multiple gallstones, CBD not dilated | These findings support the diagnosis and the biliary cause; the GP needs them as the key results. |
| Mild acute gallstone pancreatitis, no organ failure, no local complications; IV fluids, analgesia, antiemetic | The final diagnosis, its severity and the treatment summarise the admission. |
| Pain-free since 20/10; LFTs normal 21/10; afebrile; low-fat diet tolerated | Shows she is stable and recovered at discharge, which is what the GP needs to know. |
| Laparoscopic cholecystectomy 05/11/26; pre-admission clinic 30/10 | The GP should know the definitive plan and both dates, since she is waiting for surgery. |
| Low-fat diet, small regular meals, no alcohol until surgery; paracetamol 1 g QID PRN; diet sheet | Records the advice and analgesia given so the GP can reinforce them at review. |
| Warning signs: severe/persistent pain, fever/rigors, jaundice, dark urine/pale stools, persistent vomiting; GP review 1/52 | The task asks for these. The complete list should be given with the instruction to attend ED immediately, and the GP's review and urgent-referral role should be stated. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Husband asked staff not to tell patient's mother about admission | A third party's request that is not the patient's and is irrelevant to the GP's care; it need not be recorded in this letter. |
| Complained ward meals cold and served too late | A service complaint, not part of clinical handover. |
| Sister's cholecystectomy in 2020, 'no problems afterwards' | Family anecdote that does not change her management. |
| Primary school teacher; church choir; married with two children | Social background not needed for this handover. |
| Appendicectomy aged 12; alcohol 4–6 drinks/wk | Looks relevant, but the appendicectomy is unrelated and alcohol only needs to appear through the advice to avoid alcohol until surgery. |
A paragraph plan for this case
Open with the admission dates, diagnosis and a short reason for the letter. Cover presentation, key results and progress in the middle paragraph, then the surgery plan, advice and analgesia. End with the full warning-sign list and the GP's requested actions.
Where candidates slip on this task
- List all the warning signs together: severe or persistent abdominal pain, fever or rigors, jaundice, dark urine or pale stools, and persistent vomiting, with immediate ED attendance. Do not shorten the list.
- Give both dates clearly: pre-admission clinic on 30/10 and surgery on 05/11/26. The GP review is within one week of discharge, so be accurate and do not invent other follow-up.
- Do not describe the unrelated social material or the husband's request regarding the patient's mother, and avoid any statement about medicines not given in the notes, such as changes to levothyroxine.
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
- Discharge to GP after pneumonia with new atrial fibrillation discharge letter
- Discharge to community nurse: cellulitis and leg wound care discharge letter
- Urgent referral to a gastroenterologist: iron-deficiency anaemia and rectal bleeding referral letter
Your profession's guide: OET Medicine. Layout and structure: OET letter format.
Questions about this task
Should alcohol history be included?
Only through the advice to avoid alcohol until after surgery. The weekly intake is not an established cause here, so avoid suggesting one. Stating the advice given is enough for the GP to reinforce it.
Why are the warning signs addressed in a letter to the GP?
The task asks for the signs needing urgent review while she waits for surgery. The GP should know what she has been told and that urgent referral to ED is expected if any appear, so the full list should appear in one place.
Sources
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