Medicine — Complex Discharge of a Multimorbid Patient
A doctor discharges an 84-year-old man with several chronic conditions, a new diagnosis and a long medication list to his GP. This is a proficient case: the notes are dense and full of distractors, and the challenge is ruthless selection of what the GP must act on within a 180 to 200 word letter.
Letter type
Discharge
Write to
General Practitioner
Target length
180–200 words
The case notes
Patient: Mr Walter Nuhu, 84 years old, lives with wife
Admission: 10-day admission with a fall and reduced mobility; found to have a new diagnosis of atrial fibrillation
New issues: Atrial fibrillation; started on apixaban 5 mg BD and bisoprolol 2.5 mg OD
Investigations: ECG: AF, rate controlled. Bloods: eGFR 48 (stable); Hb 11.2; TSH normal
Existing conditions: Type 2 diabetes, COPD, osteoarthritis, benign prostatic hyperplasia, mild heart failure
Medication changes: Apixaban and bisoprolol started; furosemide dose unchanged; metformin continued; tamsulosin continued
Function / falls: Physiotherapy assessed; walking with a frame; falls clinic referral made; home hazard review arranged
Follow-up: GP to recheck renal function in 1 week (new apixaban); repeat ECG in 6 weeks; falls clinic to follow up
Social: Wife is main carer; daughter lives nearby; package of care increased to twice daily
Incidental: Long-standing tinnitus, unchanged; old healed ankle fracture noted on imaging
Task: Write a discharge letter to the GP, Dr Mensah, summarising the admission and the priorities for ongoing care.
Writing task
Write a discharge letter to the GP, Dr Mensah, summarising the admission and the priorities for ongoing care.
What to include, what to cut
The hardest mark to win is selection. The same case notes contain decision-relevant facts and distractors. Here is what an examiner expects to see in a Grade B letter for this scenario, and what should be left out.
Include
-
The new atrial fibrillation and the two new medicines
The single most important hand-over: a new anticoagulant in an elderly patient drives the GP's monitoring.
-
The renal recheck in 1 week and the repeat ECG
Time-bound GP actions tied directly to the new apixaban and rate control; safety depends on them.
-
The falls outcome: frame, falls clinic, home review
The fall was the reason for admission; the ongoing falls plan is decision-relevant to the GP.
Leave out
-
Stable chronic conditions and unchanged medicines
Acknowledge them briefly, but the GP already manages these; detailing each one crowds out the new priorities. Proficient selection means resisting the urge to list everything.
-
Tinnitus and the old healed fracture
Genuine distractors — incidental, unchanged, and irrelevant to the discharge. Including them is the classic proficient-level trap.
Criterion in focus · Conciseness & Clarity
Proficient cases pile on distractors precisely to test selection under the word limit. With this much in the notes, the difference between Grade C and Grade B is what you leave out: lead on the new AF and its monitoring, and cut the incidental findings entirely.
Now write the letter — and find out what is blocking your Grade B
Write a 180–200 words discharge letter from these notes, paste it into the free checker for an instant read, then submit it for a human grade against all six criteria. Dr Mariam's team returns line-by-line feedback, from $12.