We return from a short break with a case report about how smartphones can threaten patient care and the risks that new moms with bipolar disorder face.
Patients Use Delivery Apps to Skirt Life-Saving Restrictions
A new case report from Massachusetts General Hospital highlights a uniquely 21st century (and frustrating) challenge for clinicians. More and more often, patients are using smartphones and delivery apps to bypass hospital restrictions designed to safeguard their health.
This anecdote – appearing in The Primary Care Companion for CNS Disorders – centers on a 63-year-old man with heart failure, diabetes, kidney disease, COPD, obesity, and PTSD. He drew the ire of his caregivers by repeatedly ignoring prescribed fluid limits and a carbohydrate-controlled diet.
Despite education and psychiatric support, he kept ordering snacks, ice cream, and salty foods through Amazon. More brazenly, these deliveries showed up at his room, undermining his treatment plan.
Psychiatrists insist that this case illustrates a broader and (often overlooked) problem. Digital tools give patients easy access to outside food, drinks, and other items, complicating efforts to treat patients. Unmet needs – from a lack of autonomy to frustration with their care – are what usually drive these behaviors, not petulant defiance. Understanding those motivations, the authors note, can help teams remain empathic and communicate better with those in their care.
This case study also reinforces what we know about the limits of establishing guidelines for patients. While hospitals typically restrict smartphones in operating rooms and locked psychiatric units, most other inpatient settings implement fewer guardrails. Delivery apps, for example, challenge the assumptions behind dietary orders, shared decision-making, and adherence.
In this case, clinicians worked to adjust medications, provide supportive therapy, and reinforce the importance of dietary restrictions. But the patient continued to struggle. Ultimately, his extended hospitalization ended in fatal cardiac complications.
The authors argue that as technology evolves, hospitals must reconsider how they support adherence. And how they respond when patients use digital tools in ways that jeopardize their own care.
IN OTHER PSYCHIATRY AND NEUROLOGY NEWS
- New research in The Journal of Clinical Psychiatry reveals that postpartum women with bipolar disorder show much higher suicidality than those with unipolar depression.
- In a letter to the editor of PCC, a reader discusses the culturally adaptive work of Dr. Vidya Sagar.
- New commentary in JCP argues that clinical trials must strike a balance between strict criteria that ensure clear efficacy signals and broader inclusion that reflects real-world PTSD populations.
- Another PCC case study highlights a man’s prolonged symptoms after dropping high-dose benzodiazepines after decades of abuse.
- In the latest episode of “The JCP Podcast,” Stephen Brannan shares insights on his journey from the halls of academia to the world of big pharma.
