OET MEDICINE HELPLINE
OET MEDICINE PREPARATORY COURSE
BY
Dr MAHEDI HASAN SABBIR
MBBS (DMC, BANGLADESH)
WHATS APP NO- +8801749820313
WRITING SUBTEST
MODULE-1
BASIC STRUCTURE
&
Analysis of Referral Letter
Case Analysis
✓ First we will see to whom this letter will be referred
✓ Then we will select appropriate case notes
✓ After that we will transfer case note into letter format
✓ Then we will structure our letter within 180-200 words
✓ We will avoid irrelevant case note
✓ We will check and double check our letter after completing out
letter
✓ Our main target will be to fulfil all the Six criteria
➢ Purpose(Final Diagnosis/main symptoms)
➢ Content (Relevant Case Note)
➢ Conciseness and clarity(Avoid Irrelevant case note)
➢ Genre and Style (Formal word, No Symbol, No word contraction, Clinical, Precise,
Non Judgmental)
➢ Organization and layout (Proper Structure, Writing most relevant information
first)
➢ Language (Grammatical facts, Vocabulary, Punctuation, Cohesion, Spelling)
A Writing template
1. Doctor's name
2. Speciality
3. Name of Hospital and address
1. Address 4. Today's date
5. Dear (Doctor's last name)
6. Re: (patient's full name) D.O.B/Age(if DOB notgiven)
1. Normally two sentences.
2. Introduction 2. Mainly maintain the purpose of referral, and urgency
1.Complaints &Symptoms
3.Body part 1 2.Examination finding
(Initial relevant visit) 3.Treatment:
Prescription/advice/investigation/reviewschedule
1. Condition(improve/deterioration)/ new symptom
4.Body part 2 2. Examination finding
(subsequent visit) 3. Investigation results
4. Further changing any medication/ add any
advice/recommendation
1. Final condition
5.Body part 3 2. Final investigation findings
(Final/ Today’svisit) 3. Final assessment
4. Final treatment and plan
1. Personal history (marital status/smoker/alcholic/profession)
6.Body part 4 2. Medical history
3. Medication history
4. Family history
5. Allergy history
1. In view/light of the above, I believe X is/has been suffering
7.Conclusion from Y disease
2. It would be highly appreciated if you could assess his/her
and manage his/her condition including/regarding special
request.
3. Should there be any queries, please do not hesitate to
contact me.
➢ In case of given referred Doctor’s name
8.Closing Yours sincerely,
Doctor
➢ In case of not given referred Doctor’s name
Yours faithfully,
Doctor
Organization of letter always depends on Case note. Following are some structure-
a. In case of Single Visit –
1. Address
2. Introduction
3. Today’s Visit
4. Body part 4
5. Conclusion
6. Closing
b. In case of Double Visits-
1. Address
2. Introduction
3. Initial/ Today (which one is more relevant visit)
4. Today/initial (which one is less relevant visit)
5. Body part 4
6. Conclusion
7. Closing
c. In case of More Than Two visits-
1. Address
2. Intro
3. Today
4. Initial + subsequent
5. Body Part 4
6. Conclusion
7. Closing
Or
1. Address
2. Intro
3. Initial
4. subsequent
5. Today
6. Body Part 4
7. Conclusion
8. Closing
Let's start our case note
Address
1.Doctor's name Dr Leigh Waters
2.Speciality Surgeon
3.Name of the Hospital & address Stillwater Private Hospital
54 Main StreetStillwater
4.Today's Date 24.02.2018
5.Dear (Doctor’s last Nm) Dear Dr Waters,
6.Re: Pt name D.O.B/Age Re: Mrs Carol Potter D.O.B:30.12.1947
In letter, we will write,
Dr Leigh Waters
Surgeon
Stillwater Private Hospital
54 Main Street
Stillwater
24.02.2018
Dear Dr Waters,
Re: Mrs Carol Potter, D.O.B: 30.12.1947
Introduction
You will select following particular from case note to arrange your
introduction part-
1. Patient's last name
2. Patient age( if not given u can calculate it from D.O.B)/ you can also avoid this.
3. Profession
4. Final assessment/diagnosis/ cause of referral
5. Any specific request
In this case note-
1.Patient’s last name Mrs Potter
2.Patient's age 70 years
3.Profession Retired administrative assistant
4.Final assessment/ diagnosis/ cause of Worsening osteoarthritis
referral
5.Specific request Possible knee joint replacement
In letter we will write-
I am writing to refer Name of patient, a/an pt's age -year-old pt's profession, whose
features are suggestive of diagnosis/final assessment. Your further assessment and
management including/regarding special request would be highly appreciated.
For this case-
I am writing to refer Mrs Potter, a 70-year-old retired administrative assistant, whose
features are suggestive of worsening osteoarthritis. Your further assessment and
management regarding possible knee joint replacement would be highly appreciated.
Body Part 1 (Initial relevant visit)
You will select following particular from case note to arrange your
Body Part 1 -
1. Complaints & Symptoms
2. Examination finding
3. Treatment -Prescription/advice/investigation/review schedule
In this case note-
1. Increase pain in left knee with walking for last 12
months. Now quite severe -not relieved by regular
Panadol Osteo. Pain can even occur at rest after a
1. Complaints & Symptoms long walk.
2. No joint swelling/No recent injury/ right knee-some
pain on walking, not nearly as bad as left knee
1. Evidence of decrease ROM of left knee due to
pain
2. Examination finding
2. No swelling
3. Tender to pressure along joint
1. Prescription: pain relief - naproxen 250mg b.d
2. Advice: not given
3. Investigation: X-ray of left knee, Blood tests
3. Treatment 4. Review schedule: Tomorrow - discuss results.
In this letter-
Initially, Mrs Potter visited me with the complaint of increased intensity of pain in his left
knee for the last one year which was aggravated by walking despite taking analgesic and rest.
She also reported pain in the right knee which was less severe than the left knee. On
examination, limited range of movement of the left knee and tenderness on pressure along
the joint were found. Hence, naproxen was prescribed and an X-ray of left knee together with
blood tests were ordered.
Important note:
1. When you write prescription notes- please try it into passive form ex- “I prescribed naproxen” should
write- naproxen was prescribed. Same thing is applied for investigations and advice.
2. when you write about examination findings you can write-= His / Her physical examination was normal
apart from (positive finding)
Body Part 2 (Subsequent visit)
In this case we have no subsequent visit.
Body Part 3 (Final visit)
You will select following particular from case note to arrange your
Body Part 4-
1. Final condition
2. Final investigation findings
3. Final assessment
4. Final treatment and plan
In this case note-
1. Final condition Nothing is said here.
1. X-ray: Evidence of sever OA in Left knee- osteophyte
2. Final Investigation finding and
loss of joint . Patella appears normal. No evidence of
space
fracturs
2. Blood: FBE, UEC (normal)
3. Final assessment Worsening OA
1. Arrange physiotherapy
4. Final Treatment and Plan 2. Increase dose of analgesia
In this letter-
Today, Mrs Potter's X-ray revealed the features of severe osteoarthritis including presence
of osteophytes and loss of joint space without any evidence of fracture. Her blood tests
were normal. Therefore, physiotherapy was arranged and dose of analgesic was
increased.
Body Part 4
You will select following particular from case note to arrange your
introduction part-
1. Personal history(marital status/smoker/alcoholic/profession)
2. Medical history
3. Medication history
4. Family history
5. Allergy history
In this case note-
Personal history 1.Marital history-not given
1. 2.smoker/alcoholic- not given
3.Profession- Administrative Assistant (retired)
[already given in introduction]
2. Medical History 1. Osteoarthritis of hands & knees-2008
2. Hypertension- well controlled – 2015 )
3. Skin cancer removed- 2016(not relevant here
4. Intermittent Insomnia - 2 years-2016
5. Intermittent UTIs 2016
3. Medication History 1.2. Ramipril 5 mg daily
3. Panadol Osteo 2 tabs daily
Temazepam10
mg nocte p.r.n
4. Family History Mother – Breast cancer( not relevant)
5. Allergy History Not given
In this letter-
In terms of Mrs Potter’s medical history, she had been diagnosed with osteoarthritis and
hypertension in 2008 and 2015 respectively. In addition, she has history of intermittent
insomnia and UTI. Her current medications include ramipril, Panadol Osteo and temazepam.
Please note-
1. If drug name is written in Brand name, you must write the first letter of that brand name in
Capital letter. If drug name is written in generic name, you must write the first letter of that
generic name in small letter except it places the the beginning of the sentence.
2. If he/she is allergic to anyone , you can write- Please note, he/she is allergic to X/Y/Z
Conclusion
You will select following particular from case note to arrange your
Conclusion-
1. In view/light of the above, I believe X is/has been suffering from Y disease
2. Your further assessment..... include any specific request
3. Should there be any queries, please do not hesitate to contact me.
In this letter-
In light of the above, I believe Mrs Potter has been suffering from worsening OA. It would be highly
appreciated if you kindly see her and assess her for possible knee joint replacement surgery. Should
there any queries, please do not hesitate to contact me.
Closing
Yours sincerely,
Doctor
NOW COMPLETE THE LETTER
Dr Leigh Waters
Surgeon
Stillwater Private Hospital
54 Main Street
Stillwater
24.02.2018
Dear Dr Waters,
Re: Mrs Carol Potter, D.O.B: 30.12.1947
I am writing to refer Mrs Potter, a 70-year-old retired administrative assistant, whose features are
suggestive of worsening osteoarthritis. Your further assessment and management regarding possible
knee joint replacement surgery would be highly appreciated.
Initially, Mrs Potter visited me with the complaint of increased intensity of pain in his left knee for the
last one year which was aggravated by walking despite taking analgesic and rest. She also reported pain
in the right knee which was less severe than the left knee. On examination, limited range of movement
of the left knee and tenderness on pressure along the joint were found. Hence, naproxen was prescribed
and an X-ray of left knee together with blood tests were ordered.
Today, Mrs Potter's X-ray revealed the features of severe osteoarthritis including presence of
osteophytes and loss of joint space without any evidence of fracture. Her blood tests were normal.
Therefore, physiotherapy was arranged and dose of analgesic was increased.
In terms of Mrs Potter’s medical history, she had been diagnosed with osteoarthritis and hypertension
in 2008 and 2015 respectively. In addition, she has history of intermittent insomnia and UTI. Her current
medications include ramipril, Panadol Osteo and temazepam.
In light of the above, I believe Mrs Potter has been suffering from worsening OA. It would be highly
appreciated if you kindly see her and assess her condition for possible knee joint replacement surgery.
Should there any queries, please do not hesitate to contact me.
Yours sincerely,
Doctor
