OET Case Notes: Speech Pathology Dysphagia Referral (Beginner)
A speech pathologist writes to an ENT surgeon requesting videofluoroscopy for a 58-year-old with two months of progressive solid-food dysphagia. This is a clean beginner referral: one presenting problem, one investigation requested, and clear clinical background. A good starting case for practising concise, purposeful medical letters.
Letter type
Referral
Write to
ENT Surgeon
Target length
180–200 words
The case notes
Patient: Mr Thomas Park, 58 years old
Referral source: GP referral following two months of worsening difficulty swallowing
Presenting complaint: Progressive dysphagia to solids; no difficulty with liquids; occasional coughing after eating
Assessment: Oro-pharyngeal assessment normal; no oral weakness; laryngeal function intact clinically
Dietary modification: Currently IDDSI Level 5 (soft diet); maintaining adequate oral intake
Weight: 3 kg loss over 2 months (82 kg down to 79 kg)
Social history: Non-smoker; social alcohol; employed as school teacher
Clinical impression: Possible pharyngeal-phase dysphagia or structural lesion; clinical assessment insufficient to exclude
Investigation requested: Videofluoroscopy (modified barium swallow) to evaluate pharyngeal phase
Writing task
Write a referral letter to ENT surgeon Dr Sandra Ali requesting a videofluoroscopy for Mr Park, summarising your assessment findings and the reasons for referral.
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
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The nature and timeline of the dysphagia (progressive, solids only, 2 months)
The pattern of dysphagia is the most important diagnostic detail. Progressive solid dysphagia with liquid sparing points toward a structural cause — the ENT surgeon needs this to triage the referral appropriately.
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Your clinical assessment findings and their limits
Stating what you ruled out (oral weakness, laryngeal dysfunction) explains why instrumental investigation is needed and gives the surgeon a clinical baseline.
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The specific investigation requested and why
Purpose requires clarity. 'Videofluoroscopy to evaluate pharyngeal phase' is more informative than a generic 'further investigation'.
Leave out
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The patient's pre-illness weight
Mention the weight loss and current weight — but the pre-illness figure is not clinically necessary for this referral and uses words the word count does not allow.
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An explanation of IDDSI levels
ENT surgeons understand dietary modification codes. Explaining Level 5 treats the recipient as uninformed and wastes the letter's register.
Criterion in focus · Purpose
Purpose is assessed in the opening sentences. The examiner should know in the first 25 words who the patient is, what you are asking for, and why. 'I am writing to request videofluoroscopy for Mr Thomas Park, 58, who presents with two months of progressive solid-food dysphagia' earns the Purpose mark. A vague opener such as 'I am writing with regard to the above patient' does not.
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.