This is my very first experience on how to approach not only patient's physical problem but also their mental problem as well.

1. Behavioral Medicine Essay
Topic: Patient Interview
Situation: this was a patient who has to go to hospital every second week for the transfusion.
The patient complaint was swollen, tender and painful knee joint but no injury was recorded
before. One morning, he was running during exercise, the joint started to swell and turned very
painful. The patient visited hospital due to immobility of the leg. He also complained about his
history of unknown bleeding of the gingiva, nose and unknown bruise in his arm and leg. Asking
about if he is worrying about the condition, he added that he is not worried of the bleeding
since he has been having it for a long time, since he was a child. At that time, he was just
worrying about the joint problem. He was suspecting maybe some kind of infection.
Asking about his daily life before joint pain occurred, he mentioned that it was almost
completely normal. Even though there was a lot of moment when he has nose bleeding or
gingiva bleeding but he could manage it well. When he was a child, his parent did take him to
hospital to figure out what was the underlying problem but they could not because at that
time, medical technology was not as good as at the moment. What I could do was giving him
adjuvant which could help him manage the bleeding, and they also recommended him not to
play or work too hard because bleeding may occur then. Asking him if he was feeling sad about
this condition, he confessed that at first he felt a bit lost to everyone that he had to carry the
adjuvant with him most of the time and had to limit his movement. But then he get used to it.
Since the pain occurred, his daily life was a bit problematic. He said that he was only 30 but he
was acting like an old man. He could barely move. He always needed help from his wife and
colleagues from standing to walking and etc… That was a really hard time. During this hard
time, he had received a lot help, especially from his family and he confessed that he felt really
happy because he was a central point to everyone, that made him very heart warming. During
that period of time, he perceived that having a family who always be there for you is important.
It is very precious and it forms the base for everything.

2. Asking about his knowledge for the current the underlying cause of the disease, he said that his
doctor had informed him everything. The underlying cause for this kind of disease is that he is a
genetic disease, which is called Hemophilia. This is a disease that some blood clotting factor and
genetically missing. That why he has been having these unknown bleeding. The reason for the
joint pain was due to the bleeding within the joint space. It made the joint become tender and
swelling. They had performed some procedure to release all the blood in the joint space, so
that he felt pretty good then. That day, he went for medical check-up and received blood
transfusion. Being asked about recovery process, he said that he was very happy. Later on, he
didn’t need any help for mobility .His joint recovered pretty fast even though it was just after
around 2 weeks. He also included that his vulnerable bleeding condition also seems to
terminate since the supplying clotting factors were given. He told me that he really thought he
may have to suffer this condition for the whole life but due to the development of modern
medicine, he felt really thankful for it.
Things should have been normal until I was asking if he is having any child now. He turned out a
bit emotional. He swiped tears from his eye and told me that due to this genetic disease, if he is
having a child, there is a relatively high chance that his child will inherit his condition. It can be
either same or more severe than what he has. He started to tell me his story that he and his
wife have been married for more than 3 years. Now they are planning on having a child. But
since he got the diagnosis, their plan seems to be impossible. He insisted that he just didn’t
want his child to be like him. After hearing what he said, even I was touched. The atmosphere
turned really heavy, he was facing down, thinking for a moment and started to add more; that
he didn’t worry much about having a child, it is not really a huge problem but he was sad
because of his wife and his parent, they were really expecting a child in the house. I was trying
to ease him, because his circumstance was really lamentable. I also advised him some
alternative method for example adoption. I also encouraged him that there were a lot orphans
who really need a family. But then he was keeping silent for a while. Maybe he had some secret
and it was hard to say. I respected that. Then I asked him if his family knew this. He turned to
me, with a really sad face. Still remained silence but then he started talk. He said he was
keeping this as a secret to his family. He was trying really hard to find as much as alternative

3. methods but till then, seems hopeless. When being asked for the reason, he just mentioned
that he doesn’t want to let his family down because he just didn’t want to see them sad.
Knowing the serious of the problem, I gave him a lot of recommendation, but main idea was
about the fact that he should not keep secret to his family, especially his wife, because it may
affect marriage to a certain level. After a series of advices later on then I found out that the
patient was really having a fear of disappointing anyone, especially his family. Because even
though how hard i tried to convince him, his mind remained the same. At this point, I stopped
giving advice but instead, I was trying to feel empathy with the patient. I was helping him to
open his mind more, trying to get to know him what had lead him to this kind of person now
and after several talk, I started to figure out that all because of this condition. Due to his
vulnerable condition, as a kid, in everyone’s eye, he was seemed to be weak and always need
help. He was not even fond of that, instead, he was trying to act strong. He wanted to show
that he can be as healthy as everyone, making sure not to disappointing anyone. I asked him if
he was afraid of failure. He answered with confidence that he was not afraid of it, he was just
afraid of letting someone down, which he felt really guilty about it. He also added failure helps
you grow. After more discussing, I knew that I would never be able to change the way he was,
instead I gave him some information about screening program during pregnancy, which could
really help control the rate of disease appearance. Immediately after hearing this, his mood
changed completely. He was really curious about it, he asked lots of questions about the
screening, and noted down some important points. Even though I had told him everything but
he just kept asking and asking. It made me happy seeing him like that, especially how
enthusiastic he was. He also asked if this disease is curable and obviously I answered but I
avoided to say impossible with some explanations about medical genetics which is not easy at
all and scientist are still working on it. Maybe not our generation but the next one may receive
some kind of cure related to genetic disease. He also said he really hoped it would come out
soon so that not many will suffer his condition.
The interview left me a lot of thought. At first, it was really hard to get a patient’s trust.
Without trust, I would not get that much information from the patient. In this case, the patient
was pretty cooperative and easy going patient. Some points he didn’t want to tell but he

4. mentioned it later on. I was pretty happy that he was honest, which meant that he trusted me
to tell such story. Even though I felt really sorry for him, but look at his eye, his act, I’m pretty
sure he will not give up. He has a very strong will, I really admire it, he inspired me somehow
how to be a man of a family. I really like how he expressed his thought and his feeling, only by
telling such story, it got into my mind easily. Thanks to that, I could empathy him well. Being
with him, even though It was just a short time, I really felt like he was really similar my brother,
who is also a very tough man. Barely anyone can change his mind if he also set his thought.
Also, he never bothers anyone in the family, he just always tries to deal with thing on his own.
There was one thing that I couldn’t really accept to this patient’s perspective that he was hiding
such a big problem to his family, especially his wife. Because family is where we can express
ourselves and it is where we can always seeking for help. Sometimes seeking for help doesn’t
mean weakness at all. Family always understand you even though you let them down, they are
always ready to help anywhere anytime. And second thing, why would you be afraid of
disappointing others. Nobody is perfect at all.
In personal, I did received a lot of great experience from him, not just only about history taking
or examination… but also about how I can get to know my patient well. I was lucky that he was
pretty predicable, but in the future there will be lots of patient which treating their disease
doesn’t meant everything, sometimes you have to treat with their mind as well.