The task
Assume that today's date is 21 October 2026. Mrs Fairbairn is being discharged home today.
Using the information in the case notes, write a letter to Mrs Fairbairn's GP, Dr Michael Osei, informing him of her admission and discharge and outlining the follow-up required. Address the letter to Dr Michael Osei, Elmhurst Medical Centre, 8 Elm Avenue, Elmhurst. 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: Mrs Gwen Fairbairn
- DOB: 02/06/1954 (72 yrs)
- Admitted: 14/10/26 via ED — Eastvale General Hospital
- Discharged: 21/10/26
Social background
- Widow; retired librarian; volunteers at charity shop 2 days/wk
- Lives alone, two-storey townhouse; daughter (Fiona) staying with her for 1 wk after discharge
- Non-smoker; alcohol 1–2 glasses wine/wk
- Has a cat — neighbour feeding it during admission
Medical history
- Known to GP: hypertension (since 2009); hypothyroidism (since 2016)
- Pre-admission medications: amlodipine 5 mg daily; levothyroxine 75 mcg daily
- Bilateral cataract surgery 2021
- Osteoporosis — denosumab 6-monthly (next dose due Feb 2027)
- Allergies: nil known
- Vaccinations: no influenza vaccine this year; pneumococcal status unknown
Admission
- 3/7 productive cough, fever 38.6°C, SOB
- SpO2 90% on room air; RR 24
- CXR: right lower lobe consolidation; CRP 186 mg/L
- ECG: atrial fibrillation, ventricular rate 128 — new diagnosis
Progress
- IV ceftriaxone + oral azithromycin 3 days → oral amoxicillin; 7-day course completed 20/10
- O2 weaned day 3; afebrile since 17/10
- Night 2: mild confusion, resolved by day 3
- Metoprolol 25 mg BD commenced 15/10; HR now 72–80, remains in AF
- Amlodipine ceased 17/10 (BP 104/62 on metoprolol); BP now 118/70
- Stroke risk: CHA2DS2-VA score 2; apixaban 5 mg BD commenced 16/10 (wt 64 kg, creatinine 82 µmol/L)
- Echocardiogram: normal LV function, mild left atrial dilatation; TSH normal
- Pt dissatisfied with hospital food and noise on ward; wishes to make a complaint
Discharge plan
- GP review within 1 wk: HR, BP, symptoms
- Repeat U&E and FBC in 1 wk (apixaban)
- Offer influenza and pneumococcal vaccination
- Repeat CXR in 6/52 to confirm resolution
- Cardiology outpatient clinic 2/12 (appointment letter sent) — consider rhythm control
- Physiotherapy: independent with stairs; no follow-up needed
- Daughter suggests pt sell townhouse and move in with her — pt undecided
Who is reading, and what do they need?
Dr Osei is the GP who already knows her hypertension and hypothyroidism. He needs the diagnoses, the changes to her medicines, the tests and checks he must organise and what other services will follow up. The inpatient narrative can be short, and tasks should be easy to find.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| RLL consolidation on CXR; CRP 186; SpO2 90% on room air | Supports the pneumonia diagnosis and its severity. Keep the admission picture brief. |
| Antibiotics: IV ceftriaxone + azithromycin 3 days, then amoxicillin; completed 20/10 | Shows treatment is finished, so the GP knows no antibiotics continue. |
| New AF, ventricular rate 128 on ECG | A new diagnosis that the GP did not know about. Include the rate at presentation. |
| Metoprolol 25 mg BD from 15/10; HR 72–80, remains in AF | A new medicine and the current status. The letter should not imply that sinus rhythm was restored. |
| Amlodipine ceased 17/10 (BP 104/62); BP now 118/70 | A stopped regular medicine with the reason. The GP must know to adjust his records. |
| Apixaban 5 mg BD from 16/10; CHA2DS2-VA 2; wt 64 kg, creatinine 82 | A new anticoagulant with its rationale and the values relevant to dosing. This explains the U&E and FBC repeat. |
| Echo normal LV function, mild LA dilatation; TSH normal | Results of the AF work-up the GP would otherwise have to chase. |
| GP review 1 wk; U&E, FBC; vaccinations; CXR 6/52; cardiology 2/12 | These are the follow-up actions requested by the task. Include influenza and pneumococcal vaccination, and note cardiology will consider rhythm control. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Dissatisfied with food and noise; wishes to make a complaint | A complaint, which belongs in a separate process and not in a clinical letter. |
| Daughter suggests selling townhouse; patient undecided | A personal decision not yet made, with no clinical action for the GP. |
| Cat fed by neighbour; volunteers at charity shop | Social detail irrelevant to the follow-up needed. |
| Night 2 mild confusion, resolved by day 3 | A resolved inpatient event. It can be omitted or reduced to a few words. |
| Cataract surgery 2021; denosumab due Feb 2027; physiotherapy no follow-up | Trap: the denosumab date looks like a task, but it is unrelated to this admission. Physiotherapy needs no action. |
A paragraph plan for this case
Open with the admission and discharge dates and the two diagnoses. Then summarise treatment and progress, giving the changes to her medicines in one place. Close with the follow-up the GP must arrange and what the cardiology clinic will do, noting the appointment letter has been sent.
Where candidates slip on this task
- Make the medicine changes unmistakable: metoprolol and apixaban started, amlodipine stopped with the reason. The GP's record lists amlodipine and levothyroxine, so do not imply any other change.
- Discharge is 21/10 and her GP review is within 1 week with U&E and FBC. The CXR is at 6/52 and cardiology at 2/12, so keep the timeframes separate.
- Do not say the AF has resolved or that rhythm control has been decided. She remains in AF on rate control, and cardiology will consider rhythm control.
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
Should the daughter's staying be mentioned?
Optional and brief. It shows she has short-term support after discharge, but it is not an action for the GP. The townhouse discussion should be left out.
Why include creatinine and weight?
They are the values recorded when apixaban was started and explain why renal function and FBC are rechecked at 1 week. Give them briefly and avoid extra comment on dosing.
Sources
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