The task
Original independent practice. Allow 45 minutes: 5 minutes for reading and 40 minutes for writing. Assume that today's date is 6 November 2026. You have assessed Mr Imre Pechel today.
You are Mr Imre Pechel's general practitioner. Using the case notes, write a referral letter to Dr Mariola Sitters, Community Geriatrician, Multidisciplinary Falls Clinic, 18 High Street, SW6 3LJ, United Kingdom. Request assessment of his recurrent falls and possible contributing factors, including review of his medicines. Distinguish the observed symptoms on standing from an established explanation for all his falls. 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?
Recurrent falls with possible orthostatic symptoms: referral
You are Mr Imre Pechel's general practitioner. Using the case notes, write a referral letter to Dr Mariola Sitters, Community Geriatrician, Multidisciplinary Falls Clinic, 18 High Street, SW6 3LJ, United Kingdom. Request assessment of his recurrent falls and possible contributing factors, including review of his medicines. Distinguish the observed symptoms on standing from an established explanation for all his falls. 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 Imre Pechel
- DOB: 12/03/1947 (79 yrs)
- Consultation: 06/11/2026; GP referral today
Social background
- Lives alone; daughter visits daily
- Ground-floor flat; loose rug in hallway; no bathroom grab rail
- Stopped shopping independently: afraid of falling again
- Previously walked independently without aid; now steadies himself on furniture
- Retired accountant; collects stamps
- Daughter disclosed private disagreement over her brother's inheritance
Medical history
- Hypertension
- Bilateral knee osteoarthritis; intermittent pain
- Appendicectomy aged 20; uncomplicated
- Current medicines: amlodipine; temazepam PRN; paracetamol PRN
- No recent medicine changes; doses not being changed today
- Allergies: nil known
Assessment: 06/11/2026
- Three falls over 6/52; most recent 04/11
- Two falls soon after rising from bed/chair; associated light-headedness
- Other fall: foot caught loose rug; no dizziness
- No loss of consciousness, chest pain or palpitations reported
- No head strike or significant injury reported
- 04/11 fall: had just risen from chair
- Today: brief light-headedness observed on standing; settled sitting
- No reliable standing BP obtained: unsteady; orthostatic hypotension unconfirmed
- Slow gait, reduced balance; no focal neurological findings
- Alert; no features of acute illness
- Assessment: potentially several contributors; no established single cause
- Complained receptionist was unfriendly
Plan
- Refer community geriatrician: comprehensive falls assessment, including medicine review
- Request physiotherapy and OT home safety assessment
- Advised: rise slowly with support; remove rug; carry phone
- GP review in 1/52; daughter aware
- Advised: call 999 after a fall if unable to get up or head, back, neck or hip injury suspected
Who is reading, and what do they need?
Dr Sitters is the community geriatrician receiving the referral at the multidisciplinary falls clinic. Do not assume she already knows Mr Pechel's history. She needs the contrasting fall circumstances, today's observations and diagnostic uncertainty to guide assessment. Prioritise the complete medicine list and requested review; use functional, social and environmental details selectively to support multidisciplinary planning.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Comprehensive falls assessment, including medicine review | Establishes the referral's purpose and the specific action requested from Dr Sitters. |
| Three falls over six weeks; most recent 4 November | Defines the recurrence and recency that justify specialist assessment. |
| Two falls soon after rising from bed or chair, with light-headedness | Identifies the circumstances and associated symptom requiring assessment without assigning a confirmed cause. |
| Other fall: foot caught loose rug; no dizziness | Preserves the contrasting mechanism, preventing the standing symptoms from becoming an explanation for every fall. |
| Standing light-headedness settled sitting; unsteadiness prevented reliable standing BP; orthostatic hypotension unconfirmed | Separates observed symptoms from an unconfirmed diagnosis and supports investigation of potentially several contributors. |
| Amlodipine; temazepam PRN; paracetamol PRN | Provides all current medicines for the explicitly requested review without asserting that any caused the falls. |
| Slow gait, reduced balance; no focal neurological findings | Supports assessment of mobility and balance while keeping the neurological observation appropriately limited. |
| Request physiotherapy and OT home safety assessment | Makes the proposed multidisciplinary input explicit and connects assessment with practical continuing care. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Retired accountant; collects stamps | Occupation and hobby do not explain the documented mobility difficulties or guide the requested assessment. |
| Daughter's private disagreement over her brother's inheritance | The confidential disclosure has no documented connection to the falls or proposed care. |
| Uncomplicated appendicectomy aged 20 | The remote operation offers no documented contribution to the current referral question. |
| Complaint that the receptionist was unfriendly | The service complaint does not inform assessment of fall mechanisms or continuing care. |
| No known allergies | May be compressed or omitted here because no specific new medicine is requested; the current medicine list serves the immediate review. |
| Previously provided precautionary and ambulance advice | Detailed patient instructions need not occupy this focused specialist referral; assessment findings and requested actions take precedence. |
A paragraph plan for this case
Open with Mr Pechel's identification, age or date of birth, and the request for comprehensive falls assessment and medicine review. Next organise the contrasting fall circumstances and today's findings, optionally compressing the absence of reported loss of consciousness, chest pain, palpitations, head strike or significant injury, together with alertness and no features of acute illness. Finish with current medicines, selective background on hypertension and bilateral knee osteoarthritis, living alone with daily daughter visits, the ground-floor flat's rug and absent bathroom grab rail, fear-related loss of independent shopping and the change from unaided walking to furniture support, followed by physiotherapy, OT assessment and the planned one-week GP review with his daughter aware.
Where candidates slip on this task
- Use 6 November 2026 as the referral date and identify the latest fall as 4 November, after rising from a chair; avoid presenting these as separate events.
- Do not label orthostatic hypotension as confirmed: a reliable standing blood pressure was not obtained because of unsteadiness, and the rug-related fall had no dizziness.
- Keep the medicine review distinct from treatment changes: all three current medicines belong, but no recent changes or dose adjustments today are recorded; invent neither doses nor discontinuation.
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
Can I describe all three falls as caused by orthostatic hypotension?
No. Distinguish the two falls associated with light-headedness after rising from the rug-related fall without dizziness. Today's standing symptoms support further assessment, but the unreliable standing blood pressure leaves orthostatic hypotension unconfirmed. Preserve that uncertainty rather than attributing every fall to one cause.
How much medicine detail belongs in this referral?
Include amlodipine, temazepam PRN and paracetamol PRN so Dr Sitters can review possible medicine contributions. The notes record no recent changes and no dose changes today. Do not invent doses, recommend discontinuation or present any medicine as the established cause.
Must I repeat the ambulance advice in this specialist referral?
No. The documented advice is to call 999 after a fall if Mr Pechel cannot get up or an injury to his head, back, neck or hip is suspected; he does not need to decide that an injury is serious before calling. These conditions match NHS falls guidance, checked on 6 November 2026. You may accurately include this existing advice, but a focused referral can omit it while prioritising the assessment findings and requested care.
Sources
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