MY LETTER

27/05/2018

Dr McCauley- Browne
Women’s Health Clinic
11 Scarborough St
Westport, NSW, 2344

Dear Dr McCauley- Browne,

RE: Jemima Langley, D.O.B. 16/11/1958

I am writing to refer Ms Langley into your care, a 55-year-old woman who suffers from a second degree
uterine prolapse and requires your specialist evaluation for further surgery. Commented [A1]: Very good opening.

Since the onset of menopause in 2013, Ms Langley is complaining of uterine prolapse; as a result, a vaginal Commented [A2]: With since use the present perfect tense “has
pessary was done. In addition, she was referred to a physiotherapist for instruction on pelvic floor been complaining of…”

exercises. Commented [A3]: Missing article “a uterine prolapse”

Commented [A4]: Good use of passive voice.
She attended my clinic today because her condition is worsening; as such, she suffers from urinary Commented [A5]: “had worsened” links more naturally to
incontinence and the cervix is visualised inside the vaginal opening. Unfortunately, she does not following sentence beginning with past simple
the pelvic floor exercises; moreover, she recently gained 10 kg. Regarding her medications, she takes Commented [A6]: “is suffering” use present continuous for
Climara and a multivitamin. current events in progress
Commented [A7]: “has not been following” use present perfect
My diagnosis at this point is that of a second degree uterine prolapse associated to a secondary urinary to link past to present

stress incontinence. I advised the patient about a weight loss programme and regarding the importance of Commented [A8]: Good use of linking device
daily pelvic floor exercises. In addition, she requires a laparoscopic or vaginal hysterectomy; therefore, I am Commented [A9]: This sentence doesn’t fit with what is above
referring Ms Langley into your care for further management. as you’ve now moved on to the topic of medication. Use a separate
paragraph for each theme, link the paragraphs which focus on the
patient’s symptoms.
Please do not hesitate to contact me if I can provide any further information regarding this patient. Commented [A10]: Eliminate “regarding”.
Commented [A11]: Good repetition of main issue.
Yours sincerely,
Dr Nastassia Nardini
Case Notes:
Today’s Date: 13 June 2014

Patient details
Female
Ms Jemima Langley
68 Arundel Rd
Banksia NSW 2216
DOB 16/11/1958

Social background
Aged 55
Married - 3 children (aged 17, 19 and 23)

Health Inspector
Medical history
1972 - 74: heavy, painful periods (aged 14 to 16)
1975: Oral Contraceptive Pill (to control menorrhagia and dysmenorrhoea)
2012: Carpal Tunnel decompression
2013: Uterine prolapse post onset of menopause - treated with vaginal pessary. Referral to
physiotherapist for instruction on pelvic floor exercises. Prescribed HRT patch (Climara 25 mcg) for
menopause symptoms (hot flushes and vaginal dryness)
June 2014: Urinary incontinence and worsening of uterine prolapse. Effect of recent weight gain on
condition discussed with patient. Patient admitted not following pelvic floor exercises as directed by
physio. Also, stated not tolerating the vaginal pessary.
13 June 2014

Subjective
Second degree prolapse: cervix visualised inside the vaginal opening

Objective
Temp 36.90
BP 126/75
Pulse 72
RR 16
Oxygen sats 99%
Weight: 85 kg (10 kg weight gain in past 6 months)

Medication
Climara 25 mcg transdermal patch
Multivitamin daily

Impression
Second degree uterine prolapse
Stress incontinence secondary to uterine prolapse
Management
Referral to gynaecologist for further management - laparoscopic or vaginal hysterectomy. Weight loss
management - advise weight loss programme. Re-educate about daily pelvic floor exercises.

WRITING TASK
Using the information in the case notes, write a letter of referral to Dr McCauley- Browne.
Address the letter to:
Dr McCauley-Browne, Women's Health Clinic, 11 Scarborough St, Westport, NSW, 2344
Comments

Overall task achievement - You task is of appropriate length and you have paraphrased and expanded upon the
case notes as appropriate. Your response was relevant to the task and all information included was relevant.

Appropriateness of language - The letter could have been more logically organised with a paragraph focussing on
the medical history/procedures conducted, another on the symptoms and then another on advice given to the
patient. As it was, some paragraphs lacked a clear overall theme and thus there were instances of unnecessary
repetition. The main purpose was well highlighted at the beginning and appropriately restated, however, and
the level of urgency was made clear. An appropriate medical register was employed throughout.

Comprehension of stimulus – A full understanding of the case notes was demonstrated and clear connections
were made to the notes as relevant. Relevant requests were made.

Grammar and coherence – There were some very highly-skilled uses of language and the letter was coherent and
showed great improvement in relation to article use, passive voice was used appropriately. There is great scope
for improvement in terms of tense usage, however, practise in terms of tense manipulation would be beneficial.

Presentation punctuation and layout – Punctuation was used accurately, spelling improved greatly and
vocabulary usage was varied and effective.

Overall grade – .4