Medicine — Referral to Gastroenterology
A doctor receives case notes for a 62-year-old man with two months of rectal bleeding and weight loss, and must refer him urgently to gastroenterology. This is a classic Purpose-led referral: the suspected diagnosis and red-flag symptoms must lead, and most of the social history must be cut.
Letter type
Referral
Write to
Gastroenterologist
Target length
180–200 words
The case notes
Patient: Mr Colin Hartley, 62 years old, retired teacher
Presenting complaint: 8-week history of fresh rectal bleeding mixed with stool; looser, more frequent motions
Associated: Unintentional weight loss 6 kg over 3 months; fatigue
Examination: Pale conjunctivae; soft abdomen, no mass; PR: no haemorrhoids, trace fresh blood
Investigations: Hb 9.8 g/dL (microcytic); ferritin low; faecal immunochemical test positive
Medical history: Type 2 diabetes (diet-controlled), osteoarthritis (knees)
Family history: Father — bowel cancer, diagnosed age 70
Medication: Paracetamol PRN; no anticoagulants
Social: Ex-smoker (quit 10 years ago), lives with wife, gardens daily
Task: Write a referral letter to Dr Anita Rao, Gastroenterologist, requesting urgent assessment and colonoscopy for suspected colorectal malignancy.
Writing task
Write a referral letter to Dr Anita Rao, Gastroenterologist, requesting urgent assessment and colonoscopy for suspected colorectal malignancy.
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
-
Suspected colorectal cancer, stated up front
Purpose is graded first. The recipient must know in the opening sentence why this referral is urgent.
-
Red-flag triad: rectal bleeding, weight loss, iron-deficiency anaemia
These are the findings that justify an urgent (not routine) referral. Content marks reward clinically decisive selection.
-
Positive FIT and the low Hb / ferritin
Objective evidence that moves the recipient to act; far more relevant than the examination of the knees.
-
Father's bowel cancer at 70
Family history changes pre-test probability — a genuine reason to escalate, so it earns its place.
Leave out
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Osteoarthritis and paracetamol use
No bearing on the colorectal referral. Including it dilutes the purpose and costs Conciseness & Clarity marks.
-
Occupation, gardening, ex-smoker status
Background colour, not decision-relevant. The single biggest Grade B blocker is over-inclusion of this kind of detail.
Criterion in focus · Purpose
Under the 2026 stricter scoring, a referral that buries the suspected diagnosis below background history loses Purpose marks even when every fact is present. Lead with why you are writing.
Now write the letter — and find out what is blocking your Grade B
Write a 180–200 words referral 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.