The task
Assume that today's date is 5 November 2026. Ms Bernhard has attended your general practice for review. This is an original independent practice task. Allow 45 minutes: 5 minutes for reading and 40 minutes for writing.
You are Ms Bernhard's general practitioner. Using the case notes, write a referral to Dr Camilo Schulist, Occupational Physician, Workplace Health Service, 24 Station Road, NSW 2000, Australia. Request assessment of her specific work tasks and recommendations for suitable adjustments, observing the limits of her consent. 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?
Carpal tunnel syndrome affecting work: referral
You are Ms Bernhard's general practitioner. Using the case notes, write a referral to Dr Camilo Schulist, Occupational Physician, Workplace Health Service, 24 Station Road, NSW 2000, Australia. Request assessment of her specific work tasks and recommendations for suitable adjustments, observing the limits of her consent. 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: Ms Mistie Bernhard
- DOB: 12/08/1982; 44 yrs
- Right-handed
Social and occupational background
- Electrical-component assembler, same employer 8 yrs
- Full-time; weekday shifts
- Hand-crimping tool: repeated wrist bending + forceful gripping
- Other task: handheld barcode scanning of stock
- No recent change in duties; workplace causation not established
- Wants to remain working with suitable adjustments
- Enjoys cinema visits
Medical history
- Appendicectomy aged 17; uncomplicated
- Confidential history: termination of pregnancy 2015; unrelated to referral
- Private dispute with sister over inheritance; requests confidentiality
- Regular medication: nil
- No known diabetes, thyroid disease or previous wrist injury
Assessment and progress
- 08/10/26: first consultation; symptoms for 2/12
- Intermittent tingling R thumb, index and middle fingers
- Worse nocte and during crimping; persists today
- Numbness interrupts assembly; dropped components twice, no injury
- No constant numbness, neck pain or L-hand symptoms
- Today: thumb strength preserved; no thenar wasting
- No nerve conduction studies performed
- Clinical diagnosis: R carpal tunnel syndrome
- Neutral wrist splint nocte since 08/10; used consistently
- Night symptoms ↓; work symptoms remain troublesome
Plan and consent
- GP advice: temporarily avoid forceful gripping/repetitive wrist bending pending assessment
- GP review 19/11; earlier if numbness worsens or weakness develops
- Consents to referral and relevant hand/work information reaching occupational physician
- Request crimping/scanning assessment; advise temporary duties, equipment adjustments, breaks
- Employer report: discuss with patient; obtain separate consent before sending
Who is reading, and what do they need?
Dr Schulist is the occupational physician assessing Ms Bernhard, a 44-year-old electrical-component assembler with eight years at the same employer. He needs sufficient hand-function and task detail to recommend adjustments supporting her wish to remain working. Keep routine identifiers brief, and distinguish consent to this referral from the separate permission needed before sending an employer report.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Clinical diagnosis: right carpal tunnel syndrome. | Identifies the clinical problem prompting occupational assessment without implying investigation-confirmed disease. |
| Hand-crimping involves repeated wrist bending and forceful gripping. | Defines the specific physical demands the occupational physician must evaluate when recommending adjustments. |
| Numbness interrupts assembly; dropped components twice, without injury. | Demonstrates actual functional disruption and a handling concern relevant to suitable duties. |
| Consistent night splint use since 8 October; night symptoms reduced, work symptoms remain troublesome. | Shows the response to current management and explains why workplace assessment remains useful. |
| Temporarily avoid forceful gripping and repetitive wrist bending pending assessment. | Communicates the interim restrictions that must inform recommendations for work. |
| Assess crimping and barcode scanning; recommend temporary duties, equipment adjustments and breaks. | Makes the requested assessment and practical outputs explicit. |
| Consent covers referral and relevant hand/work information reaching the occupational physician. | Defines the authorised scope of disclosure to this reader. |
| Discuss any employer report with the patient; obtain separate consent before sending. | Prevents referral consent from being treated as permission for onward disclosure. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Enjoys cinema visits. | Adds no information needed to assess assembly tasks or recommend work adjustments. |
| Uncomplicated appendicectomy aged 17. | The remote resolved surgery does not inform the current hand-function assessment. |
| Confidential termination of pregnancy in 2015; unrelated to referral. | Disclosure would exceed the relevant hand/work information authorised for this referral. |
| Private inheritance dispute with sister; requests confidentiality. | The family dispute is outside the occupational assessment and has an explicit confidentiality request. |
| No known diabetes, thyroid disease or previous wrist injury. | These potentially relevant diagnostic negatives are optional because the immediate request concerns task demands and adjustments. |
| No regular medication. | This single brief fact may be included as written, compressed or omitted; no medication-related work issue is identified. |
A paragraph plan for this case
Open with the assessment request and clinical diagnosis, keeping identification, right-handedness and the full-time weekday schedule brief if used. Group crimping and scanning demands, assembly disruption, intermittent right thumb/index/middle-finger tingling, symptoms worse at night and during crimping, and splint response; optionally compress the absence of constant numbness, neck pain and left-hand symptoms. End with interim restrictions, requested adjustments, relevant follow-up if included, and the two distinct consent boundaries.
Where candidates slip on this task
- Do not turn symptoms during crimping into proven workplace causation: duties are unchanged and causation is unestablished; describe carpal tunnel syndrome as a clinical diagnosis, with no nerve conduction studies performed.
- Keep chronology precise: the initial consultation was 8 October, with two months of symptoms then. Preserved thumb strength and absent thenar wasting do not negate the documented assembly difficulties.
- Keep referral consent separate from employer-report consent; if mentioning follow-up, retain the 19 November review and both earlier-review triggers: worsening numbness or developing weakness.
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 referral say that work caused her carpal tunnel syndrome?
No. The notes link symptoms with crimping but explicitly state that workplace causation is not established and duties have not recently changed. Describe the relevant task demands and functional effects so Dr Schulist can assess adjustments without presenting an unsupported causal conclusion.
Can the occupational physician send recommendations directly to her employer?
The recorded consent authorises the referral and relevant hand/work information reaching the occupational physician. It does not authorise an employer report. Make the separate requirement clear: discuss that report with Ms Bernhard and obtain her consent before sending it. Omit the unrelated confidential histories.
Sources
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