OET Writing sample (medicine)
OET urgent referral letter
An urgent referral is read by someone deciding, in seconds, whether to see your patient now. That changes the shape of the letter: the current problem and the action you need come first, and background shrinks to what supports the decision. This guide shows how to signal urgency, what to put first, and works through an original practice task with a model letter.
What makes a referral "urgent"
In practice tasks, urgency is usually signalled in the notes or the task instruction: "urgent", "same-day", "please see today", or a plan that sends the patient straight to the emergency department or an on-call team. Your letter must make that urgency obvious to the reader. OET's criteria guidance on organisation notes that in urgent cases the patient's current status should come first, and the Purpose criterion rewards a reason for writing that is clear from the opening.
The table below compares a routine and an urgent referral. For a full routine example, see the referral letter sample.
| Feature | Routine referral | Urgent referral |
|---|---|---|
| Opening sentence | Patient, problem, what you want | Patient, suspected problem, urgency word, what you want and when |
| Paragraph order | Often chronological: presentation, investigations, management | Current status first, then the findings that justify urgency, then what you have done |
| Background history | Relevant history in moderate detail | Minimal: only what affects immediate management (medications, allergies, key conditions) |
| Timing information | May mention preferred timeframe | Exact times of onset, doses given and how the patient is arriving |
| Closing | Polite request, follow-up offer | Restate the specific action needed now |
Five ways to signal urgency
- Use an urgency word in the first sentence: "urgent", "same-day", "immediate", "today". Do not save it for the last line.
- Name the concern. "Suspected giant cell arteritis with transient visual loss" tells the reader why time matters. "Headache" does not.
- Lead with the most worrying finding. The symptom or result that makes this urgent goes at the start of the second paragraph.
- Give times, not just dates. When symptoms started this morning or a medicine was given an hour ago, the time is clinically useful.
- Say how and when the patient will arrive. "Her daughter is bringing her to the Eye Casualty now" lets the reader prepare.
Original practice task
These notes are fictional and written for practice. Look for the one finding that turns a routine problem into a same-day referral.
MEDICINE — WRITING TASK (practice) Time allowed: Reading time 5 minutes, Writing time 40 minutes Notes: Today's date: 20/10/2026 You are a GP at Lakeside Surgery, 5 Quarry Road, Millbrook. Patient: Mrs Margaret Ellison, DOB 09/01/1953 (73 yrs) Social background: - Widowed, lives alone, 2nd-floor flat with lift - Retired librarian; volunteers at charity shop 2 days/week - Ex-smoker (stopped 1995). Alcohol 1–2 glasses wine/week - Daughter lives nearby; available to drive her today - Holiday to Spain planned December Medical history: - Hypertension (2015): amlodipine 5 mg daily - Type 2 diabetes (2020): metformin 500 mg BD, HbA1c 52 mmol/mol (06/2026) - Osteopenia (DEXA 2023): calcium + vitamin D - Cataract surgery L eye 2022 - Allergy: penicillin (rash) Consultation notes: 14/10/2026 - New R temporal headache x 2 weeks, worse at night - Scalp tender when brushing hair. Tired - Plan: paracetamol PRN; ESR, CRP, FBC 17/10/2026 (results) - ESR 78 mm/hr, CRP 46 mg/L. FBC normal - Review booked 20/10 20/10/2026 - Jaw pain on chewing x 4 days - 08:00 today: "curtain" over R eye ~5 min, resolved - No diplopia. VA R 6/9, L 6/6 - R temporal artery tender, thickened, reduced pulse - BP 148/86, HR 78, T 37.2 - Neuro exam otherwise normal - Flu vaccine due - Assessment: suspected giant cell arteritis with visual symptoms - Prednisolone 60 mg given at surgery 11:15 Plan: - Same-day referral to on-call ophthalmology, Eye Casualty - Hospital to arrange temporal artery US/biopsy - Blood glucose monitoring on steroids - Consider bone protection Writing Task: Using the information in the case notes, write a letter to Dr Helen Okafor, Ophthalmology Registrar on call, Eye Casualty, Millbrook General Hospital, Hospital Road, Millbrook, requesting urgent assessment. Mrs Ellison will take the letter with her today. 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.
Model letter
Dr Helen Okafor Ophthalmology Registrar on call Eye Casualty Millbrook General Hospital Hospital Road Millbrook 20 October 2026 Dear Dr Okafor, Re: Mrs Margaret Ellison, DOB 09/01/1953 I am writing to request urgent same-day assessment of Mrs Ellison, a 73-year-old woman with suspected giant cell arteritis who had transient loss of vision in her right eye this morning. At approximately 8 am today, Mrs Ellison noticed a curtain-like shadow over her right eye, which resolved after about five minutes. Her visual acuity is now 6/9 in the right eye and 6/6 in the left. She has had a right temporal headache with scalp tenderness for two weeks and jaw pain on chewing for four days. On examination, her right temporal artery was tender and thickened, with a reduced pulse. On 17 October, her ESR was 78 mm/hr and her CRP 46 mg/L. I gave her prednisolone 60 mg at 11.15 am. As she has type 2 diabetes treated with metformin, her blood glucose will need monitoring while she is on steroids. She also takes amlodipine for hypertension and is allergic to penicillin. Her daughter is driving her to the Eye Casualty now. I would be grateful if you could assess her today and arrange confirmatory investigations, such as a temporal artery ultrasound or biopsy. Yours sincerely, Dr Lucy Hart General Practitioner Lakeside Surgery
What the model does well
- The first sentence contains urgency, the suspected diagnosis and the red-flag symptom. A registrar triaging the letter knows what to do after one line.
- Current status leads the second paragraph (this morning's visual episode and today's acuity), before the two-week history.
- The treatment already given is timed, so the hospital team knows exactly when steroids started.
- Background is limited to what changes management: diabetes because of steroids, other medication and the allergy.
- The closing repeats the action and says how the patient is arriving.
Content selection table
| Case note | Decision | Reason |
|---|---|---|
| Transient visual loss R eye at 08:00 today | Include first | The finding that makes this urgent. |
| Visual acuity R 6/9, L 6/6 | Include exactly | The ophthalmologist's baseline. |
| Temporal headache, scalp tenderness, jaw pain | Include | Supports the suspected diagnosis. |
| Temporal artery findings | Include | Key examination evidence. |
| ESR, CRP values | Include exactly | Raised markers support the referral. |
| Normal FBC, BP, HR, temperature, neuro exam | Omit or one phrase | Not abnormal enough to change immediate management. |
| Prednisolone 60 mg at 11:15 | Include with time | Essential for the receiving team. |
| Type 2 diabetes, metformin | Include | Steroids affect glucose control. |
| Amlodipine, penicillin allergy | Include briefly | Current medication and allergy are needed for safe care. |
| HbA1c value | Optional | Useful context but not needed for today's decision. |
| Osteopenia, bone protection | Optional | Relevant to longer-term steroid treatment; lower priority today. |
| Cataract surgery L eye | Optional | Eye history may interest an ophthalmologist, but it concerns the other eye. |
| Daughter driving her today | Include | Tells the reader how and when she will arrive. |
| Lives alone, former job, volunteering, alcohol, smoking | Omit | No effect on urgent assessment. |
| Flu vaccine due, holiday in December | Omit | Distractors. |
This selection is a guide, not an official answer key. Assessors look at whether your choices suit the reader and whether the information is accurate.
Common mistakes in urgent referrals
The urgency appears only at the end
"I would be grateful if you could see her urgently" in the last paragraph is not enough on its own. The first sentence should already say "urgent" or "same-day".
Following the order of the notes
Starting with the headache on 14 October and reaching the visual loss in the third paragraph buries the key information. This is the main Organisation & Layout risk in urgent letters.
Too much history
Social background, old surgery and unrelated conditions slow the reader down. In an urgent letter, if a fact does not change what happens in the next few hours, it is probably not needed.
Forgetting what you have already given
Omitting the steroid dose and time is a Content problem: the receiving team could repeat or delay treatment.
Note form under time pressure
"VA R 6/9. Temporal artery tender +++" is how the notes look, not how a letter reads. Keep full sentences even when the content is urgent. See common OET Writing mistakes.
Useful phrases for urgent referrals
- "I am writing to request urgent same-day assessment of…"
- "I would be grateful if you could see Mr X today, as…"
- "Of particular concern is…"
- "I have given… at [time] and arranged for him to attend the emergency department immediately."
- "She is being brought to the department by her daughter and should arrive within the hour."
Phrases help, but assessors also value openings tailored to the patient rather than a memorised template. Adapt them to each case.
Frequently asked questions
Where should urgency go in an OET referral letter?
In the first sentence, together with the patient and the suspected problem. Repeat the specific action and timing in the closing paragraph.
Should an urgent referral be chronological?
Usually not. Start with the patient's current status and the finding that makes the case urgent, then add supporting history and what you have already done.
How much background should I include in an urgent letter?
Only what affects immediate management, such as current medications, allergies and conditions that change treatment. Social details and old history are usually omitted.
Is this an official OET task?
No. The patient, clinicians and notes are fictional and were written by LetterScore AI for practice. Use official OET materials for authentic samples.