Patient write-up marking criteria: where the points sit

Read the point allocations before writing anything, because they contradict how most students spend their time. Subjective data carries **30 points** and objective data **25**, which is fifty-five of the hundred available. Assessment carries 10 and the Plan 15. So the two sections that feel like the clever part of a write-up — working out the diagnosis and deciding what to do — are worth a quarter of the mark between them, while the two sections that feel like transcription are worth more than half. A note with an elegant differential and a thin history is losing marks in the largest category available, and it is the commonest shape of a disappointing write-up. That inversion is deliberate on the marker's part rather than an oversight: a diagnosis is only as good as the data gathered to reach it, and the allocation is telling you which skill the write-up is really assessing at this stage of training.

The history section is broken into three scored components and the middle one is where marks quietly vanish. A full symptom analysis wants location, quality, quantity or severity, timing, setting, aggravating and relieving factors, and associated manifestations — seven elements, each of which can be present or missing. The review of systems must report **pertinent positives and negatives**, and the negatives are the half that gets dropped: recording that the patient denies chest pain is doing work, because it narrows the differential and shows you asked. And the relevant past, family and social history, allergies and medications must be tied to the complaint rather than transcribed wholesale. Work through the seven elements as an explicit list while you write rather than trusting the narrative to cover them, because a fluent paragraph can read completely while still omitting timing or setting entirely.

The objective section contains the most concrete instruction in the whole document and it is phrased as a prohibition. Abnormalities must be **fully described**, sizes must be measured and recorded, and you are told to avoid 'ok', 'clear', 'within normal limits' and bare positive or negative. That is a checkable rule: a marker can scan for those words. Replace them with what you actually observed — not 'skin clear' but the absence of the specific findings you looked for; not 'mole present' but a measurement and a description. Vital signs must be there, with height and weight where appropriate. The instruction is doing more than enforcing style: those phrases record a judgement without recording the observation behind it, which means nobody reading the note afterwards can tell what was actually examined.

Then the section that catches notes which are individually fine everywhere else. The consistency criterion, worth 10 points, asks whether the note supports the differential diagnosis process and whether there is evidence that you reasoned your way to the assessment. It is reinforced structurally: the systems examined in the objective section must be **consistent with those identified in the subjective history**. So a note that takes a respiratory history and then examines the abdomen has broken a stated link, and a diagnosis appearing in the assessment with nothing in the subjective or objective sections pointing at it has broken the same one. Read your own note backwards from the diagnosis and check every step is supported. This criterion is also the one you can most reliably recover before submitting, since it needs no new information at all, only a careful reread of what you have already written.

Two small things worth doing deliberately. The assessment asks for diagnoses **clearly listed and worded appropriately**, which means the conventional diagnostic phrasing rather than a description of the problem. And the plan is explicitly broader than prescribing: it must include teaching, health maintenance and counselling alongside pharmacological and non-pharmacological measures, and where there is more than one problem the plan needs to address each. Those non-pharmacological and educational elements are where the plan section's fifteen points are most often left on the table.