The task
Original independent practice. Findings, treatment dates and documented discharge arrangements are fictional case facts, not universal treatment instructions. Allow 45 minutes: 5 minutes for reading and 40 minutes for writing. Assume that today is 3 November 2026. Mr Matejka is returning to residential care today.
You are the doctor discharging Mr Norman Matejka from the medical ward. Using the case notes, write a discharge letter to Dr Alida Fiala, Care-Home General Practitioner, Residential Care Medical Service, 44 Clinic Road, SW1A 2AA, United Kingdom, explaining his recovery, completed treatment, current infection-control advice and follow-up for possible recurrence. 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.
Free · no sign-up · medicine
Which case notes belong in this letter?
Recovery from C. difficile infection: discharge
You are the doctor discharging Mr Norman Matejka from the medical ward. Using the case notes, write a discharge letter to Dr Alida Fiala, Care-Home General Practitioner, Residential Care Medical Service, 44 Clinic Road, SW1A 2AA, United Kingdom, explaining his recovery, completed treatment, current infection-control advice and follow-up for possible recurrence. 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 and background
- Name: Mr Norman Matejka
- DOB: 08/09/1944 (82 yrs)
- Residential care since 2024; returning today, 03/11/26
- GP already knows mild dementia and knee osteoarthritis
- Baseline: staff administer medicines and prompt fluids
- Walks with frame; normally one formed stool daily
- Remote cataract surgery; no ongoing eye symptoms
- Daughter blames kitchen staff for infection; allegation unsupported
Admission: 24 October 2026
- 24/10/26: admitted with watery stools approximately 6/day, cramps and poor intake
- Recent antibiotic course for cellulitis completed before admission; leg now healed
- Stool toxin positive for C. difficile; first documented episode
- Dehydrated on admission; received IV fluids
- 24/10 provisional instruction: isolate in room; meals alone; pending IPC review
Treatment and progress
- Oral vancomycin 24/10–02/11: 10-day course completed; all doses received
- IV fluids stopped 26/10; drinking with staff prompts
- 29/10: last unformed stool
- 30/10–03/11: one formed stool daily; usual bowel habit restored
- Appetite improving; no further nausea
- 03/11: afebrile; abdomen soft, non-tender
- Renal function returned to documented baseline
Current infection-control advice
- 02/11 IPC review: room isolation ended; initial room-only instruction superseded
- Ongoing care advice: soap-and-water handwashing for patient and staff
- Care home briefed on toilet/environmental cleaning
- No loperamide: advice documented for patient and care staff
Discharge plan: 3 November 2026
- Discharge today; no further antibiotics prescribed
- Staff to chart stools/intake, encourage fluids; GP review 06/11
- Recurrent diarrhoea → same-day GP assessment; stool sample if requested
- Marked deterioration, collapse or new confusion → emergency assessment
- Home confirms staff can monitor; daughter informed of discharge
Who is reading, and what do they need?
Dr Fiala already knows Mr Matejka's mild dementia and knee osteoarthritis and needs the hospital episode and actionable discharge changes. His return to residential care, usual staff-administered medicines, fluid prompting and baseline mobility provide context. Prioritise completed treatment, restored bowel habit, the latest infection-control decision and monitoring arrangements; familiar chronic diagnoses do not need a fresh history.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Stool toxin positive for C. difficile; first documented episode. | Identifies the treated infection and its documented episode status for future assessment of recurrence. |
| Oral vancomycin, 24 October–2 November: ten-day course completed; all doses received. | Makes treatment completion explicit and prevents an assumption that the care home must continue the course. |
| One formed stool daily, 30 October–3 November; last unformed stool 29 October. | Demonstrates restored usual bowel habit and gives a clear reference point for monitoring. |
| 2 November IPC review ended room isolation. | Communicates the current authoritative decision rather than the provisional admission restriction. |
| Soap-and-water handwashing; toilet/environmental cleaning; no loperamide. | Summarises the continuing patient-and-staff precautions and documented medication advice after isolation ended. |
| No further antibiotics; staff chart stools/intake, encourage fluids; GP review 6 November. | Defines the immediate care-home tasks and scheduled medical follow-up. |
| Recurrent diarrhoea: same-day GP assessment; stool sample if requested. | Provides the agreed response to possible recurrence without ordering an unconditional stool test. |
| Marked deterioration, collapse or new confusion: emergency assessment. | Preserves all documented emergency triggers rather than allowing staff to wait for routine follow-up. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Mild dementia and knee osteoarthritis already known to the GP. | A repeated chronic-disease history adds little for this established reader; functional care needs can be addressed directly. |
| Remote cataract surgery; no ongoing eye symptoms. | Resolved eye history does not affect this infection-related discharge. |
| Daughter blames kitchen staff; allegation unsupported. | An unsubstantiated attribution should not become a factual explanation of the infection. |
| 24 October provisional room isolation and meals alone, pending IPC review. | This superseded instruction must not be presented as current care-home advice. |
| Recent cellulitis antibiotics completed before admission; leg now healed. | Prior antibiotic exposure may be compressed as context, but healed cellulitis needs no separate follow-up narrative. |
| Daughter informed of discharge. | Completed family notification is secondary to the GP's treatment, monitoring and recurrence responsibilities. |
A paragraph plan for this case
Open with today's return to residential care after the first documented toxin-positive C. difficile episode and the completed vancomycin course. Summarise restored bowel habit and selected recovery evidence, compressing the admission stools, cramps and poor intake, dehydration, IV-fluid course, improving appetite, absence of further nausea, current examination and renal recovery as appropriate. Close with the latest IPC decision, continuing precautions and loperamide advice, the home's confirmed monitoring capacity, fluid support, dated GP review and both complete documented escalation pathways.
Where candidates slip on this task
- Use the 2 November IPC decision as the current instruction; do not carry forward the provisional room-only and meals-alone restrictions from admission on 24 October.
- State that all ten days of oral vancomycin ended on 2 November and no further antibiotics were prescribed; do not invent a dose or additional course.
- Distinguish the last unformed stool on 29 October from formed stools documented from 30 October; restored bowel habit supports discharge but does not guarantee against recurrence.
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 GP after gallstone pancreatitis discharge letter
- Discharge to community nurse: cellulitis and leg wound care discharge letter
Your profession's guide: OET Medicine. Layout and structure: OET letter format.
Questions about this task
Does ending room isolation mean all precautions should be removed?
No. The latest IPC review ended room isolation, but the notes retain soap-and-water handwashing for patient and staff, toilet and environmental cleaning, and advice against loperamide. Present the current combination rather than copying the superseded room-only instruction or implying that no further precautions apply.
Is the earlier dehydration treatment essential in full?
No. Admission dehydration and IV fluids can be compressed if they help explain the hospital course. Current drinking with staff prompts, restored bowel habit and the monitoring plan are more useful for ongoing care. Exact fluid-stop dates and every recovery observation need not be reproduced.
Sources
Last checked 22 Oct 2026. Rules and prices change: confirm on the official page before you book or apply.
OETAce is an independent practice site. OET is a registered trademark of Cambridge Boxhill Language Assessment (CBLA); we are not affiliated with or endorsed by CBLA. All practice material here is original.