The task
Assume that today's date is 3 November 2026. Mr Tavaris Gottlieb has attended your practice after his second unsuccessful catheter-removal trial. Allow 45 minutes: 5 minutes for reading and 40 minutes for writing.
This is original independent practice. You are Mr Tavaris Gottlieb's general practitioner. Write a referral letter to Dr Theo Dalziel, Consultant Urologist, Urology Outpatient Department, 36 Clinic Road, NSW 2000, Australia. Request assessment of recurrent urinary retention following two unsuccessful catheter-removal trials while taking tamsulosin, and advice on further treatment and catheter management. 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 urinary retention: referral
This is original independent practice. You are Mr Tavaris Gottlieb's general practitioner. Write a referral letter to Dr Theo Dalziel, Consultant Urologist, Urology Outpatient Department, 36 Clinic Road, NSW 2000, Australia. Request assessment of recurrent urinary retention following two unsuccessful catheter-removal trials while taking tamsulosin, and advice on further treatment and catheter management. 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.
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One-page worksheet. Answers and reasons are on the linked webpage, so you can practise before checking.
Case notes
Patient details
- Name: Mr Tavaris Gottlieb
- DOB: 08/08/1956 (70 yrs)
- GP review: 03/11/26; currently at home with catheter
Social background
- Lives alone; independent with catheter bag care
- Daughter can provide transport to appointments
- Concerned catheter prevents usual swimming; wants alternatives
- Complained that clinic chairs were uncomfortable
Medical history
- Weak stream and hesitancy for 6/12 before retention
- No previous urological surgery or neurological disease
- No regular anticholinergics, opioids or OTC cold medicines
- No known drug allergies
- Healed wrist fracture 2016; no ongoing symptoms
Initial episode
- 12/10: painful inability to void; palpable distended bladder
- Catheter inserted → 850 mL drained; pain resolved
- 12/10: emergency clinician commenced tamsulosin modified-release tablet 400 micrograms orally once daily; continued through both removal trials and ongoing
- Reports no missed tamsulosin doses before or during either trial; no postural dizziness
- Urine culture: no growth; renal function preserved
Catheter-removal trials
- 19/10: first trial; small voids only; residual 620 mL
- 19/10: recatheterised; symptoms relieved
- 02/11: second trial; painful inability to void; scan 710 mL
- 02/11: recatheterised; catheter remains in situ
Current assessment
- 03/11: comfortable, afebrile; no suprapubic tenderness
- Urethral catheter freely draining clear urine; no visible haematuria
- DRE: smoothly enlarged prostate; no palpable nodule
- 02/11 renal function stable compared with initial presentation
- Ultrasound: no hydronephrosis
- Worried retention means cancer; asks what investigations may be needed; malignancy not diagnosed
Plan
- Refer Dr Theo Dalziel: repeated failed trials; investigate cause and advise further treatment/catheter strategy
- Community nursing catheter support arranged pending review
- Suspected catheter blockage or persistent absent drainage, even without pain → urgent clinical help; fever or rigors, even if catheter draining → urgent clinical help
- Patient willing to discuss medical, catheter and procedural options
Who is reading, and what do they need?
Dr Dalziel needs enough history to understand the repeated failures and advise on treatment and catheter management. Identify Mr Gottlieb using his name and date of birth, then prioritise trial outcomes, continuing tamsulosin at the documented dose and current drainage. Relevant examination and renal findings support assessment. Routine social logistics, allergy details and prior counselling need not dominate the referral.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Urology assessment requested: recurrent retention, further treatment and catheter strategy. | Focuses the consultation on repeated retention and a management plan addressing his wish for alternatives to resume swimming. |
| Six-month weak stream/hesitancy; 12/10 retention relieved after catheter drainage of 850 mL. | Provides concise symptom and initial-treatment context for the subsequent unsuccessful removal trials. |
| Tamsulosin modified-release tablet 400 micrograms orally once daily commenced on 12/10; continued through both trials and ongoing; no missed doses or postural dizziness reported. | Identifies the treatment and dose already tried, with reported adherence and tolerance, so the repeated failures can be understood in context. |
| 19/10 first trial: small voids, residual 620 mL; recatheterisation relieved symptoms. | Documents the first unsuccessful trial with objective retention evidence and the response to catheter replacement. |
| 02/11 second trial: painful inability to void, scan 710 mL; recatheterised, catheter remains. | Establishes the repeated failure prompting referral and makes the current catheter requirement explicit. |
| 03/11 comfortable, afebrile, no suprapubic tenderness; catheter freely draining clear urine, no visible haematuria. | Defines current clinical and drainage status without suggesting that earlier retention has resolved permanently. |
| Smoothly enlarged prostate, no palpable nodule; renal function stable; ultrasound without hydronephrosis. | Supports assessment of possible causes and complications without establishing benign obstruction or excluding malignancy. |
| Community nursing arranged; independent bag care; willing to discuss medical, catheter and procedural options. | Clarifies interim support and the range of management approaches he is willing to consider. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Clinic chairs were uncomfortable. | The facilities complaint has no bearing on retention assessment or catheter management. |
| Healed wrist fracture in 2016; no ongoing symptoms. | The resolved injury does not explain the documented urinary problem or affect the requested management. |
| Daughter can provide appointment transport. | Optional access information can be omitted because no transport difficulty or appointment barrier is documented. |
| Initial urine culture: no growth; renal function preserved. | Historical testing can be compressed or omitted when current findings already orient the specialist; neither result establishes the cause. |
| Home advice: urgent help for suspected blockage or persistent absent drainage, even without pain; separately, fever or rigors even if drainage continues. | Prior counselling is optional in this specialist referral. If included, preserve the independent triggers so help is not delayed until pain develops or drainage stops. |
A paragraph plan for this case
Open with the request for investigation, further treatment and catheter advice after two unsuccessful trials, then give the preceding stream symptoms, initial retention episode and continuing tamsulosin with its documented dose. Present the two trial outcomes chronologically, followed by current catheter function, examination and selected renal findings; no previous urological surgery or neurological disease and no regular use of anticholinergics, opioids or OTC cold medicines are optional supporting details. Relevant medication categories may be selected, preserving the regular-use qualifier without implying that all exposure is excluded. Close with community nursing support and willingness to discuss all listed management options, mentioning the swimming concern or his request for an explanation of investigations where useful to the consultation.
Where candidates slip on this task
- Keep the first trial’s 620 mL residual separate from the second trial’s 710 mL scan; neither measurement is the initial 850 mL catheter drainage.
- A smoothly enlarged prostate without a palpable nodule does not establish benign prostatic obstruction or exclude cancer; present his cancer worry as a concern, not a diagnosis.
- Tamsulosin modified-release tablets are continuing at 400 micrograms once daily, including during both unsuccessful trials, and the catheter remains in situ. Report the existing regimen without increasing the dose, prescribing another removal trial or promising procedural treatment.
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
Must the referral diagnose benign prostatic hyperplasia?
No. The notes document a smoothly enlarged prostate and preceding weak stream and hesitancy, but the cause of recurrent retention still requires investigation. Preserve those observations without converting them into confirmed obstruction or reassurance that malignancy has been excluded.
How much catheter information does the urologist need?
Prioritise the dates and outcomes of both unsuccessful trials, recatheterisation after the second trial and present free drainage. Community nursing support usefully explains interim care. Detailed home counselling and transport arrangements are optional rather than substitutes for the referral request.
When should Mr Gottlieb seek urgent help while awaiting review?
Suspected catheter blockage or urine persistently failing to drain requires urgent clinical help even without bladder pain. Fever or shaking chills also requires urgent clinical help, even if urine is still draining. These are independent reasons to seek help from his community nurse or doctor; he should not wait for them to occur together.
Sources
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