Decoded: One System for Medicine Referrals and Discharges
Problem: candidates write referrals and discharges the same way — yet one argues forward and the other hands over. Answer in brief: learn one system with two modes: referral mode (question + evidence) and discharge mode (course + ongoing + red flags). Below: the system, both modes, demonstrations, eight tasks and FAQs — grounded in OET Medicine Writing Decoded by Jobin Thomas.
Learning outcomes
By the end you will be able to: run the shared preparation system; switch between referral and discharge modes; and verify mode-correctness before submitting. System follows the source book.
The shared system
Both modes share preparation: parse reader and decision, harvest by category, rank by safety, draft to structure, verify. The modes diverge at structure and emphasis — same engine, different gears. Learn the shared system once, then the two mode maps.
Referral mode: question + evidence
Structure: purpose with explicit question → background capsule → evidence arranged for the question (supporting first, exclusions that narrow) → interim management → precise request. Every paragraph serves the question; background beyond one capsule paragraph is ballast. The request names triage, assessment or advice — never “opinion” alone.
Discharge mode: course + ongoing + red flags
Structure: admission reason (one line) → hospital course (what was done, what changed) → current status (function + clinical) → ongoing plan (medications, follow-up owners, dates) → red flags with action (“return if…”, “contact…”). Discharge readers act on handover completeness — missing owners or dates fail the mode.
Demonstrations (newly written)
Labelling: both demonstrations are newly written with fictional cases.
Discharge demo (newly written, ~185 words)
“Dear Dr Mensah, Thank you for referring Mr Boateng, aged 68, admitted with community-acquired pneumonia (CURB65 score 2). He received five days of intravenous co-amoxiclav, stepped down to oral therapy completed yesterday, with defervescence by day three and CRP falling from 210 to 34. Oxygen requirements resolved; he mobilises independently. Comorbid type 2 diabetes remained stable on existing metformin. He is discharged today on no new regular medication. Please arrange a chest X-ray in six weeks to confirm resolution and review his smoking cessation referral, already sent. He has been counselled to re-present with recurrent fever, worsening breathlessness or haemoptysis, and to complete his diabetes annual review due next month. I will follow the outstanding sputum culture and contact you should it grow anything significant. Yours sincerely, Medical Registrar.” Note: course, status, owners, dates, red flags — handover complete.
Mode check (newly written)
Same case, wrong mode: a discharge written as referral (“I suspect pneumonia, please assess”) leaves the GP with no course or plan — mode mismatch fails regardless of language quality. Check mode before drafting, not after.
Practice bank: 8 tasks with answers
Task 1. Mode? “Post-hip-replacement to GP.” Answer: discharge mode.
Task 2. Mode? “Possible MS to neurology.” Answer: referral mode.
Task 3. Discharge skeleton: five headings. Answer: reason/course/status/ongoing/red flags.
Task 4. Referral skeleton: five headings. Answer: purpose/capsule/evidence/interim/request.
Task 5. Red-flag trio for pneumonia discharge. Answer guidance: fever return, worsening breathlessness, haemoptysis — each with action.
Task 6. Ownership lines: X-ray + culture. Answer: GP arranges film; hospital follows culture.
Task 7. Convert a referral into a discharge (same fictional case). Answer guidance: question-led → handover-complete rewrite.
Task 8. Full letter in assigned mode, timed. Answer: mode-verified.
Common errors and corrections
Mode blindness. One shape for both — classify first. Ownerless discharges. Follow-ups unassigned — every item has an owner and date. Red-flag silence. No safety-net — three flags minimum with actions. Evidence-free referrals. Questions without findings — objective support per claim. Mixed modes. Half-referral half-discharge — commit to the task’s mode.
Independent task and self-check
Write one of each mode this week from similar cases. Check: mode skeletons followed, owners/dates (discharge) and question/evidence (referral) present.
Study sequence with the book
Week 1: shared system + both mode maps. Weeks 2–3: step-by-step letters alternating modes with samples compared. Week 4: timed mixed-mode letters; mode-check discipline.
FAQs
How do I recognise the mode? The task’s reader and request reveal it — question asked = referral; care handed over = discharge. Can one case need both? Rarely in one letter — follow the task. How many red flags? Three relevant ones with actions beats ten listed. Who owns outstanding results? State explicitly — never assume. Does structure differ much? Enough to fail mode-blind letters — learn both maps.
The matching book
OET Medicine Writing Decoded: Your Step-by-Step System to Crafting High-Scoring Referral and Discharge Letters by Jobin Thomas (Jobins Training, 2025) teaches the system with worked letters. Use this article for the two modes; use the book for the step-by-step volume.
Keep practising with OET Medicine Writing Decoded: Your Step-by-Step System to Crafting High-Scoring Referral and Discharge Letters
Enjoyed this guide? OET Medicine Writing Decoded: Your Step-by-Step System to Crafting High-Scoring Referral and Discharge Letters takes you further, with deeper explanations, more practice tasks and complete model answers. Continue practising with the full book →
Sources and editorial note
System and mode design verified against full EPUB text extraction (~187,000 characters); framing sections read. Cases, letters and drills newly written and labelled fictional; illustrative clinical content only. No lengthy verbatim reproduction. Recheck OET format on the official OET site before test day. British English throughout.