The task
Assume that today's date is 21 October 2026.
Using the information in the case notes, write a letter of referral to Dr Anna Lindqvist, a gastroenterologist at Riverside Endoscopy Centre, requesting urgent assessment and colonoscopy. Address the letter to Dr Anna Lindqvist, Gastroenterologist, Riverside Endoscopy Centre, 140 Harbour Road, Northbridge. 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.
Case notes
Patient details
- Name: Mr Kevin Doherty
- DOB: 14/03/1965 (61 yrs)
- Address: 22 Fernhill Road, Ashgrove
- Occupation: retired bank manager (retired 2024)
Social background
- Married (Linda), 2 adult children living overseas
- Ex-smoker (quit 1998); alcohol approx. 10 standard drinks/wk
- Usually plays golf 2x/wk — stopped last month, 'too tired'
- Booked trip to Europe Dec 2026 — keen to 'get everything sorted' before then
Medical history
- Hypertension (2015) — perindopril 5 mg mane
- Osteoarthritis both knees — ibuprofen 400 mg PRN (approx. 3x/wk, 2 yrs)
- Appendicectomy age 12
- Seasonal hay fever — loratadine PRN
- Allergies: penicillin (rash)
- Family Hx: father — colorectal cancer, diagnosed aged 68
- No previous colonoscopy; did not return national bowel screening kit (2023)
08/10/26 — presenting complaint
- 3/12 fatigue, ↓ exercise tolerance, SOB climbing stairs
- Unintentional wt loss 6 kg in 4/12 (88 → 82 kg)
- 6/52 change in bowel habit: looser stools 2–3x/day; occasional dark red blood mixed with stool
- No abdominal pain, nausea or vomiting; appetite normal
- Sleeping poorly — attributes to neighbour's renovations
Examination
- Pale conjunctivae; HR 92 reg; BP 128/76; BMI 26
- Abdo soft, non-tender, no masses, no hepatomegaly
- PR: no palpable mass; dark red blood on glove
Investigations (results 14/10/26)
- FBC: Hb 98 g/L (ref 130–180), MCV 72 fL; ferritin 6 µg/L
- iFOBT: positive
- U&E, LFTs normal; coeliac serology negative
- Lipids: total cholesterol 5.4 mmol/L
Management
- Ibuprofen ceased — regular paracetamol 1 g up to QID for knees
- Commenced oral iron (ferrous sulfate 325 mg, 105 mg elemental iron) daily
- Pt anxious about possibility of cancer
- Pt's friend's wife recently diagnosed with bowel cancer; pt watched TV documentary on bowel cancer
- Pt asked whether golf club membership can be paused on medical grounds — letter provided
Plan
- Urgent referral to gastroenterologist for colonoscopy ± gastroscopy
- Repeat FBC and ferritin in 4/52
- GP review 2/52, or earlier if bleeding increases or symptomatic
Who is reading, and what do they need?
Dr Lindqvist is a gastroenterologist who will triage this request and perform or arrange the procedure. She needs the presenting features, risk factors, findings and results that justify urgency, plus medicines and allergy relevant to procedure planning. Patient concerns and social detail are not needed.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| 6/52 change in bowel habit; occasional dark red blood mixed with stool | A core lower GI symptom supporting colonoscopy. Give its duration. |
| Unintentional weight loss 6 kg in 4/12 (88 → 82 kg) | A red-flag symptom that supports the urgency request. |
| 3/12 fatigue, reduced exercise tolerance, SOB on stairs | Symptoms consistent with the anaemia. They show clinical impact. |
| Hb 98 g/L, MCV 72 fL, ferritin 6 µg/L; iFOBT positive | The key results justifying the urgent request. Include the reference range or flag them clearly. |
| Pale conjunctivae; HR 92; abdomen normal; PR no mass, blood on glove | Examination findings that show no mass was palpable and bleeding was confirmed. |
| Father colorectal cancer aged 68; no previous colonoscopy; kit not returned 2023 | Risk factor and screening gap, both relevant to prioritising investigation. |
| Ibuprofen ceased; paracetamol; ferrous sulfate commenced; perindopril 5 mg | Current medicines and the changes made. NSAID use of about 3x/wk for 2 yrs is relevant to GI assessment. |
| Allergy: penicillin (rash) | Safety information the receiving clinician needs before any procedure. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Booked trip to Europe Dec 2026; wants everything sorted | Trap: it adds personal urgency but is not a clinical reason. Urgency should rest on the findings. |
| Golf club membership pause letter; golf stopped 'too tired' | The club letter is an administrative matter. The reduced activity is already covered by the fatigue symptoms. |
| Anxious about cancer; friend's wife; TV documentary | The patient's worries and their sources do not help the specialist triage. Do not state a diagnosis in the letter. |
| Sleeping poorly, attributed to renovations | Unrelated to the bowel and anaemia presentation. |
| Cholesterol 5.4; hay fever; loratadine; appendicectomy; U&E, LFTs, coeliac normal | Incidental or normal results that do not drive this referral. Normal tests do not exclude other causes. |
A paragraph plan for this case
Start with the request for urgent assessment and colonoscopy, naming the patient and the main concern. Then give the history, examination and results, followed by relevant background: family history, screening, medicines and allergy. Close with what has been done and the follow-up arranged, repeat bloods and GP review.
Where candidates slip on this task
- Do not state or imply a cancer diagnosis. Present the symptoms, blood results and family history as the reasons for urgency, and describe the request as for assessment and colonoscopy.
- The plan says colonoscopy with or without gastroscopy, while the task asks for colonoscopy. Make the request consistent and avoid overstating what is required.
- State the medicine change precisely: ibuprofen stopped, regular paracetamol, ferrous sulfate daily started. Note the penicillin allergy as a rash, and give the results date of 14/10 accurately.
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
Why not mention the patient's anxiety?
The reader is triaging on clinical grounds, and the anxiety does not change urgency. It also stems from outside events, not clinical findings, so it adds length without helping the specialist.
Is the follow-up plan needed for the specialist?
Briefly. Repeat FBC and ferritin in 4/52 and GP review at 2/52 show what is already arranged. They are secondary to the findings and the request.
Sources
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