The task
Assume that today's date is 5 November 2026. You have reviewed Mr Kariuki Gacheri following the return of his urgent colorectal referral. This is original independent practice material; all patient-specific details are fictional.
You are Dr Judith Ngui, a general practitioner. Write to Dr Raphael Makori, Colorectal Surgeon, Urgent Colorectal Clinic, Surgical Outpatients Department, 24 Clinic Road. Resubmit Mr Kariuki Gacheri's referral, supplying the information requested when it was returned and explaining his interval clinical deterioration. The clinic retains access to the original referral, so avoid repeating the full background. 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.
Free · no sign-up · medicine
Which case notes belong in this letter?
Persistent rectal bleeding with altered bowel habit: referral
You are Dr Judith Ngui, a general practitioner. Write to Dr Raphael Makori, Colorectal Surgeon, Urgent Colorectal Clinic, Surgical Outpatients Department, 24 Clinic Road. Resubmit Mr Kariuki Gacheri's referral, supplying the information requested when it was returned and explaining his interval clinical deterioration. The clinic retains access to the original referral, so avoid repeating the full background. 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: Mr Kariuki Gacheri
- DOB: 14/03/1968 (58 yrs)
- Review date: 05/11/2026
Social background
- Married; wife available to accompany him
- Retired bus driver; independent with daily activities
- Enjoys crosswords
- Disclosed private disagreement about daughter's wedding costs
Medical history
- Hypertension; amlodipine daily
- No anticoagulants, aspirin or NSAIDs
- NKDA
- Appendicectomy 1987; uncomplicated
Previous referral
- 22/10: urgent colorectal referral for rectal bleeding and altered bowel habit
- Then: symptoms 6/52; intermittent blood mixed with stools; frequency ↑ from once to three times daily
- Initial abdomen soft; no palpable mass
- 29/10: referral returned; quantitative FIT, FBC report and rectal examination findings missing
- Original referral remains accessible to clinic; full background already supplied
Missing information now available
- 03/11 FIT: 86 micrograms Hb/g faeces
- 03/11 FBC: Hb 137 g/L; platelets 278 × 10^9/L
- 05/11 rectal examination: no palpable mass or fissure; blood on glove
- FIT and FBC reports attached to resubmission
Interval progress and current assessment
- Now: daily small-volume bleeding; no clots or continuous bleeding
- Since 01/11: new urgency and incomplete evacuation
- No melaena, vomiting or severe abdominal pain
- Weight unchanged: 76 kg
- BP 128/78 mmHg; pulse 76/min; no dizziness
- Abdomen remains soft, non-tender; no palpable mass
Plan
- Explained: cause unconfirmed; further investigation necessary
- Resubmit today; request urgent assessment/investigation for persistent symptoms and interval deterioration
- Safety advice: emergency help for heavy/non-stop bleeding or large clots; ambulance if needed; do not drive
- Practice to confirm receipt; no clinic appointment allocated
- Complained receptionist sounded bored on telephone
Who is reading, and what do they need?
Dr Makori’s clinic retains the original referral and needs missing evidence and subsequent changes to arrange urgent assessment. Name and birth date identify the patient; the review date anchors the update. Hypertension, amlodipine, absence of anticoagulants, aspirin or NSAIDs, and NKDA are optional context. His wife’s availability matters only for attendance support; familiar background needs little repetition.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| 29 October return: quantitative FIT, FBC report and rectal examination findings missing | Explains the resubmission and identifies all three information gaps that must now be addressed. |
| 3 November FIT: 86 micrograms Hb/g faeces | Supplies the requested quantitative result for the surgeon’s assessment. |
| 3 November FBC: Hb 137 g/L; platelets 278 × 10^9/L | Provides the available blood results requested when the referral was returned. |
| 5 November rectal examination: no palpable mass or fissure; blood on glove | Completes the missing examination information while preserving both the positive finding and its limitations. |
| Daily small-volume bleeding; no clots or continuous bleeding | Establishes the change in bleeding frequency and accurately qualifies its current severity. |
| Since 1 November: new urgency and incomplete evacuation | Identifies the new symptoms and their onset, supporting the request for urgent assessment. |
| Resubmit today; urgent assessment/investigation for persistent symptoms and interval deterioration | States the action required from the receiving clinic and the reason for urgency. |
| FIT and FBC reports attached | Helps the clinic locate the supporting documents needed to process the resubmission. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Retired bus driver; independent with daily activities; enjoys crosswords | These details do not help resolve the referral’s information gaps or assess the interval symptoms. |
| Private disagreement about daughter’s wedding costs | This private family matter has no documented connection to the colorectal assessment. |
| Uncomplicated appendicectomy in 1987 | Remote uncomplicated surgery adds little to this focused update and belongs to the retained background. |
| Original six-week history, stool frequency change and initially soft abdomen without palpable mass | The clinic already has this baseline; compress only what helps explain the interval change, prioritising current findings. |
| Receptionist sounded bored on telephone | The complaint does not explain the missing clinical information or assist the surgeon’s decisions. |
| Safety counselling already provided | Repeating completed counselling is optional in this focused update; the requested findings and interval deterioration take priority. |
A paragraph plan for this case
Open with patient identifiers, the 5 November review, the 22 October urgent referral for rectal bleeding and altered bowel habit, its return, and the renewed request for urgent assessment. Use the middle paragraphs for the missing FIT, FBC and rectal examination information with attachments, followed by daily bleeding and the symptoms beginning on 1 November. Close with the requested investigation and receipt arrangements, noting that no appointment is allocated; optional supporting detail can briefly cover absent melaena, vomiting or severe abdominal pain, unchanged weight, observations, current abdominal findings and the explanation that the cause remains unconfirmed.
Where candidates slip on this task
- Keep the 22 October referral, 29 October return and 5 November review distinct; urgency and incomplete evacuation began on 1 November, not at referral.
- Report FIT 86 micrograms Hb/g faeces, Hb 137 g/L and platelets 278 × 10^9/L exactly; neither these results nor absent palpable masses establish the cause.
- Describe intermittent bleeding becoming daily and the new urgency and incomplete evacuation; do not invent heavier bleeding, weight loss, anaemia, a confirmed diagnosis or an allocated appointment.
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
- Urgent referral to a gastroenterologist: iron-deficiency anaemia and rectal bleeding referral letter
- Urgent referral to a rheumatologist: suspected rheumatoid arthritis referral letter
- Urgent referral to a dermatologist: suspected melanoma referral letter
Your profession's guide: OET Medicine. Layout and structure: OET letter format.
Questions about this task
How much of the original referral should be repeated?
Use only enough context to identify the original urgent referral and explain the change since then. The clinic retains the full background, so the returned referral’s missing information and subsequent symptoms deserve most space. A brief comparison with the earlier intermittent bleeding can clarify deterioration.
Do the blood results or absent palpable mass justify reducing urgency?
The notes still request urgent assessment for persistent symptoms and interval deterioration. Present the numerical results and examination findings without turning them into reassurance or a diagnosis. Blood on the glove, daily bleeding, and new urgency and incomplete evacuation remain relevant to the surgeon’s assessment.
Sources
Last checked . 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.