The task
Assume that today is 5 November 2026. Ms Ester Schmidtke was discharged yesterday. You are reviewing a late culture result. This is original independent practice. Allow 45 minutes: 5 minutes for reading and 40 minutes for writing.
You are the ward doctor who telephoned Ms Ester Schmidtke today. Using the case notes, write an update to her general practitioner, Dr Emma-Louise Dermody, explaining the specialist's revised antibiotic decision, the communication already completed and the acknowledgement required. Address the letter to Dr Emma-Louise Dermody, General Practitioner, 24 Station Road, SW1V 2AA, 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.
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Which case notes belong in this letter?
Pyelonephritis recovery: update
You are the ward doctor who telephoned Ms Ester Schmidtke today. Using the case notes, write an update to her general practitioner, Dr Emma-Louise Dermody, explaining the specialist's revised antibiotic decision, the communication already completed and the acknowledgement required. Address the letter to Dr Emma-Louise Dermody, General Practitioner, 24 Station Road, SW1V 2AA, 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.
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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: Ms Ester Schmidtke
- DOB: 14/06/1978 (48 yrs)
- Admitted 02/11/26; discharged home 04/11/26
- Regular GP: Dr Emma-Louise Dermody
Social background
- Lives independently; daughter nearby
- Office administrator; enjoys pottery
- Daughter privately described arguments about inheritance
Medical history
- Appendicectomy 2007
- No regular medicines; no known drug allergies
- Not pregnant; no diabetes or known renal disease
Admission and progress
- 02/11: fever, vomiting, dysuria, R loin pain
- Assessment: acute pyelonephritis
- Urine collected before antibiotics
- IV ceftriaxone → clinical improvement
- 04/11: afebrile, tolerating fluids/tablets; renal function normal before discharge
- Discharge: oral cefalexin; culture pending
- Original summary: finish cefalexin; GP review 06/11
Late result and revised treatment
- 05/11 final urine culture: E. coli; cefalexin resistant, trimethoprim susceptible
- Result reviewed by Dr Achim Mathurin, infectious diseases consultant
- Documented revised decision: stop cefalexin immediately
- Prescribed oral trimethoprim 200 mg BD for 14 days, 05–18/11 inclusive
- Hospital pharmacy supplied complete replacement course at 10:00 today
Patient contact
- 11:00: ward doctor telephoned patient; explained change; patient correctly repeated new instructions
- Patient confirmed cefalexin stopped; first trimethoprim dose taken
- Telephone review: improving; drinking normally; no vomiting or recurrent fever
Communication and follow-up plan
- Updated summary + culture report sent electronically to GP
- Dr Dermody must acknowledge update to ward doctor today; ward doctor tracks receipt
- GP: amend medication record; original cefalexin instruction superseded
- GP review remains 06/11: assess recovery, tolerance and adherence
- Advice given: urgent assessment for fever, worsening loin pain or vomiting; ambulance for confusion/drowsiness
- Complaint: ward breakfast arrived late
Who is reading, and what do they need?
Dr Dermody is Ms Schmidtke’s regular GP receiving a post-discharge pyelonephritis treatment correction. She needs the final susceptibility findings, the consultant’s replacement regimen, evidence of patient communication, and a same-day acknowledgement request. Brief recovery context can support tomorrow’s review; a detailed admission narrative would compete with the actions needed now.
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 culture: E. coli resistant to cefalexin, susceptible to trimethoprim. | Both susceptibility findings explain why the discharge antibiotic instruction requires correction. |
| Dr Mathurin’s revised decision: stop cefalexin immediately. | Identify the specialist decision and its immediate consequence so the original instruction cannot remain active. |
| Oral trimethoprim 200 mg BD for 14 days, 5–18 November inclusive. | The replacement regimen needs sufficient precision for the GP to understand and reconcile treatment. |
| 11:00 telephone explanation; correct repeat-back; cefalexin stopped; first trimethoprim dose taken. | Explanation and repeat-back establish completed patient communication; confirmed implementation adds useful evidence that the change has begun. |
| Complete course supplied at 10:00; updated summary and culture report sent electronically. | These useful supporting details clarify medicine availability and document transmission; neither independently proves GP receipt. |
| GP acknowledgement today to ward doctor; ward doctor tracks receipt. | Make the outstanding communication action and responsibility for confirming receipt explicit. |
| Amend medication record; 6 November review: recovery, tolerance and adherence. | These practical next steps help the GP continue care; they can be concise alongside the central acknowledgement request. |
| Urgent assessment: fever, worsening loin pain or vomiting; ambulance: confusion/drowsiness. | Report the complete recorded escalation advice together, preserving the distinction between urgent assessment and ambulance thresholds. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Independent living, daughter nearby, office administration and pottery. | These social details do not change the antibiotic correction or the GP’s immediate responsibilities. |
| Daughter privately described inheritance arguments. | This private family information has no stated connection to treatment or follow-up. |
| Appendicectomy in 2007. | The remote operation does not explain the late culture result or affect the documented replacement plan. |
| Ward breakfast arrived late. | The complaint does not assist medication reconciliation, acknowledgement or recovery review. |
| Urine collected before antibiotics. | Although apparently relevant to culture interpretation, collection timing is unnecessary to explain the documented susceptibility-led decision. |
| Admission symptoms, ceftriaxone response, normal renal function, medication/allergy and comorbidity negatives. | Compress or omit this supporting background when the treatment correction and continuing care remain understandable. |
A paragraph plan for this case
Open with Ms Schmidtke’s identifiers, discharge timing and the pyelonephritis culture update, grouping susceptibility, consultant decision, replacement regimen and superseded cefalexin instruction. Next, summarise pharmacy supply, patient telephone communication, any brief recovery context and electronic transmission. End with same-day acknowledgement and receipt tracking, medication-record correction, tomorrow’s review and the complete recorded escalation advice.
Where candidates slip on this task
- Anchor today to 5 November 2026 and yesterday to 4 November; distinguish the acknowledgement due today from the unchanged GP review on 6 November.
- Keep trimethoprim at 200 mg BD for 14 days, 5–18 November inclusive; cefalexin stops immediately, and the pharmacy has already supplied the replacement course.
- Separate the consultant’s decision, patient explanation with correct repeat-back, and GP receipt acknowledgement; report the complete recorded escalation advice together without claiming broader reassurance or extra counselling.
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 much admission history does this update need?
The GP needs enough context to recognise a late culture correction after pyelonephritis discharge. Initial symptoms, ceftriaxone response, normal renal function and current recovery can be brief or omitted when revised treatment and follow-up remain clear. Independent living, pottery, inheritance arguments and the breakfast complaint do not support this purpose.
What must the communication section distinguish?
Distinguish the consultant’s documented decision from the ward doctor’s completed telephone explanation and the GP’s outstanding acknowledgement. The patient’s correct repeat-back is central; pharmacy supply, confirmed first dose and electronic transmission strengthen continuity. Identify acknowledgement to the ward doctor on 5 November and preserve the ward doctor’s responsibility for tracking receipt.
Sources
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