The task
Original independent practice. Findings, measurements and agreed care 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. Dr Wattoo has read your 20 October referral, including the background, initial findings and management. Following today's telephone discussion, Ms Kenny will attend the specialist service today. Dr Wattoo requests a brief written update on the deterioration and interim care arrangements.
You are Ms Latoria Kenny's general practitioner. Using the case notes, write a referral update to Dr Farah Wattoo, Adolescent Physician, Specialist Eating-Disorder Service, 42 Clinic Road, SW1A 2AA, United Kingdom, for the same-day assessment agreed by telephone. Explain the deterioration since the original referral, current risks and interim supervision arrangements. Dr Wattoo already has the initial referral, so its background details need not be repeated. 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: Referral letter.
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Which case notes belong in this letter?
Adolescent restrictive eating: referral
You are Ms Latoria Kenny's general practitioner. Using the case notes, write a referral update to Dr Farah Wattoo, Adolescent Physician, Specialist Eating-Disorder Service, 42 Clinic Road, SW1A 2AA, United Kingdom, for the same-day assessment agreed by telephone. Explain the deterioration since the original referral, current risks and interim supervision arrangements. Dr Wattoo already has the initial referral, so its background details need not be repeated. 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 social background
- Name: Ms Latoria Kenny
- DOB: 12/04/2010 (16 yrs)
- Lives with mother; mother able to stay off work today to support care
- Year 11; examinations later this month; worried about missing school
Medical background
- Previous anxiety; attended school counselling last year
- No previous eating-disorder treatment
- Childhood eczema; inactive for several years
- Mother disclosed sister's examination failure; asks that this remain private
Initial review: 20 October 2026
- 20/10/26: 3/12 skipping breakfast/lunch; fears gaining weight
- Exercising daily; distressed when asked to eat more
- Weight 63 kg; height 1.65 m
- Pulse 76/min; BP 112/72 mmHg
- Immediate eating-disorder referral sent; mother supporting meals pending assessment; 03/11: Dr Wattoo confirms referral read, including background, initial findings and management
- Advised to stop exercise; early GP review arranged
Current review: 3 November 2026
- 03/11/26: weight 60 kg (↓3 kg since 20/10); BMI 22.0 kg/m²
- Pulse 64/min; BP 108/70 mmHg; temperature 36.5°C
- Dizzy on standing; no collapse or chest pain
- Supper supervised; still skips school lunch and exercises privately
- Anxiety ↑; withdrawing from friends
- Private interview: denies self-harm or suicidal thoughts
- School bus pass due for renewal next month
- Enjoys drawing; prefers pencil sketches
- Today's electrolytes within laboratory reference ranges; ECG sinus rhythm
- Restrictive eating suspected; continuing weight loss and symptoms concerning
Agreed plan
- Telephone discussion: service agrees same-day medical and mental-health assessment
- Agrees to attend and share care plan with mother
- Mother to accompany, supervise meals/fluids and remain until clinical handover
- No exercise pending specialist assessment; agreed with patient
- Safety advice: collapse/chest pain/acute confusion → ambulance; unable to maintain fluids → urgent medical assessment
Who is reading, and what do they need?
Dr Wattoo has read the initial referral and agreed by telephone to assess Ms Kenny, aged 16, today. She needs an update on deterioration and the practical arrangements through clinical handover. Current weight change, observations, dizziness and continuing restriction/exercise deserve priority. Selected current mental-health or investigation findings may support the update; repeating the earlier consultation is unnecessary.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Telephone agreement for same-day medical and mental-health assessment. | Establishes the agreed urgency and both components of the receiving service's assessment. |
| Weight 60 kg, down 3 kg since 20 October; BMI 22.0 kg/m². | Quantifies recent weight loss without letting the current BMI obscure the concerning trajectory. |
| Pulse 64/min; BP 108/70 mmHg; temperature 36.5°C. | Current pulse and blood pressure help the service assess her physical condition; temperature can be omitted. |
| Dizzy on standing; no collapse or chest pain. | Communicates the current symptom without diagnosing an unmeasured postural blood-pressure change; the negative symptoms can be compressed. |
| Supper supervised; still skips school lunch and exercises privately. | Shows that restriction and exercise continue despite existing meal support and previous advice. |
| Increased anxiety and social withdrawal. | Offers useful current psychological context for the combined assessment when space permits. |
| Agreed attendance; mother accompanies, supervises meals/fluids until handover; no exercise pending assessment. | Maternal supervision through handover is central to the interim plan; attendance agreement and exercise advice add useful context. |
| Collapse/chest pain/acute confusion: ambulance; unable to maintain fluids: urgent medical assessment. | Communicates the mother's emergency-call instructions and the separate need for urgent review if Ms Kenny cannot maintain fluids before handover. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Childhood eczema; inactive for several years. | Resolved eczema does not affect the requested eating-disorder assessment. |
| Mother's disclosure about the sister's examination failure; request for privacy. | This confidential third-party information has no stated necessity for the patient's immediate care. |
| Year 11 examinations later this month; worried about missing school. | A brief mention may support engagement, but examination logistics need not appear in this focused update. |
| Previous anxiety; school counselling last year. | Dr Wattoo already has this background; today's psychological changes provide more useful new information. |
| Initial pulse 76/min and BP 112/72 mmHg. | These observations are in the referral Dr Wattoo has read; today's measurements are the useful update. |
| Height 1.65 m recorded at the initial review. | Height need not be repeated when current weight change and recorded BMI provide the selected anthropometric context. |
| School bus pass due for renewal next month. | A future administrative renewal does not affect today's assessment or accompaniment arrangements. |
| Enjoys drawing; prefers pencil sketches. | No connection is documented between this preference and today's clinical handover. |
A paragraph plan for this case
Open with the telephone-agreed same-day medical and mental-health assessment. Update Dr Wattoo on the recent weight loss, current observations and dizziness, and continuing restriction/exercise despite meal support. Add selected current psychological or investigation findings if useful; the initial referral already supplies the background. Close with agreed attendance, maternal supervision through clinical handover, and the complete documented escalation instructions. Care-plan sharing and the current exercise restriction can be included briefly.
Where candidates slip on this task
- Present the 3 kg loss over the fourteen days from 20 October to 3 November; the existing referral does not replace today's telephone-agreed same-day assessment.
- Do not treat BMI 22.0, reference-range electrolytes, sinus rhythm, or denials of self-harm and suicidal thoughts as proof of low risk or absence of illness.
- Keep interim supervision and the complete documented escalation instructions together; maternal support lasts until clinical handover, and the exercise restriction applies pending specialist assessment.
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 BMI 22.0 make this a routine referral?
No. The notes document recent weight loss, dizziness and continuing meal skipping and exercise, and the service has already agreed to assess her today. Present that agreed urgency alongside the current findings. Neither BMI nor the reported investigation results establishes that the situation is low risk.
Must I repeat the initial referral or include every current finding?
No. Dr Wattoo has read the initial referral, so concentrate on what has changed and today's care arrangements. Anxiety, the private interview and investigation results are useful supporting choices. Prioritise recent weight loss, current pulse/BP and dizziness, continuing restriction/exercise, same-day assessment, maternal supervision and the documented emergency instructions. Exclude the sister's confidential information.
Sources
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