The task
Original independent practice. Assume that today's date is 5 November 2026. You have identified an omission in Ms Rutto's discharge summary. Allow 45 minutes: 5 minutes for reading and 40 minutes for writing.
You are a surgical registrar. Using the case notes, write an addendum to Dr Bridgit Mbaabu, Ms Sylvia Rutto's general practitioner, explaining the omitted histology follow-up arrangements, the additional responsibility agreed today and the original instructions that remain valid. Address the letter to Dr Bridgit Mbaabu, General Practitioner, 24 High Street, SW19 2AB, United Kingdom. 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: Update letter.
Free · no sign-up · medicine
Which case notes belong in this letter?
Laparoscopic cholecystectomy recovery: update
You are a surgical registrar. Using the case notes, write an addendum to Dr Bridgit Mbaabu, Ms Sylvia Rutto's general practitioner, explaining the omitted histology follow-up arrangements, the additional responsibility agreed today and the original instructions that remain valid. Address the letter to Dr Bridgit Mbaabu, General Practitioner, 24 High Street, SW19 2AB, United Kingdom. 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 Sylvia Rutto
- DOB: 18/06/1972 (54 yrs)
- GP: Dr Bridgit Mbaabu; original discharge summary received
- Laparoscopic cholecystectomy and discharge: 02/11/26
Social background
- Lives with daughter; supported at home after discharge
- Office administrator; enjoys embroidery
- Complained that ward staff were unfriendly
- Daughter disclosed a private dispute about inheritance
Medical history
- Recurrent symptomatic gallstones over 6/12
- Remote ankle sprain; fully recovered
- Non-smoker; no known drug allergies
Treatment/Progress
- Elective procedure; uncomplicated; no drain
- Gallbladder sent for histology
- Mobilising independently; oral intake tolerated before discharge
- 05/11 telephone review: discomfort ↓; eating/drinking normally
- No fever, vomiting or jaundice; wounds reportedly dry
Assessment and addendum plan — 05/11/26
- Summary audit today: pending histology follow-up omitted; result still unavailable
- GP agreed today by telephone: track histology update; contact surgical secretary if absent by 12/11
- Surgical team retains result review, communication to patient/GP and further assessment arrangements
- GP wound/recovery review booked 09/11; remains required
- Addendum adds histology tracking; all original discharge instructions remain valid
- Patient informed today that histology pending and follow-up arrangements corrected
Original discharge plan — patient-specific instructions
- Gentle activity, ↑ gradually; avoid strenuous exercise
- Normal healthy diet; small meals initially if easier
- Driving: only when emergency stop comfortable; check insurance requirements
- Wounds closed with dissolvable sutures; no removal needed
- No changes to discharge medicines; no new prescription
- Urgent GP assessment or NHS 111 for severe/worsening persistent pain, fever, jaundice, wound discharge or new unilateral leg pain or swelling; leg symptoms alone require urgent assessment
- Call 999 for sudden breathlessness or chest pain, with or without leg symptoms; do not drive to A&E
- No routine surgical clinic booked; arrange review if histology requires
Who is reading, and what do they need?
Dr Mbaabu is Ms Rutto’s GP and has received the original discharge summary. She needs the omission explained, her newly agreed tracking task specified and surgical responsibilities distinguished. Identification and operative context can be brief. Recovery findings and home support are optional background, while routine care needs only selective reminders. The additional arrangement must clearly preserve existing discharge instructions.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| 5 November audit: histology follow-up omitted; result still unavailable. | Establishes why an addendum is necessary and identifies the unresolved follow-up issue. |
| GP agreed: track histology; contact surgical secretary if absent by 12 November. | Defines the additional responsibility accepted today, including its deadline and escalation contact. |
| Surgical team retains result review, patient/GP communication and further assessment arrangements. | Prevents the tracking request from being mistaken for transfer of clinical ownership. |
| GP wound/recovery review booked for 9 November; remains required. | Confirms that the new arrangement does not replace the existing recovery appointment. |
| Histology tracking added; all original discharge instructions remain valid. | Clarifies the scope of the correction and preserves continuity of the established plan. |
| Urgent GP assessment or NHS 111: severe/worsening persistent pain, fever, jaundice, wound discharge or new unilateral leg pain or swelling. Optional emergency reminder: call 999 for sudden breathlessness or chest pain, with or without leg symptoms; do not drive to A&E. | Reinforces urgent assessment, including leg symptoms alone. The emergency reminder may remain in the original summary; if repeated, it must not depend on leg symptoms. |
| Driving only when an emergency stop is comfortable; check insurance requirements. | Retains a practical recovery restriction without implying that surgery or improving discomfort establishes driving readiness. |
| Patient informed today: histology pending and follow-up arrangements corrected. | Documents patient communication and helps the GP maintain a consistent explanation. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Office administrator; enjoys embroidery. | Occupation and leisure interests do not affect the omitted follow-up arrangement or its correction. |
| Complaint that ward staff were unfriendly. | The complaint does not inform the GP’s clinical responsibilities in this addendum. |
| Daughter’s private disclosure about an inheritance dispute. | This confidential family information has no documented relevance to postoperative care or histology tracking. |
| Remote ankle sprain, fully recovered. | The resolved injury has no bearing on the current recovery review or outstanding result. |
| Non-smoker; no known drug allergies. | Neither fact changes the follow-up correction, and no prescription change is proposed. |
| Recurrent symptomatic gallstones over six months. | Although related to the operation, repeating the surgical indication adds little for the GP who received the original summary. |
A paragraph plan for this case
Open with brief patient identification, the 2 November operation and the omission identified on 5 November, distinguishing the missing arrangement from the unavailable result. Next separate GP tracking and the 12 November escalation from retained surgical responsibilities; the absence of a routine surgical appointment can be compressed here. Close with the 9 November recovery review, explicit preservation of all original discharge instructions and the urgent-assessment reminder. Driving conditions, the emergency reminder and patient notification may be added selectively.
Where candidates slip on this task
- Keep the dates distinct: surgery and discharge occurred on 2 November, the agreement was made on 5 November, and the tracking deadline is 12 November.
- Do not assign histology interpretation or patient notification to the GP: the additional agreement concerns tracking, while the surgical team retains review, communication and further assessment arrangements.
- New unilateral leg pain or swelling warrants urgent GP assessment or NHS 111 advice even without chest or breathing symptoms. Repeating the emergency reminder is optional when all original instructions are explicitly preserved; if included, sudden breathlessness or chest pain requires 999 help whether or not leg symptoms are present. Improving discomfort and reportedly dry wounds do not exclude later complications or establish histology findings.
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
- Community-acquired pneumonia after admission: update update letter
- Pyelonephritis recovery: update update letter
- Suspected severe asthma exacerbation: update update letter
Your profession's guide: OET Medicine. Layout and structure: OET letter format.
Questions about this task
Does the GP now take responsibility for interpreting and communicating the histology?
The notes assign the GP tracking of the histology update and contact with the surgical secretary if it is absent by 12 November. Result review, communication to Ms Rutto and her GP, and further assessment arrangements remain with the surgical team.
Must every original discharge instruction be repeated?
The GP already has the original summary, so a complete repetition is unnecessary. Explicitly preserve all original instructions and the booked recovery review, and reinforce urgent GP assessment or NHS 111 advice for the symptoms in n27, including new unilateral leg pain or swelling alone. Other practical reminders and the emergency advice in n28 are optional. If emergency advice is repeated, sudden breathlessness or chest pain requires a 999 call regardless of leg symptoms, and the patient should not drive to A&E.
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.