Social history in an OET letter: what to include about home, family and lifestyle
Include a social history note in an OET letter only when it changes what the reader will do: who the patient lives with or who cares for them, home access (stairs, living alone), work or driving if it affects recovery, and smoking, alcohol or diet when they relate to the problem. Hobbies, past jobs, pets and family details with no effect on care are usually left out, and the notes you keep are best grouped in one short paragraph rather than scattered through the letter.
Why social history is easy to get wrong
OET case notes usually include a "social background" or similar section: where the patient lives, with whom, their job, hobbies, smoking and drinking. Some of it is there because the reader needs it. Some of it is there to see whether you can leave it out. Copying all of it costs words and weakens Conciseness & Clarity; cutting all of it can lose a note the reader depends on, which affects Content.
The rule is the same as for every note (see case-notes selection): would the reader do anything differently if they knew this?
Keep or cut: a quick table
| Social note | Usually keep when… | Usually cut when… |
|---|---|---|
| Lives alone | Discharge, mobility, medication management, falls risk | The reader is a specialist assessing one problem and home is irrelevant |
| Main carer (spouse, child) | They will give care, medication or transport | They play no part in the plan |
| Stairs / home layout | Mobility is reduced or equipment is needed | Mobility is normal |
| Job | It affects recovery, return to work, timing of treatment | It is just a description of the person |
| Driving | The patient must not drive, or relies on driving to attend | No effect on care |
| Smoking | Wound, respiratory, cardiac, vascular, or cessation offered | The problem is unrelated |
| Alcohol | It affects medication, falls, liver, mental health or withdrawal risk | Low intake, unrelated problem |
| Diet / exercise | Diabetes, weight, cardiac rehab, the reader is a dietitian or physio | Unrelated |
| Hobbies, pets, holidays | Rarely; e.g. gardening with an open wound and infection advice | Almost always |
| Religion / language | It affects care (interpreter needed, dietary needs, blood products) | No effect on care |
How to write it: compress and connect
Social notes are often a list. Turn them into one or two sentences that show why they matter, using the techniques in case notes to full sentences.
Notes (invented): lives alone, 2nd-floor flat, no lift; daughter visits weekly; ex-teacher; enjoys crosswords; non-smoker; occasional wine.
Weak (copied list):
Mrs Lowe lives alone. She lives in a second-floor flat. There is no lift. Her daughter visits weekly. She is a retired teacher who enjoys crosswords. She does not smoke and drinks wine occasionally.
Better (selected and connected):
Mrs Lowe lives alone in a second-floor flat without a lift, and her daughter visits once a week; she may therefore need help with shopping until her mobility improves.
The better version keeps the three notes that affect discharge planning and links them to the request. Crosswords, her former job, smoking and wine were cut because nothing in the plan depends on them.
Worked example (invented case)
Case summary (invented): Mr Tomasz Lis, 58, post-operative after a right total knee replacement. Lives with wife; she works full time. House: bedroom upstairs, toilet downstairs. Works as a delivery driver. Smoker, 10 per day; cessation advice given. Drinks 2–3 beers at weekends. Keen fisherman. Has a dog. Discharge in two days with crutches. Task: write to the community physiotherapist.
Selection:
| Note | Decision | Reason |
|---|---|---|
| Wife works full time | Keep | He will be alone during the day |
| Bedroom upstairs, toilet downstairs | Keep | Stairs practice and equipment |
| Delivery driver | Keep | Return to work and driving affect rehab goals |
| Smoker, advice given | Keep briefly | Affects wound healing; already addressed |
| Weekend beer | Cut | No effect on physiotherapy |
| Fishing, dog | Cut | No effect on the plan |
Sample paragraph:
Mr Lis lives with his wife, who works full time, so he will be alone during the day. His bedroom is upstairs and the toilet downstairs, so stair practice will be a priority. He works as a delivery driver and is keen to return to work and driving as soon as it is safe.
Smoking could go in the medical background with the wound, since a physiotherapist is less likely to act on it; either choice is defensible if it is brief.
Where it goes in the letter
For most letters, social history sits after the medical background and before the request, so the reader reaches the request already knowing the home situation. In a discharge letter where home support is the point (e.g. a request for carers or equipment), it may come earlier. See Organisation & Layout for paragraph order.
Common mistakes
- Copying the whole social section as short sentences.
- Mentioning hobbies "to show the patient as a person" when they change nothing.
- Leaving out who will be at home, when the letter is about discharge.
- Scattering social notes across several paragraphs.
- Judgemental wording about lifestyle ("he drinks too much"): give the amount instead.
Practise and check
Try a case from the practice page and highlight every social note before you write, then decide keep or cut. To see what you included, missed or should have cut, paste your letter and the notes into the letter checker. medEmu's grade is an estimate for practice, not an official OET result.
Sources
This guide is medEmu's writing advice, not official OET guidance; all patients and case notes are invented. The network used for this run could not reach oet.com, so no OET test facts are stated beyond the criterion names. For the official Writing assessment criteria, see oet.com.