Templates help — but only when you adapt them
A memorised frame gets the structure right under time pressure. What scores is what you put inside it: the right patient details, the specific request, and only the notes this reader needs. A template copied without adapting it to the case can still lose marks for Purpose and Content.
1. Purpose (opening)
Say who the patient is and what you want the reader to do — in the first one or two sentences.
I am writing to refer Mr/Ms [name], a [age]-year-old [man/woman] with [problem], for your assessment and management.
Referral to a specialist.
I am writing to urgently refer [name], who [key finding], for your review [today / within 24 hours].
Use “urgently” only when the case notes justify it — and say how urgent.
I am writing to inform you that [name] is being discharged [today/tomorrow] following [admission reason], and to request [specific follow-up].
Discharge to a GP or community nurse: the request is what makes the purpose clear.
I am writing to transfer the care of [name], who is moving to your unit [today] for [rehabilitation / ongoing care].
Transfer letters.
I am writing regarding your patient, [name], as I am concerned that [concern], and I would be grateful if you could [review / advise].
Pharmacist, physio or nurse writing to a doctor about a concern.
Avoid: “I am writing regarding Mr Smith” with nothing else — the reader still doesn’t know what you want.
2. Clinical history
Expand the relevant notes into full sentences, in a logical order. Link findings instead of listing them.
[He/She] presented with a [three-month] history of [symptom].
Over the past [two weeks], [his/her] symptoms have [worsened / become more frequent].
[He/She] describes [symptom], which is [worse on exertion / relieved by rest].
[He/She] reports [symptom] but denies [important negative].
Include a negative only when it matters to the reader (e.g. no red-flag symptoms).
[His/Her] past medical history includes [condition], for which [he/she] takes [medication].
Avoid: Copying note-form fragments (“c/o SOB x 2 weeks”) — always write full sentences.
3. Examination and investigations
Report only the findings that matter for this reader, and say what they show.
On examination, [finding] was noted.
Examination revealed [finding]; the remainder of the examination was unremarkable.
“Unremarkable” saves listing normal findings.
Blood tests showed [result], which is consistent with [interpretation].
Of particular concern, [key abnormal result].
Flags the one result that changes management.
An [ECG / X-ray / ultrasound] confirmed [finding].
Avoid: Listing every normal result — it hurts Conciseness & Clarity.
4. Management so far
Say what has been done and what the patient was told — the reader needs to know what not to repeat.
[He/She] was started on [medication and dose].
[Medication] was increased to [dose] [one month ago].
[He/She] was advised to [action] and to seek urgent review if [warning sign].
In line with [local guidance], I have [action taken today].
A follow-up appointment has been arranged for [date / timeframe].
5. Current condition
Bring the reader up to date — this is often where the reason for the letter becomes clear.
Despite this, [his/her] symptoms have [persisted / worsened].
[His/Her] [symptom] has improved slightly; however, [problem] persists.
[He/She] remains symptomatic despite [treatment].
At discharge, [he/she] is [mobilising with a frame / independent with personal care / on room air].
Discharge and transfer letters.
6. Closing request
Repeat or sharpen the request, then close politely. Match the closing to the letter type.
I would be grateful for your assessment and advice regarding [specific question].
Referrals: a specific question is stronger than “further management” alone.
I would appreciate your advice on whether [option] would be appropriate.
Thank you for seeing this patient.
Referral to someone who hasn’t met the patient.
Thank you for your ongoing care of this patient.
Only when the reader already looks after the patient (e.g. a discharge letter to their GP) — not for a new referral.
Please do not hesitate to contact me if you require any further information.
Avoid: “Thank you for your ongoing care” in a referral to a specialist who has never seen the patient.
Time expressions: from case notes to letter
Abbreviations in the notes: c/o = complains of · SOB = shortness of breath · ↑ = increased · x 3 months = for 3 months.
| Case notes | In the letter | Watch out |
|---|---|---|
| c/o back pain x 3 months | a three-month history of back pain | Singular “three-month” before a noun — not “three-months history”. |
| cough ↑ over last 2 weeks | his cough has worsened over the past two weeks | Present perfect with “over the past …”. |
| fever since yesterday | she has had a fever since yesterday | “Since” + present perfect, never present continuous. |
| on metformin x 6 months | he has been taking metformin for the past six months | “For” + a period; “since” + a point in time. |
| started naproxen 1 week ago | naproxen was started a week ago | “Ago” goes with the past simple. |
| paracetamol first, then codeine | initially … subsequently … | Sequence words keep the history easy to follow. |
| headaches ↑ frequency lately | her headaches have recently become more frequent | “Recently” usually takes the present perfect. |
| SOB on exertion x 2 months, at rest today | a two-month history of breathlessness on exertion; today, she is also breathless at rest | Contrast two time frames clearly. |
Stop repeating the same verbs
Repeating “presented with” or “reported” in every sentence makes a letter feel like a list. Mix in these alternatives — and combine related findings into one sentence.
| Instead of always… | Try |
|---|---|
| presented with | was seen with · complained of · reported · described · attended with |
| reported | described · mentioned · stated · noticed · denied (for negatives) |
| was commenced on | was started on · was prescribed · began taking · was given |
| was advised to | was encouraged to · was asked to · was instructed to · was recommended to |
| examination revealed | on examination, … was noted · examination showed · there was evidence of · he/she was found to have |
| investigations showed | blood tests revealed · an X-ray confirmed · results indicated · … was raised/reduced at … |
| has improved / worsened | has settled · has eased · has deteriorated · has progressed · has become more frequent |
| remains symptomatic | continues to experience · still has · symptoms persist · has not responded to |
Now practise them one sentence at a time
Write a time expression, a varied sentence or a purpose statement and get instant feedback — the first drills in each section are free.
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