OET Writing practice · Medicine
Chronic low back pain without red flags – physiotherapist
An original practice task written by LetterScore AI. Read the case notes in 5 minutes, then write your referral letter in 40 minutes, about 180–200 words in the body.
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Case notes
MEDICINE — WRITING TASK (practice) Time allowed: Reading time 5 minutes, Writing time 40 minutes Read the case notes below and complete the writing task which follows. Notes: Today's date: 11/09/2026 You are a GP at Moorfield Medical Practice, 9 Station Road, Moorfield. Patient: Mrs Ana Ferreira, DOB 23/05/1983 (43 yrs) Social background: - Hairdresser, own salon; stands 8–9 hrs/day. Has reduced hours to 4 days/week due to pain - Married, son aged 3 yrs. Husband works away Mon–Fri - Non-smoker. Alcohol occasional - Previously swam 2×/week; stopped 4 months ago, fears making back "worse" Medical history: - Hypothyroidism, levothyroxine 75 mcg daily (TSH normal 06/2026) - Two vaginal deliveries (2019, 2023) - Dyspepsia with naproxen (2026) - NKDA Consultation notes: 14/07/2026 - c/o lower back pain × 3 months, gradual onset, no injury. Central lumbar pain, occasionally spreading to R buttock, not below knee - Worse after long days standing and lifting son; eases with lying down - No bladder/bowel change, no saddle numbness, no leg weakness. No fever, no weight loss, no night sweats. No history of cancer - O/E: reduced lumbar flexion, bilateral paraspinal muscle tenderness. Straight leg raise negative bilaterally. Lower limb power, reflexes and sensation normal - Dx: non-specific low back pain, no red flags. Imaging not indicated - Naproxen 500 mg BD × 2 weeks; advice to keep active 04/08/2026 - Stopped naproxen after 5 days: indigestion. Now paracetamol 1 g PRN, partial relief - Pain 6/10, disturbing sleep. Worried about "slipped disc" – reassured - FBC, CRP normal (checked for fatigue) 11/09/2026 - Pain persists (5 months total), 5–6/10. No new symptoms; red flags again absent - Avoids bending, stopped swimming; afraid to lift son – husband away, finding childcare difficult - STarT Back tool: medium risk (fear of movement, low confidence) - Wt 78 kg (Jan 2026: 73 kg), BMI 29 - Mood: frustrated, not depressed (PHQ-2 score 1) - Neuro examination unchanged, normal - Mild R wrist pain (hairdressing), no swelling – advised wrist stretches - Goals: return to swimming, lift son safely, work full week again Plan: - Referral to physiotherapy for assessment and graded exercise/activity programme - Reassurance and education about back pain - Continue paracetamol PRN; avoid NSAIDs (dyspepsia) - GP review in 8 weeks - Advised to return urgently if leg weakness, numbness in groin area, or bladder/bowel problems Writing Task: Using the information in the case notes, write a letter to Mr Jonas Lindqvist, Physiotherapist, Moorfield Physiotherapy Clinic, 58 Canal Street, Moorfield, referring Mrs Ferreira for assessment and treatment. Mr Lindqvist does not have access to Mrs Ferreira's medical records. 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.
How to approach this referral letter
- The reader has never met the patient. State the reason for referral, and how urgent it is, in the first paragraph.
- Select the history, findings and investigation results that support the referral, and group them by topic rather than by date.
- End with what you are asking the reader to do, and any action you have already taken.
Members also get the model answer, the note-selection table and task-specific tips for this task.