The task
Original independent practice task. Assume that today's date is 5 November 2026. Ms Minji Hwangbo has attended your general practice for review. Reading time: 5 minutes; writing time: 40 minutes.
You are Ms Minji Hwangbo's general practitioner. Using the case notes, write a referral to Dr Sienna Coleman, Infectious Diseases Physician, Specialist Outpatient Clinic, 18 High Street, SW1P 2AB, United Kingdom. Request assessment of persistent symptoms following documented treatment for Lyme disease, distinguishing the patient's belief in continuing infection from the clinical findings. 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?
Persistent symptoms after treated Lyme disease: referral
You are Ms Minji Hwangbo's general practitioner. Using the case notes, write a referral to Dr Sienna Coleman, Infectious Diseases Physician, Specialist Outpatient Clinic, 18 High Street, SW1P 2AB, United Kingdom. Request assessment of persistent symptoms following documented treatment for Lyme disease, distinguishing the patient's belief in continuing infection from the clinical findings. 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 Minji Hwangbo
- DOB: 12/03/1984 (42 yrs)
- Review today: 05/11/26; initial consultation: 05/08/26
Social background
- School administrator; symptoms → reduced working hours
- Lives with partner; supportive, assists with household tasks
- School software training booked for December; routine requirement for all administrators
- Complained receptionist was unfriendly when booking appointment
- Private disagreement with sister over sale of family jewellery
Medical history
- Appendicectomy in childhood; previously generally well
- Regular medicines: nil
- No known drug allergies
Initial illness and documented treatment
- 05/08: expanding oval rash after tick bite during UK woodland walking
- GP record: clinical diagnosis of Lyme disease
- Records confirm oral doxycycline 100 mg BD for 21 days from 05/08; course completed, no missed doses
- Rash and initial flu-like symptoms resolved during treatment
- No further tick exposure reported
Current assessment — 05/11/26
- Persistent fatigue, generalised aches, poor concentration since treatment; little improvement
- Previously full workload; briefly resumed full hours in September → reduced again in October due to fatigue; sustained administrative tasks still difficult
- No fever, recurrent rash or swollen joints
- No facial/limb weakness, numbness, palpitations or syncope
- Afebrile; observations stable
- No rash or synovitis on examination
- Neurological and cardiovascular examinations unremarkable
- Recent FBC, CRP, renal/liver function and thyroid tests unremarkable
- No repeat Lyme testing performed
- Patient believes infection continues; requests prolonged antibiotics
- Continuing infection unconfirmed; no objective focal findings today
Plan
- Refer: assess persistent symptoms, consider alternative causes, advise investigation/management
- No additional antibiotics started pending specialist assessment
- GP follow-up arranged; temporary work adjustments offered
Who is reading, and what do they need?
Dr Coleman, an infectious diseases physician, needs a self-contained referral for Ms Minji Hwangbo, aged 42. She needs the documented diagnosis and treatment, persistent symptoms, and distinction between patient belief and current findings to plan assessment. Selected negatives and investigations can support that distinction without exhaustive detail; no known drug allergies is optional background.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Clinical Lyme diagnosis; expanding oval rash after tick bite while walking in UK woodland. | Establishes the recorded diagnosis; the presenting history offers useful context without requiring a detailed account of the walk. |
| Completed oral doxycycline 100 mg twice daily for 21 days from 5 August, without missed doses; rash and initial flu-like symptoms resolved. | Gives the specialist the actual regimen and adherence needed to review previous treatment; resolution of the initial symptoms provides useful context. |
| Persistent fatigue, generalised aches and poor concentration; reduced working hours again in October after briefly resuming full hours in September; sustained administrative tasks remain difficult. | Defines the unresolved problem and its functional impact; the attempted return to full hours should not be presented as recovery. |
| Patient believes infection continues and requests prolonged antibiotics. | Identifies her concern and requested treatment while keeping these explicitly attributed to her. |
| Continuing infection unconfirmed; no objective focal findings, rash or synovitis today. | Separates the clinical assessment from her belief without claiming that continuing infection has been excluded. |
| Recent FBC, CRP, renal/liver function and thyroid tests unremarkable. | Summarises investigations already undertaken, supporting further assessment without suggesting that alternative causes have been excluded. |
| Assess persistent symptoms, consider alternative causes, and advise on investigation and management. | Gives the specialist a clear remit beyond deciding whether to prescribe further antibiotics. |
| No additional antibiotics pending assessment; GP follow-up arranged and temporary work adjustments offered. | Clarifies interim management and continuing GP involvement; follow-up and work support can be compressed if space is limited. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Routine school software training booked for December. | A future requirement for all administrators does not explain her current difficulties or inform the infectious diseases assessment. |
| Complained that the receptionist was unfriendly. | The booking complaint has no stated connection to the clinical assessment or referral request. |
| Private disagreement with sister over family jewellery. | No connection with her symptoms is documented, so including it could invite unsupported psychosocial explanations. |
| Childhood appendicectomy; previously generally well. | The remote operation does not advance this assessment; previous general health needs, at most, brief background. |
| Supportive partner assists with household tasks. | Although useful functional context, it adds less than the documented work limitations and can usually be omitted. |
| No regular medicines. | This may be omitted from the short narrative when the completed doxycycline course and current antibiotic decision are clear. |
A paragraph plan for this case
Open with the assessment request and routine identifiers, using 5 November 2026 as the referral date. Outline the August clinical diagnosis, documented doxycycline regimen and treatment response, then the persistent symptoms and their effect on work. If using the September–October work history, distinguish an attempted return to full hours from symptom resolution. Separate her antibiotic request from the unconfirmed continuing infection. Select supporting negatives and investigations rather than listing them all, and finish with interim management.
Where candidates slip on this task
- The records specify oral doxycycline 100 mg twice daily for 21 days from 5 August, completed without missed doses. Report the regimen accurately; completion and initial improvement do not prove eradication.
- Unremarkable blood tests and examinations do not exclude continuing infection or alternative causes; retain the documented uncertainty and avoid assigning a definitive explanation for her symptoms.
- No further tick exposure was reported, and no repeat Lyme testing occurred; neither point establishes eradication or continuing infection, so retain either only when useful.
- Briefly resuming full working hours does not mean her symptoms resolved. Routine future software training is not evidence that workplace changes caused her concentration difficulties.
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
How should her request for prolonged antibiotics be handled?
Identify it as the patient’s request, linked to her belief that infection continues. Keep that separate from the documented assessment: continuing infection is unconfirmed and there are no objective focal findings today. The referral seeks assessment and management advice, without endorsing her proposed treatment.
Must every negative symptom and normal result appear?
No. Choose supporting details that help Dr Coleman interpret the persistent symptoms and understand the assessment already undertaken. The central distinction must remain clear without a complete inventory. If summarising investigations, preserve their limited meaning: unremarkable results do not exclude all alternative causes.
Sources
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