The task
Assume that today's date is 22 October 2026. You reviewed Mrs MacAulay at home yesterday.
You are a speech pathologist in the community rehabilitation team. Using the information in the case notes, write a letter to Dr Lachlan Zielinska, the treating neurologist, updating him on Mrs MacAulay's speech and swallowing and requesting a timely discussion about enteral feeding. Address the letter to Dr Lachlan Zielinska, Consultant Neurologist, Neurology Outpatient Clinic, Hospital Road. 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 Wen MacAulay
- DOB: 14/03/1968 (58 yrs)
- Dx: motor neurone disease (bulbar onset), diagnosed 02/2025
- Referred by Dr Zielinska; SP review since 03/2025; last update to neurologist 07/2026
Social background
- Lives with husband, who prepares all meals; 2 adult children live interstate
- Former primary school teacher; previously sang in community choir
- Husband frustrated by wait for home modifications — says local council is 'useless'
- Pt keen to remain at home and to stay involved in all decisions about her care
Medical history
- Riluzole 50 mg BD
- Hysterectomy 2009
- Mild R hand weakness — typing slower but accurate
- Respiratory physician review 09/26: mild ↓ in respiratory function; NIV not yet required
- Allergies: nil known
Speech assessment 21/10/26
- Speech slow, hypernasal, imprecise consonants; ↑ fatigue later in day
- Intelligibility to unfamiliar listeners ↓ from ~80% (07/26) → ~40%
- Husband understands most speech; pt no longer able to manage phone calls using natural speech alone
- Pt reports frustration; avoiding social outings
Swallowing
- Before 14/10: coughing with thin fluids at most meals; wet voice after drinks
- Mealtimes ↑ from ~20 min → 45–60 min; fatigue → often leaves meals unfinished
- Weight 64 kg (07/26) → 58 kg (21/10/26) — ~9% loss over 3/12
- VFSS 14/10/26: silent aspiration of thin fluids; pharyngeal residue with solids
- Diet since 14/10: IDDSI Level 5 minced & moist; Level 2 mildly thick fluids
- Chest infection 08/26 treated by GP with oral antibiotics — ?aspiration
- Pt says previous speech pathologist 'never explained anything'
- Husband trained in fluid thickening and choking first aid
Communication device
- 6/52 trial of text-to-speech app on tablet (loan from equipment library) completed
- Uses device independently for phone calls and with strangers; prefers speech with husband
- Message banking of familiar phrases completed 2025 — loaded onto device
- NDIS application for own device submitted 10/26
Enteral feeding
- Pt and husband raised tube feeding at session; pt wishes to discuss with neurologist; undecided
- Pt anxious about procedure; requested written information
- Dietitian review 16/10: thickened high-energy supplements commenced; supports early gastrostomy discussion
Plan
- Request neurologist review soon to discuss gastrostomy, before further ↓ weight and respiratory function
- SP: fortnightly home visits; review swallow and device use; strategies — upright for meals, small sips, rest before meals
- Daughter's wedding 12/26 — pt hopes to give a speech using device
Who is reading, and what do they need?
Dr Zielinska is the treating neurologist who received the last update in 07/2026. He needs the change since then, objective swallowing and weight data, her current wishes about tube feeding, and a clear, time-sensitive request. He knows the diagnosis and medication, so detail should focus on change.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Intelligibility to unfamiliar listeners fell from about 80% (07/26) to about 40% | Gives the objective change since the last update that the neurologist will act on. |
| Hypernasal, imprecise speech; fatigue later in day; cannot manage phone calls by speech alone | Shows functional impact and why the communication device matters. |
| VFSS 14/10: silent aspiration of thin fluids, pharyngeal residue with solids | The key swallowing result that underpins the feeding discussion. |
| Weight 64 kg to 58 kg, about 9% over 3 months | Objective nutritional decline supporting the request for timely review. |
| Meals now 45–60 minutes, often unfinished; IDDSI Level 5 and Level 2 since 14/10 | Shows effort and intake problems and the diet already modified. |
| Chest infection 08/26 treated with oral antibiotics, ?aspiration | Relevant to the aspiration picture, and must be recorded as queried, not confirmed. |
| Device trial completed; independent use for calls and strangers; NDIS application submitted | Summarises the communication outcome briefly and shows a device solution is in progress. |
| Wants to discuss tube feeding with neurologist, undecided, anxious, wants written information; dietitian supports early discussion | This is the reason for the letter and the patient's current position, which the neurologist needs before the consultation. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Husband says council 'useless' over home modifications | A complaint outside the neurologist's request and unrelated to speech or swallowing. |
| Previous speech pathologist 'never explained anything' | Criticism of another clinician; it adds nothing to the clinical request. |
| Daughter's wedding in 12/26; hopes to give a speech | Trap: a meaningful goal, but it does not support the request for a feeding discussion, so it may be omitted or only briefly noted. |
| Hysterectomy 2009, mild R hand weakness, former teacher and choir | Not relevant to the update or request; the neurologist already knows the history. |
| Riluzole dose; respiratory review detail beyond mild decline | The treating neurologist already prescribes and knows these; at most a brief mention of respiratory status is needed. |
A paragraph plan for this case
Start with the purpose and the request for timely review, then report speech changes and the communication device. Follow with swallowing, weight and diet findings, then her wishes about feeding and the ongoing plan.
Where candidates slip on this task
- Do not present the patient as having decided on tube feeding. She is undecided, anxious, wants to discuss it with the neurologist and has asked for written information.
- Report the weight change as given (64 kg to 58 kg, about 9% over 3 months) and link the urgency to avoiding further falls in weight and respiratory function, without predicting outcomes.
- State the chest infection as possible aspiration only. Note that NIV is not yet required and respiratory function shows a mild decrease, without overstating respiratory status.
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 Speech Pathology letter tasks
- Silent aspiration on swallow study: update on fluid and medication changes update letter
- Transfer of care: developmental language disorder, family relocating referral letter
- Vocal nodules: referral for voice therapy closer to home referral letter
Your profession's guide: OET Speech Pathology. Layout and structure: OET letter format.
Questions about this task
Should I mention the husband's training?
Briefly at most. His training in fluid thickening and choking first aid shows home capacity for the current diet, but the focus should stay on the objective decline and the request for a timely feeding discussion.
Is the wedding speech worth including?
It is a personal goal, not evidence for the request. Unless words allow a very brief note about the device's value, leave it out and use the space for swallowing, weight and the patient's wishes about tube feeding.
Sources
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