The task
Assume that today's date is 22 October 2026. Mrs Farquhar's videofluoroscopic swallow study was completed two days ago.
You are a speech pathologist in the outpatient speech pathology department of the local hospital. Using the information in the case notes, write a letter to Mrs Farquhar's GP, Dr Rahul Fordyce, updating him on the results of her swallow study and your recommendations, and asking him to review her medications. Address the letter to Dr Rahul Fordyce, General Practitioner, Family Medical Practice, 22 Main 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 Isla Farquhar
- DOB: 03/05/1947 (79 yrs)
- Address: Unit 4, 15 High Street
- Referred by GP (Dr Rahul Fordyce) 2/12 ago: ? swallowing problem — recurrent chest infections
Social background
- Lives with daughter (52), who prepares meals and manages medications
- Retired primary school teacher; plays bridge weekly
- Son lives overseas; daughter says her brother 'never helps with anything'
- Daughter works part-time from home
Medical history
- Recurrent chest infections: 3 episodes in last 6/12, each treated with oral antibiotics by GP
- R CVA 2022 — mild residual L arm weakness
- Type 2 diabetes — metformin 1 g BD (large tablet)
- Hypertension — perindopril daily
- Osteoporosis — calcium carbonate/colecalciferol tablet daily (large tablet)
- Low potassium — slow-release potassium chloride tablet BD (large; must not be crushed)
- Bilateral cataract surgery 2015
- Allergies: nil known
Speech pathology assessment
- Clinical swallow assessment 06/10/26: no cough on thin fluids; mildly wet voice after drinks
- Full upper and lower dentures — fit well
- Daughter reports: pt takes tablets one at a time with several mouthfuls of water; large tablets 'feel stuck'; sometimes found left in mouth
- Videofluoroscopic swallow study (VFSS) 20/10/26
- VFSS: silent aspiration of thin fluids (no cough response); delayed swallow initiation
- VFSS: no aspiration with mildly thick fluids (IDDSI Level 2); soft & bite-sized solids (IDDSI Level 6, current diet) cleared well — no change needed
- VFSS: barium test tablet held in throat; cleared only after several swallows
- Pt complained about long wait in radiology waiting room
Treatment/Progress
- All fluids → mildly thick (IDDSI Level 2); thickener supplied; daughter trained in preparation
- Sit fully upright for all food, fluids and medications and for at least 30 min after
- Single small sips from a cup; no straws
- Oral hygiene incl. dentures twice daily to ↓ risk of aspiration pneumonia
- Pt initially reluctant — dislikes taste/texture of thickened drinks; agreed to trial
- Risk of ↓ fluid intake on thickened fluids → dehydration
Plan
- URGENT GP medication review with pharmacist (metformin, calcium/vitamin D, potassium chloride SR) — consider smaller or alternative forms; SR potassium must not be crushed
- 22/10/26: phoned GP practice & community pharmacist → same-day medication-specific administration plan needed before further doses of large tablets; daughter informed. Any new form/vehicle must suit assessed swallow (thin liquid medicines not automatically safe)
- GP to monitor chest and hydration; daughter to keep daily fluid intake chart
- Daughter advised: fever, ↑ breathlessness or productive cough → see GP promptly
- SP home review 4/52 — check acceptance of thickened fluids; repeat VFSS PRN
Who is reading, and what do they need?
Dr Fordyce referred Mrs Farquhar for suspected swallowing problems with recurrent chest infections. He now needs the study result, the diet and fluid changes in place, and a clear request about her large tablets with the time pressure. He knows her history, so keep to findings and actions.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Referred for ?swallowing problem; 3 chest infections in 6 months | Anchors the letter to the GP's referral question and the reason for the study. |
| VFSS: silent aspiration of thin fluids, delayed swallow initiation | This is the key result that drives the fluid change and the medication request. |
| Mildly thick fluids and Level 6 solids: no aspiration, solids cleared; no diet change | Tells the GP what is currently safe on study and that solids do not need changing. |
| Barium tablet held in throat; large tablets 'feel stuck', sometimes left in mouth | Explains why medicine form is a swallowing problem as well as a medication one. |
| Metformin, calcium/colecalciferol, slow-release potassium chloride are large; SR must not be crushed | Names the three tablets to review and the crushing restriction. Other medicines, such as perindopril, are not flagged. |
| Urgent review with pharmacist; same-day plan needed before further large-tablet doses | This is the core request, and the time pressure comes from the call made today to the practice and pharmacist. |
| Any new form must suit assessed swallow; thin liquid medicines not automatically safe | Prevents the GP substituting a thin liquid that would still carry aspiration risk. |
| Fluids mildly thick, upright posture, daughter's intake chart, GP monitor chest and hydration, review 4 weeks | Shows the management in place and the dehydration risk the GP is asked to watch. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Son overseas 'never helps with anything' | A family grievance with no clinical relevance. |
| Complaint about long radiology wait | A service complaint, not relevant to results or requests. Trap: it appears in the assessment section. |
| Retired teacher, weekly bridge | Social detail that does not alter swallowing management. |
| Perindopril, cataract surgery 2015, diabetes and CVA history details | The GP already knows these; only the large tablets matter, and the CVA may be compressed. |
| Dentures fit well; clinical assessment finding of mild wet voice | Minor supporting findings that the VFSS result supersedes. |
A paragraph plan for this case
Open with the study result and its link to the referral, then summarise the changes made to fluids and posture. Place the medication problem and the urgent request in its own paragraph, then monitoring, advice given to the daughter and the review date.
Where candidates slip on this task
- Do not call thin liquid medicines safe or suggest crushing the slow-release potassium; the notes say neither assumption holds. Ask for a plan suited to her assessed swallow.
- Convey that the plan is needed before further doses of the large tablets, and that the practice and pharmacist were phoned today. Do not invent instructions about missed or stopped doses.
- If you give the daughter's advice, include all three signs: fever, increased breathlessness and productive cough. Do not claim aspiration caused the chest infections; the notes do not establish that.
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
- Motor neurone disease: progressive dysarthria and dysphagia 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
Is the dehydration risk worth including?
Yes. Thickened fluids may reduce intake, and the GP is asked to monitor hydration. Mention it with the daughter's daily fluid chart as the monitoring tool, rather than as a prediction that dehydration has occurred.
Should I list every medicine she takes?
No. Only the three large tablets named in the plan need review. Listing perindopril or other history would dilute the urgent request and repeat what the GP already knows.
Sources
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