OET Writing: Referral vs. Discharge Letter Structure

The OET Writing sub-test is a 45 minute assessment designed to simulate real-world clinical communication. Unlike general English tests, you are not being asked to write a creative essay. You are being asked to act as a professional healthcare provider. The test provides you with a set of case notes. You must then synthesize these notes into a formal letter. The most common letter types are referral letters and discharge letters. While they share a similar formal layout, their internal organization differs based on what the recipient needs to know.

In a referral scenario, you are usually sending a patient to a specialist or another department for an opinion, a procedure, or urgent management.

In a referral letter, your first paragraph must state the "Why" immediately. For example: "I am writing to refer Mr. Smith for urgent cardiac evaluation following a suspected myocardial infarction." The recipient needs to know the level of urgency within the first two sentences.

When reviewing OET writing questions for referrals, you will notice many historical details in the case notes. For a referral, you should prioritize:

• Current presenting symptoms and their severity.
• Relevant clinical findings from recent examinations.
• Specific medications or treatments initiated during the current consultation.
• The specific request for the specialist (e.g., "I would appreciate your urgent assessment").

A discharge letter is typically sent from a hospital setting back to a General Practitioner (GP) or a community health nurse. The recipient already knows the patient but needs to know what happened while they were away.

While a referral letter is often organized by "Clinical Importance," a discharge letter often follows a more chronological OET Writing structure. You should summarize:

• The date and reason for admission.
• The course of treatment in the hospital (e.g., "Mr. Jones underwent a total hip replacement on 12 April").
• Any complications or significant changes in health status during the stay.

The final section of a discharge letter is the most critical for the recipient. You must clearly outline the ongoing management plan. This includes medication changes, wound care instructions, and scheduled follow up appointments.

The OET assessment criteria for "Conciseness and Clarity" depend entirely on your recipient. Before you start writing, ask yourself: "What does this person already know, and what do they need to do?"

Practicing with OET writing sample questions is the only way to master the art of information selection. In many samples, you will be given 2 pages of case notes but only have a 200 word limit.

This "information overload" is intentional. The examiners are testing whether you can identify what is "clinically relevant." If you include a patient's childhood chickenpox in a referral for a broken leg, you will lose marks for content and conciseness.

• Use the 5 Minute Reading Time: Do not pick up your pen. Use this time to identify the recipient and the primary purpose of the letter.
• Group Your Information: Use thematic paragraphs. For example, have one paragraph for "Social History" (if relevant) and another for "Current Medications."
• Avoid the "Note-Taking" Style: Do not write in fragments. Use full sentences and professional transitions like "Consequently," "In addition to," and "Despite this."
• Check Your Word Count: Aim for 180 to 200 words. If you are significantly over, you likely haven't filtered the case notes well enough.

To get the most realistic experience before your test, we recommend using a structured OET Practice Test and Study Guide that mimics the actual exam conditions you will face.