11/02/19

Dear Dr. Hodges

Re: Mr. John Aloisus; D.O.B.: 04/09/1985

I am writing to update you regarding Mr. Aloisus, a 35-year-old archaeologist (comma) who was
treated for pulmonary tuberculosis and is being discharged back into your esteemed care. Your
continued monitoring would be appreciated.

1. Was treated—isn’t he still undergoing the treatment for TB?

2. Continued monitoring—ongoing care

Mr. Aloisus was hospitalized on February 1, complaining of night sweats, fever, and hemoptysis. On
examination, his SpO2 was recorded at 92%, and scattered rales were heard over chest
auscultation. He was also had significant for cachexia. Subsequently, Mr. Aloisus was transferred
to the respiratory isolation ward after serological and radiological investigations revealed a
presence of confirmed the diagnosis of tuberculosis along with infiltration. Consequently, ; and
he was commenced on an anti-tuberculous a 4-drug anti-tuberculous regimen was
commenced, and in addition to being prescribed vitamin B6 50mg tablets twice a week were
prescribed. In addition, his nursing management consisted of regular monitoring of side effects (of
what?) and weekly sputum analysis.

1. Too much information for one paragraph with some important details being left out.

Mr. Aloisus was hospitalized on…when he had presented with………..His investigation findings,
including chest x-ray, sputum acid fast stain, and mycobacterial cultures were positive for tuberculosis.
Therefore, he was shifted to the respiratory isolation unit and commenced on…..(named the
medications). In addition,………was prescribed ….

During Mr. Alosisus’ hospital stay, appropriate infection control measures were taken; and his
nursing management focused on his diet, ensuring medication compliance, monitoring for drug side
effects, and weekly sputum cultures. His response to the treatment was satisfactory.
 As of today, Mr. Aloisus appears to be progressing well and ready for discharge. He is advised to
continue isoniazid and rifampicin for four months while ceasing (comma) and to cease
pyrazinamide and ethambutol after two months. Please note that he should be monitored for
medication compliance, as there is a possibility of dose modification based upon the improvement.
Additionally, he should be observed for signs of toxicity and uric acid levels, along with a visual
examination and an Ishihara test.

1. What about the acid fast stain? Wasn’t it negative.

2. What about Directly observed therapy?
3. The summary could have been a lot better

On today’s assesment, Mr. Alosisus appears to have progressed well, and his sputum acid fast stain is
negative. He is being discharged on the 4-drug regimen for 2 months, following which……….should
be ceased. Vitamin B-6 supplements are advised to be continued. It is recommended that the treatment
is supervised by a DOT nurse, who would also assess for any changes in the medication based on his
improvement. Please note, he should be monitored for the side effects of the drugs through relevant
blood tests, and periodic visual acuity and Ishihara tests.

Your further care and regular follow-up would be appreciated. If you require any additional
information, please do not visit it to contact me.

Yours sincerely

Doctor

Remarks:
1. Purpose—clear, but could have been worded
2. Organization and Layout—has generally been fine; however, there is too much
information in one paragraph. For such letters, the ideal paragraphing is
Presentation/diagnosis/initial management>Hospital management, stay, and recovery;
today’s assessment and discharge plan
3. Content—missed out on some important information. The summary is an OK. You are
 continuously lagging in this section
4. Concision and Clarity—no significant concerns
5. Genre and Style—is fine as well
6. Language—improving

Estimated Grade: B/380