Pharmacy — Discharge Medication Advice for a Patient Starting Metformin
A community pharmacist writes a discharge advice letter to a 54-year-old woman newly diagnosed with type 2 diabetes who is starting metformin for the first time. This is a beginner case: one new medication, clear instructions, one common side effect to manage, and one safety warning. Ideal for first attempts at pharmacy advice letters before more complex multi-drug cases.
Letter type
Discharge
Write to
Patient
Target length
170–190 words
The case notes
Patient: Mrs Fatima Hassan, 54 years old; new diagnosis: type 2 diabetes mellitus
New medication: Metformin 500 mg once daily with morning meal; to increase to 500 mg twice daily after 2 weeks if tolerated
Common side effects: Nausea, diarrhoea, stomach upset — take with food to reduce these; usually improve within 2–3 weeks
Important safety note: Stop metformin and contact GP immediately if she is scheduled for a contrast CT scan (iodinated contrast interaction risk) or feels very unwell with vomiting (dehydration risk — lactic acidosis)
Monitoring: Fasting blood glucose target 4–7 mmol/L; HbA1c check with GP in 3 months; renal function (eGFR) checked by GP before starting (normal)
Diet: GP-led dietary advice already given; patient has dietitian referral pending; pharmacist reinforces: reduce refined carbohydrates and sugary drinks
Task: Write a discharge advice letter to Mrs Hassan explaining how to take her metformin, what side effects to expect, and what to watch out for.
Writing task
Write a discharge advice letter to Mrs Hassan explaining how to take her metformin, what side effects to expect, and what to watch out for.
What to include, what to cut
The hardest mark to win is selection. The same case notes contain decision-relevant facts and distractors. Here is what an examiner expects to see in a Grade B letter for this scenario, and what should be left out.
Include
-
Take metformin with food and the dose escalation plan
Taking with food is the key instruction that prevents the side effects most likely to cause the patient to stop the medication. The dose escalation — 500 mg once daily for 2 weeks, then twice daily — is clinically important; patients often miss the step-up.
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The CT scan and vomiting warnings — when to stop and contact the GP
These are the two pharmacist-specific safety nets for metformin. Both are conditions where continuing the medication is hazardous but a patient would not know to stop.
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The 3-month HbA1c check with the GP
The patient needs to know monitoring is ongoing — this is not a take-it-and-forget prescription. Naming the follow-up builds adherence.
Leave out
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A full explanation of how type 2 diabetes causes high blood sugar
This was covered by the GP at diagnosis. One brief sentence ('your new tablet helps your body use insulin more effectively') is enough before moving to the instructions.
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The dietitian referral timeline
An administrative fact outside the pharmacist's scope. State briefly that dietary advice is part of the management plan; the appointment date is not your information to give.
Criterion in focus · Language
A beginner pharmacy advice letter is an ideal Language assessment opportunity — the test is whether medical information has been accurately translated into plain, respectful patient language. 'Metformin reduces hepatic gluconeogenesis' must become 'the tablet helps your body manage blood sugar more effectively'. 'Lactic acidosis' must become 'a rare but serious condition that can happen if you become dehydrated — stop the tablet and call your GP'. Accurate clinical meaning, plain words.
Now write the letter — and find out what is blocking your Grade B
Write a 170–190 words discharge letter from these notes, paste it into the free checker for an instant read, then submit it for a human grade against all six criteria. Dr Mariam's team returns line-by-line feedback, from $12.