Radiography — Discharge to GP after Fluoroscopic Swallowing Study Findings
A radiographer reports to the GP following a video fluoroscopic swallowing study in a 68-year-old man with dysphagia, identifying silent aspiration of thin fluids and requesting urgent referral to a speech pathologist. This intermediate case requires communicating significant radiological findings clearly and making a specific clinical recommendation.
Letter type
Discharge
Write to
General Practitioner
Target length
190–210 words
The case notes
Patient: Mr Raymond Walsh, 68 years old; referred for video fluoroscopic swallowing study (VFSS) by ENT following 3 months of progressive dysphagia and two episodes of aspiration pneumonia
VFSS findings: Silent aspiration of thin liquids (observed on VFSS): patient did not cough or show any clinical signs of aspiration despite observed penetration and aspiration below the vocal cords; aspiration occurred on approximately 40% of thin fluid trials; aspiration absent with Level 2 (mildly thick) fluids; no obstruction identified; no pharyngeal tumour visible fluoroscopically
Swallowing physiology: Reduced laryngeal elevation on swallowing; delayed swallowing reflex; posterior pharyngeal residue — partially cleared with dry swallows
Radiologist: Formal radiologist report pending — expected within 48 hours; preliminary findings communicated to the GP by phone at 14:30 today; this letter confirms those findings
Recommendation: Urgent referral to speech pathology for swallowing rehabilitation and texture/fluid modification; in the interim, advise patient to use Level 2 mildly thick fluids and avoid unmodified thin fluids; GP should advise patient not to eat or drink thin fluids unsupervised until reviewed by SLP
Task: Write a discharge letter to the GP, Dr Sheila Nwosu, summarising the VFSS findings and requesting urgent SLP referral.
Writing task
Write a discharge letter to the GP, Dr Sheila Nwosu, summarising the VFSS findings and requesting urgent SLP referral.
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
-
Silent aspiration of thin fluids on approximately 40% of trials — patient showed no cough or clinical signs despite aspiration below vocal cords
Silent aspiration is clinically dangerous precisely because it is silent — the GP and patient cannot rely on clinical signs to detect it. This finding changes the patient's management immediately.
-
That aspiration was absent with Level 2 mildly thick fluids — and the interim recommendation to use thickened fluids
The GP needs an actionable interim instruction before the SLP appointment. Level 2 fluids were protective — this is the specific modification that reduces risk while waiting for the formal SLP assessment.
-
That the formal radiologist report is pending (48 hours) and that preliminary findings were communicated by phone at 14:30
The GP must know the formal report has not yet been issued. Documenting the verbal communication time is clinical accountability — the GP has been informed; the letter confirms it.
Leave out
-
The swallowing physiology detail: laryngeal elevation, pharyngeal residue mechanism
The SLP handles the rehabilitation of the swallowing physiology. The GP needs the outcome finding (silent aspiration on thin fluids) and the management recommendation (urgent SLP, interim thickened fluids). State the findings; not the mechanism.
-
The two previous aspiration pneumonia episodes in detail
Relevant context in one clause: 'referred following two previous aspiration pneumonia episodes.' The GP already knows this history; the VFSS letter documents the imaging findings, not the referral history.
Criterion in focus · Purpose
A post-VFSS letter to the GP has a dual purpose: to report significant radiological findings and to request a specific clinical action. Both must be explicit. 'The VFSS confirmed silent aspiration of thin fluids' is the finding. 'I am requesting urgent referral to speech pathology and advise Level 2 mildly thick fluids in the interim' is the action. A letter that reports the findings without making the request explicit leaves the GP to decide the next step independently — which is the opposite of the letter's purpose.
Now write the letter — and find out what is blocking your Grade B
Write a 190–210 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.