Grand Rounds – Intracranial Hypertension, Family Support and Physician Compassion and Empathy

November 5, 2020

Dr. Carmen Collins recalled a recent time that she experienced headaches, vision loss and even fell down some stairs.

The third-year resident in The University of Alabama Tuscaloosa Family Medicine Residency, which is operated by UA’s College of Community Health Sciences, went to the hospital emergency room, where she received an MRI. When the results came, “there was radio silence. The doctors said they were waiting to hear from specialists,” Collins said.

When she looked at the MRI results, what she saw scared her.

Collins provided the College’s October Grand Rounds lecture, focusing on a case study of idiopathic intercranial hypertension, with herself as the patient. She also included information about the health benefits patients experience when their physicians provide empathy and compassion, as well as the benefits that accrue to physicians who include compassion and empathy in their care of patients.

Intracranial hypertension occurs when the pressure of the fluid that surrounds the brain is too high. Elevated cerebrospinal fluid or CSF pressure can cause severe headaches and vision loss, and if untreated can cause permanent visual loss or blindness.

Intracranial hypertension is a rare disorder and there are two types: primary intracranial hypertension, known as idiopathic intracranial hypertension; and secondary intracranial hypertension.

Unlike secondary intracranial hypertension, idiopathic intercranial hypertension has no known cause. It mostly affects young, overweight females ages 20 to 45.

Collins said she called her mother, was admitted to the hospital and by the time she was placed in a room her family was there. “It was a whole paradigm shift when my parents and family got there.”

Studies have shown that family support is important at the bedside. Family support decreases length of stay in the hospital, increases adherence to medication regimen at discharge, improves retention of information and decreases mortality after hospitalization.

Collins said empathy and compassion expressed to patients by physicians and other health-care providers are also important, leading to improved clinical outcomes for patients and decreased anxiety and depression.

In addition, health professionals who provide patients with compassion and empathy report less burnout and increased wellbeing, Collins said. Empathy is defined as the ability to sense, feel and understand another’s emotions. Compassion is an emotional response to another’s pain or suffering with an authentic desire to help.

Collins said common causes of provider burnout include family responsibilities, time pressure, a chaotic work environment, low control of the pace of work and time required to input information into electronic medical records.

“When we experience burnout, our compassion and empathy go down,” she said.

Collins said her experience with idiopathic intracranial hypertension, as both a doctor and patient, “has increased my empathy and has encouraged me to be more explanatory and to not leave patients in the dark. It makes a difference.”