A Doctor’s Discharge And Referral Letters, Marked

OET publishes five graded candidate letters from its Medicine papers, with a grade printed on each: C, C plus, B, B and A. All five answer the same cardiology referral, so what separates them is not the case but the decisions, and we pulled all five out of the booklet to count them. One of the findings contradicts advice a candidate was given by an AI tool shortly before scoring 290.

What the five graded letters measure

• Four of the five open Thank you for. The only one opening I am writing to is the only C.
• Word count does not track grade: 188 scored B, 189 scored C plus, 212 scored A, 223 scored C and 262 scored B.
• Two of the five, including the A, carry a wrong date of birth in the reference line, and neither assessor mentions it.
• That C plus letter keeps all seven of the brief’s personal facts and the C keeps five, against three in the A.
• In OET’s 2025 statistics, no profession’s A share in Writing rounds above zero, Medicine included.

Medicine’s published tasks are four referrals and one request, and not one discharge

Start with what doctors are actually set, because what gets taught and what gets set are not the same thing. Across OET’s twelve professions it publishes five paper sample tests each, 60 writing tasks in total. Medicine’s five are four letters of referral, named as such in the instruction, and one unlabelled letter to an occupational therapist requesting a workplace assessment.

No Medicine instruction names a discharge letter. Only Nursing’s do, in two of its five tests, which matters because the discharge letter is one of the first things most courses teach a doctor to write, and a discharge letter sample for doctors is one of the phrases we are asked about most often at our centre.

The five Medicine instructions, in full

•   Four name a letter of referral: to a gastroenterologist twice, to an endocrinologist, and to a consultant cardiologist.

•   One names no type and asks for a letter to an occupational therapist requesting a workplace assessment.

•   None names a discharge. In the Medicine briefs a discharge is an event the letter reports, not the letter you write.

•   A label is not a shape, though. OET’s guide calls one Occupational Therapy task a discharge letter on the strength of the words is to be discharged, without the phrase discharge letter appearing anywhere in it.

Which letter you are being handed, and where in the paper that is stated, is the subject of which letter type to write.

The brief behind all five graded letters is Medicine’s fifth test. You are Ms Bennet’s GP of two years. She had a myocardial infarction after a long-haul flight on 8 February, was stented, was discharged on captopril and atorvastatin, never attended cardiac rehabilitation, and has arrived today wanting to stop the captopril because of its side effects. The task asks you to write a letter of referral to Dr Banerjee, consultant cardiologist, briefly outlining her history and treatment so far and requesting advice and a review of her medication.

The opening verb separates the C from the rest, and an AI tool got it backwards

Line up the first sentence of each letter against its grade.

OET’s own worked example points the same way. Its writing guide works three examples, a referral, a discharge and a transfer, and opens the referral one with thank you for seeing Mrs Priya Sharma, a type 2 diabetic, for further management of her blood sugar levels. The two highest-graded letters here are near-copies of that shape. A tip in the same guide names the opposite habit: many candidates start their letters with I am writing to refer, which it says is sometimes appropriate, but not all tasks ask you to write a referral letter.

In February 2026 a doctor posted that they had scored 290 in Writing, asked for a remark and got the same score back, and described their preparation: they had practised with an AI tool, and the tool told them not to use thank you for seeing and recommended I am writing to instead. They added that they could see many people who got high scores still using the thank you for seeing opening, so they had begun to doubt the tool.

The booklet backs the candidate rather than the tool. Four of the five graded letters open thank you for, and the one that opens I’m writing to is the only C of the five.

No opening formula is sufficient on its own, and the booklet says so. That C plus opens thank you for agreeing to see my patient and its assessor still writes that the candidate begins without an immediate purpose, clear only by the final sentence. So the opening formula buys you nothing unless the request arrives with it.

Be careful with OET’s warning here, because it does not settle the question on its own. The caveat is that not every task is a referral, and this task is a named letter of referral, so I am writing to refer would fit it. What the five letters show is an observed pattern on this brief rather than a rule, and it still points the opposite way from the advice the candidate was given. The same mismatch between fluent-sounding advice and what the marker rewards runs through why strong doctors lose marks.

The longest of the five letters is a B, and the shortest in-range letter is a C plus

Every OET paper prints the same instruction, approximately 180 to 200 words, and OET states that there is no automatic penalty for writing over or under the range, only that a letter significantly over it has probably carried irrelevant material or lost its organisation. Approximately is the papers’ own word, so read the figures below as distances from the top of the range rather than as penalties.

Two readings follow from that table and they pull in opposite directions. Being inside the range earned a C plus as readily as a B, the two differing by a single word, and the longest letter in the set outscored the second shortest by a band. So length on its own buys nothing.

The assessor did name length as a problem in two of the five, though. Overlength is read as a symptom rather than punished as an offence: what costs the marks is the irrelevant material the extra words carry, not the words.

Social detail separates the letters, and the A keeps three facts where the C keeps five

The brief supplies seven personal facts: divorced, two daughters aged 16 and 18 living mainly with their father, a custody dispute, a commercial lawyer’s job with frequent international travel, a father who died at 53 of heart disease, a brother with mental health problems, and a mother who moved in to help.

The OET Ultimate Writing Guide works one case in which a patient’s children, grandchildren, profession and financial status will not be needed for the reader because they will not impact the care they provide, which is a judgement about that reader rather than a list of banned topics. Decide how much of it a cardiologist needs and you have made the single decision that most separates these five letters.

The pattern is not a clean slope. Note first that the C plus carries all seven personal facts against the C letter’s five and still scores higher, because its other criteria carry it, so social detail is not a grade on its own.

At the top what changes is the reason each fact is there. It keeps the travel because a long-haul flight preceded the infarction, keeps the family stress because stress is why she wants to stop her medication, and keeps the family history, cardiac and psychiatric both, because a father who died of heart disease at 53 bears on the referral. The C letter keeps the children and the childcare dispute, which bear on nothing the cardiologist will do. Relevance to the request is the test, and it is the same test described in reading the case notes.

Only the A letter dates both the admission and today’s consultation

The case turns on a sequence: infarction, stent, discharge, medication started, rehabilitation declined, and today’s request to stop the drug. A cardiologist needs to know how long ago each step happened, and the accuracy of that sequence is scored under Content, which OET’s Writing assessment criteria judge partly on whether content from case notes is accurately represented. Here is how each letter handled it.

All five are faulted on dates in some way, including the A, which is marked for omitting the date of discharge and commencement on medication. That is worth knowing before you spend the five minutes of reading time on anything else: the dates are the cheapest marks on the page and nobody collected all of them.

Two of the five letters misdate the patient in the reference line, and no assessor says so

Read the top of the A letter closely. Its reference line gives the patient’s date of birth as 06/12/2021. The case notes read DOB: 06 Dec 1975 (45 y.o.), so the day and month are right and the year is the year of the test itself, which would put her birth seven months after the consultation the letter describes. The assessor commentary for that letter runs to a full paragraph and does not mention it.

The A is not the only one. One of the two B letters opens Re: Mrs Eleanor Bennet, DOB 16.12.1975, which has the year right and the day wrong, and its assessor does not mention that either. So two of the five letters misdate the patient in the line whose only job is to identify her, and both cleared the C plus band comfortably.

An A in OET Writing is therefore not an error-free letter. The same commentary names two real omissions in it, an alcohol figure and a discharge date, and praises its selection of case note details in the very next sentence. The six criteria are Purpose, Content, Conciseness and Clarity, Genre and Style, Organisation and Layout, and Language, and a mistyped year in a reference line lands on none of them squarely, however much it would matter in a real clinic.

No profession’s A share in OET Writing rounds above zero, Medicine included

The booklet’s A letter is rarer than the booklet suggests, and OET’s own statistics say so. In 2025 Medicine was 57.5 per cent of all OET candidates, the largest profession by a wide margin, and its Writing results look nothing like its other three sub-tests.

The zero is not a Medicine problem. All twelve professions record 0 per cent at grade A in Writing for 2025, from Speech Pathology to Veterinary Science. Medicine’s own candidates reach A in the other three sub-tests at 15.6, 11 and 4.5 per cent, so the Writing zero is not a limit on the cohort.

A rounded zero is not the same as nobody, though, and OET’s other two breakdowns show where the A grades went. Across its 50 first-language groups and 66 nationality groups, an A share above zero in Writing appears in four rows: Greek speakers at 0.3 per cent, Portuguese speakers at 0.1, Greek nationals at 0.4 and Brazilians at 0.2. Four rows out of 116, and those rows overlap, since a Greek national is likely a Greek speaker, so they describe perhaps two populations rather than four.

Where that leaves a doctor’s realistic target

•   Medicine’s Writing grades in 2025: B for 79.9 per cent, C plus for 11, C for 8.5, D for 0.1, E for 0.5, and no A share above zero.

•   That 8.5 per cent at C is the lowest C share of all twelve professions, and the 79.9 per cent at B is the second highest behind Speech Pathology.

•   Both the median and the mode grade for Medicine Writing are B, which makes B the target and the ceiling at once.

One doctor in five lands below B, and for the 11 per cent of them at C plus the contest is the ten points between 340 and 350. For the 9.1 per cent at C or lower it is a much longer way back, since C runs from 200 to 290. Either way the six writing criteria repay study more than any template does.

AI tools are scoring doctors’ letters, and 38 of 729 forum threads show it

We read 824 public forum threads posted between February and September 2026, of which 729 sit in a forum for international medical graduates taking OET. Each row below names the rule it was counted by, because a forum count is worth no more than its definition, and two counts we attempted failed that test and are reported as failures rather than figures.

The AI rows are the ones to act on. A doctor in August 2026 asked whether a letter scored 350 by one chatbot and 370 by another meant they were safe at the 300 they needed. Another, in July, reported being scored in the 370 to 390 range by a chatbot and then scoring 290. A third, in May, found one tool giving 280 to 300 where another gave a higher range, and asked whether it was safe to sit the test on that spread.

None of those tools is marking against the published descriptors, and none of them has the five graded letters in front of it: a B on this brief can run to 262 words, four of the five open on the reader rather than on the writer, and two of the five misdate the patient and keep their grade anyway. A number you can act on needs a reader who has marked against those descriptors, which is what feedback against all six criteria provides.

Across the five letters, the marker rewarded four decisions and forgave the rest

Put every assessor comment on the five letters side by side and four decisions stand out. The clustering is our reading rather than OET’s wording, and all four decisions are taken before the first sentence is written.

1.   Open on the reader’s action rather than your own intention. The two letters the assessor credits with a clear and immediate purpose both do it, and the declaration of intent is what the C letter does instead.

2.   Give the reader a timeline they can act on. Only the A dates both the admission and the consultation; the two Cs leave the reader to guess.

3.   Cut the social history to what bears on the request. One clause about stress earns its place when stress is why she wants to stop the drug.

4.   Put the request at the start as well as the end. Two of the three B and A letters do that, and the assessor faults the third for keeping its specific concerns until later. OET’s criterion asks for a purpose that is immediately apparent and sufficiently expanded, and its guide puts that expansion in the last paragraph.

The list of what it forgave is instructive. A wrong year sits in the A letter’s reference line. One B runs 62 words over the range and contradicts itself about whether the discharge was a week or a month ago. The C plus has no salutation and no date at all, and still cleared the C band.

So the scoring is not a defect count. Each of the six criteria asks a different question, and the errors that cost a band are the ones that land on more than one of them at once.

Medicine case notes carry drug names, doses and a referral the patient declined

One last thing the five letters expose. The Medicine brief is denser in exactly the places a doctor finds easy and a marker finds revealing: captopril 50mg twice daily, atorvastatin 80mg daily, a balloon-expandable stent placed via the groin because of small arteries in the arm, a defibrillator applied by a first-aider, a cardiac rehabilitation referral the patient never took up.

Clinical fluency is what makes those details feel mandatory. The A letter names both drugs and both doses and drops the access route and the first-aider entirely. The B at 262 words keeps the groin access and the small arteries, flagged with please note, and spends exactly 30 words on the scene at the airport. Both cleared B, so neither choice is fatal, but the shorter one reads as a summary and the longer one reads as a handover of the whole record.

The order to work in, as a doctor

1.   Identify the letter type and the named reader, from the instruction first and the notes second.

2.   Settle the timeline, because the dates are the cheapest marks and nobody in the booklet collected them all.

3.   Cut the personal history to the facts that bear on the request.

4.   Then write. The clinical content will look after itself, because you already know it.

What will not look after itself is the judgement about which half of that content the cardiologist needs, and that is the thing OET prints five graded examples of. The task, the timing and the six criteria that frame all of it sit in the Writing component.

Frequently asked questions

What does OET Writing look like for doctors?

One task, 45 minutes, split into five minutes of reading time and 40 minutes of writing, producing a letter of 180 to 200 words from a set of case notes. In OET’s published paper sample tests, Medicine’s five tasks are four letters of referral named in the instruction and one unlabelled letter to an occupational therapist requesting a workplace assessment. The readers are consultants and specialists: a cardiologist, two gastroenterologists, an endocrinologist and an occupational therapist across the five.

Is there an OET discharge letter for doctors?

Not in the published paper tasks. None of Medicine’s five instructions names a discharge letter; only Nursing’s do, in two of its five tests. In the Medicine briefs the discharge is an event inside the case notes that your letter reports, not the letter you are asked to write. That is worth knowing because the discharge letter is commonly taught first.

What does a B-grade medical letter look like?

There are two in OET’s graded booklet and they look very different from each other. One runs 188 words, opens Thank you for seeing Mrs Eleanor Bennet, and attaches the social history to the risk factors rather than telling it as a story, though its reference line gets the patient’s date of birth wrong. The other runs 262 words, 62 above the range, keeps the stent access route and the scene at the airport, and contradicts itself about whether the discharge was a week or a month earlier. Both are Bs, which tells you the band is a profile rather than a word count.

What do doctors over-include in OET Writing?

Personal history first, clinical detail second. The C-graded letter puts the divorce, the two children, the childcare dispute, the lawyer’s stressful life and the father’s death at 53 into one paragraph; the A-graded letter keeps three facts in three sentences: a commercial lawyer who travels overseas frequently and has been in a stressful family situation, a family history of heart disease and mental health problems, and extra help from her mother. On the clinical side the longest letter in the set keeps the stent access route and the first-aider at the airport, which the A letter drops.

Should a doctor open with I am writing to refer?

The evidence on this brief says no. Of the five graded Medicine letters, four open with Thank you for and the single letter that opens I’m writing to is the only C. OET’s guide uses thank you for seeing, followed by the patient and the reason, in its own referral example. Its warning about I am writing to refer is narrower than it looks, since the caveat is that not every task is a referral and this one is, so treat the pattern across the five letters as the evidence rather than the warning. An AI tool was recorded in February 2026 advising a candidate to do the opposite, and that candidate scored 290.

How many words should a doctor’s OET letter be?

The papers say approximately 180 to 200 words, and OET’s preparation page says there is no automatic penalty for going over or under the range, only that a letter significantly over it has probably carried irrelevant material. The five graded Medicine letters bear that out: 188 words scored B, 189 scored C plus, 212 scored A, 223 scored C and 262 scored B. Length on its own does not move the grade.

What is a good OET Writing score for a doctor?

In OET’s 2025 statistics Medicine’s mean Writing score was 349, one point below the 350 floor of grade B, while its means for Listening, Reading and Speaking were 377, 375 and 385. Writing grades for Medicine split 79.9 per cent B, 11 per cent C plus, 8.5 per cent C, 0.1 per cent D and 0.5 per cent E, with no A share that rounds above zero. Both the median and the mode were B, so B is the realistic target.

Can you get an A in OET Writing?

Not often enough to plan for. OET’s 2025 statistics record no A share above zero in Writing for any of the twelve professions, while Medicine’s candidates reached A in Listening, Reading and Speaking at 15.6, 11 and 4.5 per cent. The grade exists but is vanishingly rare: of the 50 first-language and 66 nationality groups OET also publishes, only four rows show any A share at all, the highest being 0.4 per cent. An A requires 450 on the 500 scale. Plan for a secure B, which is 350 to 440.

Can you trust ChatGPT to score your OET letter?

The forum record suggests not. Across 729 threads in a doctors’ OET forum between February and September 2026, 45 name an AI tool or the acronym AI and 38 of those also mention writing. One candidate was scored in the 370 to 390 range by a chatbot and then scored 290. Another found one tool giving 280 to 300 on a letter another graded higher. A third was advised by a tool to drop the opening that four of OET’s five graded Medicine letters use.

How do Medicine case notes differ from other professions?

They carry drug names and doses, a procedure with an access route, and, in this brief, a recommendation the patient did not follow, which is the point the letter has to make. The difficulty for a doctor is not comprehension. It is that clinical fluency makes every detail feel necessary, and the graded letters show the top band going to the letter that named both drugs with doses and dropped the stent access route and the first-aider.