The task
Assume that today's date is 23 October 2026. Mrs Bukhari completed her sixth occupational therapy session two days ago.
You are an occupational therapist at an outpatient hand therapy clinic. Using the information in the case notes, write a letter to Dr Vikram Srivastava, Mrs Bukhari's general practitioner. Update him on the outcome of her occupational therapy and ask him to review her medical management. Address the letter to Dr Vikram Srivastava, General Practitioner, The Medical Centre, 42 High Street. 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.
Case notes
Patient details
- Name: Mrs Lakshmi Bukhari
- DOB: 14/03/1968 (58 yrs)
- Referred by GP (Dr Vikram Srivastava) 08/26 for hand function & work tasks
- Dx: seropositive rheumatoid arthritis (2019)
Social background
- Hairdresser in busy salon, 4 days/wk (↓ from 5 days since 06/26)
- Lives with husband; 2 adult children
- Daughter getting married 12/26 — pt wants to style bridal party's hair
- Enjoys gardening & sings in local choir
- Says salon manager 'doesn't care' & books her the most difficult clients
Medical history
- RA meds: methotrexate weekly + folic acid; managed by rheumatologist
- Last rheumatology review 05/26 — 'stable'; next appt 02/27
- Pt says rheumatologist is 'always rushed & never listens'
- Hypothyroidism — thyroxine daily
- Appendicectomy 1990
- OTC ibuprofen PRN past 3/52 — now taking most days
- Allergies: nil known
OT intervention
- 6 sessions 26/08/26 – 21/10/26
- Joint protection & energy conservation education — able to describe & apply principles at work
- Bilat custom resting hand/wrist splints at night — worn most nights, well tolerated
- Adapted tools: ergonomic offset-handle scissors, lightweight hairdryer, padded brush handles, height-adjustable stool
- Hand function ↑: now completes cut & blow-dry without rest break (previously needed 2 breaks)
- Self-rated work performance ↑ 4/10 → 7/10
Current presentation (21/10/26)
- Morning stiffness ↑ over past 4/52: now ~90 min (was ~20 min)
- Swelling & tenderness bilat MCP 2–3 & wrists, R > L; warmth over R wrist
- Pain 6/10 at end of work day (was 3/10)
- Unable to start clients before 10:00; cancelled 3 early appts this month
- Fatigue ↑; nil fever, nil wt loss reported
- Reports nil missed methotrexate doses
- Hair dye has stained R splint strap — replacement strap given
Plan
- Continue night splints, adapted tools & joint protection strategies
- Letter to GP: review medical mx of flare ± request earlier rheumatology review
- Pt to discuss later start times / shorter shifts with employer
- OT review 6/52 to reassess hand function & work tolerance
Who is reading, and what do they need?
Dr Srivastava referred Mrs Bukhari and knows her diagnosis, so he needs the therapy outcome briefly and, above all, the evidence of a flare to act on. He is a doctor, so give findings and dates, and keep therapy detail short.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Referred by GP 08/26; seropositive RA since 2019; methotrexate weekly with folic acid | Briefly links back to the referral and gives the treatment context for the medical review request. |
| 6 sessions 26/08–21/10: joint protection, energy conservation, night splints, adapted tools | Summarises what the therapy consisted of, so the GP understands the update and that the plan continues. |
| Cut and blow-dry without rest break (was 2); self-rated work performance 4/10 to 7/10 | Shows therapy benefit, with the rating clearly labelled as self-rated rather than an objective measure. |
| Morning stiffness about 90 min over past 4/52 (was about 20); pain 6/10 end of day (was 3/10) | These comparisons are the core evidence for the flare and the reason for asking about medical management. |
| Swelling and tenderness MCP 2–3 and wrists, R > L; warmth over R wrist | Examination findings give the GP something concrete to assess and act on. |
| Fatigue up; unable to start before 10:00; cancelled 3 early appointments; no fever or weight loss reported | Shows functional impact on work and records the negatives the patient reported. |
| OTC ibuprofen PRN for 3/52, now most days; reports no missed methotrexate doses | Increased NSAID use is relevant to the GP's medication review. Adherence is the patient's report, not verified. |
| Last rheumatology review 05/26 'stable'; next appointment 02/27 | Supports the request for review and for an earlier rheumatology appointment given the changed presentation. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Salon manager 'doesn't care' and books difficult clients | The patient's opinion of her employer is not clinical information for the GP. |
| Rheumatologist 'always rushed and never listens' | Looks relevant to the rheumatology request, but passing on a criticism of a colleague is unhelpful. The dates are what support an earlier review. |
| Hair dye stained R splint strap; replacement given | A minor equipment matter already resolved. |
| Hypothyroidism on thyroxine; appendicectomy 1990 | Background history unrelated to the flare, and the GP already knows it. |
| Daughter's wedding 12/26; choir; gardening; family | Personal motivation and leisure detail not needed for the medical review request. |
A paragraph plan for this case
Begin with the purpose: an update on therapy and a request for medical review. Follow with a short paragraph on therapy delivered and its gains, then a paragraph on the flare findings, work impact and ibuprofen use. End with the specific requests and the OT review in 6 weeks.
Where candidates slip on this task
- Keep the two parts clear: therapy has helped function, but the joints have worsened over 4/52 on examination. Do not let the positive outcome blur the request for medical review.
- Label evidence correctly: the work rating is self-rated, and the missed-dose information is the patient's report. Do not present either as objectively verified.
- State the requests precisely: review of medical management of the flare, and consideration of an earlier rheumatology review, with the existing 02/27 appointment mentioned for context.
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 Occupational Therapy letter tasks
- Falls risk and carer strain in Parkinson's disease update letter
- Home safety follow-up after wrist fracture referral letter
- Transfer of care for a child with developmental coordination disorder referral letter
Your profession's guide: OET Occupational Therapy. Layout and structure: OET letter format.
Questions about this task
Is the ibuprofen worth including?
Yes. She has moved from occasional use over the past 3/52 to most days, which is relevant to the GP's review of her management. Report it as recorded without adding conclusions about its effect.
How much therapy detail does the GP need?
A concise outline: six sessions, education, night splints, adapted tools, and the functional gain. The GP's decision depends mainly on the flare findings, so most space should go there.
Sources
Last checked 22 Oct 2026. Rules and prices change: confirm on the official page before you book or apply.
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