Maxing Out Attack Isn’t Enough: What Pokémon GO Taught Me About Chronic Care and Governance
When I was fighting a Dynamax Legendary Pokémon in Pokémon GO, I was reminded the hard way that “maxing out attack alone won’t get you very far.”
The other day, I challenged a Regice Max Raid twice in a row.
Battle 1: A team with Guard and Spirit
From the very first turn, I had a good feeling about the first battle.
Several players had brought Pokémon that were well prepared on the support side: skills that raised defense (“Guard”) and skills that healed the whole party (“Spirit”). They used them generously at all the key moments.
Some players were using Spirit so proactively that I sometimes thought, “We probably didn’t need to heal that much right now.” It looked a bit like overhealing.
But in a long fight that lasts close to ten turns, that kind of overprotection is almost just noise. Even with some inefficiency, there was basically no realistic way for the team to collapse. It took time, but we made it through steadily to the end. To top it off, I even got a shiny Regice out of it.
Battle 2: The collapse of a damage‑only team
Riding high from that first victory, I joined the second lobby in a good mood.
This time, though, it was clear that several players were of a very different type. They were fielding glass‑cannon attackers like Charizard and Roggenrola—a front line full of high damage but paper‑thin defenses.
Once the battle started, those players never used any defensive buffs or healing. For the first few turns, our firepower did take a decent chunk off Regice’s HP. There were even moments when I thought, “Huh, maybe this will work out after all.”
But as the turns went on, the situation flipped. The fragile attackers started dropping one after another, until only a few Pokémon were left on the field. From there, no matter how much we tried to fire off Guard and Spirit, we simply couldn’t stabilize. Our lack of resources and accumulated fatigue were exposed all at once, and in the end the entire team quietly—but inevitably—fell apart.
No time limit in Max Raids
Here, the details of Max Raid mechanics really matter.
Unlike regular raids, Max Raids in Pokémon GO do not have a time limit.
That means you can’t use the usual excuse: “If we just had 20 more seconds—10 seconds—we would have won.” You have all the time in the world, and you still end up wiping. What’s left is a much harsher reality: the team failed because its damage balance, role distribution, and preparation of defensive and healing skills were fundamentally flawed.
From a pure efficiency standpoint, the first team—with its seemingly “excessive” Guard and Spirit—might look wasteful. But in a long fight, that redundancy is just a rounding error. What matters far more is not wiping, and being able to make it to the end.
The second team, stacked with attackers and light on Guard and Spirit, looked flashy at the beginning. The longer the fight went on, however, the more its fragility was exposed, and the more likely it became that we would never reach the finish line.
Of course, these two battles are not only about games.
Chronic disease management as an unlimited‑time Max Raid
In medicine—especially in chronic disease management—we see a very similar structure.
Chronic conditions such as diabetes, hypertension, and dyslipidemia are not like acute illnesses that require emergency transport and determine life or death within hours or days. In many cases, patients and healthcare professionals are given years, even decades. If we only look at the condition “as long as we have enough time,” we actually have plenty.
And yet, we still see many cases where complications progress and patients, families, and healthcare systems are gradually cornered. The problem here, again, is not “we didn’t have enough time,” but the underlying structure.
Early lifestyle counseling and self‑management support (Spirit) are weak.
Multidisciplinary teams and community‑based integrated care—our defensive Guard—are thin.
The roles and workflows for ongoing support and follow‑up are poorly designed.
We do have time, but we keep fighting without paying attention to Guard and Spirit. The result is a long, grinding struggle.
In this analogy, the “attackers” are not limited to a single profession.
It includes physicians, other healthcare workers, and patients themselves—anyone who tends to focus on what will move the numbers right now: "working harder on diet therapy, starting a new antidiabetic medication," and so on.
By contrast, things like regular fundus examinations, urinary albumin‑to‑creatinine ratio (UACR), peripheral neuropathy assessments, foot care, and vaccination status checks fall more on the Guard side of the work. How well we build in these periodic checks to detect complications and risks early has a huge impact on the team’s overall durability in the long game.
What we may really want to maximize are the team’s Guard and Spirit. Patient education, continuous multidisciplinary support, linkage to community resources, and risk‑stratified follow‑up systems—these kinds of “receptive” and “supportive” structures largely determine whether we can actually finish the marathon.
Universities, attackers, and the governance skill tree
If we shift our focus to universities, the picture looks quite similar.
Universities welcome future Nobel Prize candidates and outstanding researchers who will lead their fields—their exceptional attackers. They provide funding, facilities, and academic freedom, and send them to the front lines. There is nothing wrong with that in itself.
However, analyses of scandals and failures in universities, hospitals, and companies repeatedly point out that “individual ethics and skills” do not fully explain what has happened. In many cases, structural and cultural factors shape how likely problems are to occur: misaligned incentives, weak checks and balances, lack of transparency, malfunctioning whistleblower systems, and so on.
Ultimately, of course, individuals are responsible for breaking rules. Even so, when the same kinds of misconduct keep recurring in some organizations but rarely occur in others, it is reasonable to suspect differences in Guard and Spirit—in other words, in governance and support design.
Many organizations follow a pattern: first, they select people on the assumption that everyone will compete as an attacker; then, those who do not perform as well in that competition are later reassigned to Guard or Spirit roles. In this setup, people who are naturally suited for defense or support can spend years being worn down as “second‑string attackers” before they are finally moved into the roles where they actually fit.
Instead, we might need to evaluate Guard and Spirit aptitude from the beginning and design explicit career paths for those roles. Not only for star attackers, but also for students and early‑career researchers who want to develop skills in risk management, consensus building, and institutional design. They should be able to choose that path with confidence from day one. For organizations, that means treating Guard and Spirit roles as first‑class positions, not leftover slots for failed attackers.
Public policy schools and governance‑oriented graduate programs in places like the US and UK can be seen as exactly this kind of education: they cultivate the skill trees of organizational Guard and Spirit. Their aim is to train high‑level public and governance professionals in policy formulation, implementation and evaluation, risk management, ethics, and accountability. In programs focused on science and technology policy or evidence‑informed policymaking, there are even efforts to equip researchers themselves with skills for engaging with policy and embedding evidence into governance.
From the perspective of healthcare systems, institutions such as NICE (the National Institute for Health and Care Excellence) in the UK also function as organizational Guard and Spirit. Instead of leaving everything to the individual judgment of healthcare professionals and patients—the attackers—NICE conducts technology assessments and develops guidelines based on evidence and cost‑effectiveness. It provides safety barriers and rational support to the system as a whole by evaluating medical technologies from multiple angles. No matter how brilliant individual professionals or patients and family members are, there are risks and biases that they cannot absorb alone; institutions like NICE are frameworks designed to take on those risks at the system level.
Beyond “try harder”: seeing it as a structural problem
The lesson from Pokémon GO Max Raids is not simply that “all‑out offense is bad.”
Even when there is plenty of time, teams that have not unlocked their Guard and Spirit skills will gradually fall apart. It is a somewhat cruel reality.
Chronic disease management, the governance of universities and healthcare organizations, and institutions like NICE or public policy schools all share a common question—not only “who should be our attackers,” but also “what Guard and Spirit we should cultivate in advance at the organizational level.”
It is a shift from seeing problems as failures of individual effort to seeing them as failures of structure. Digging out that perspective from a small defeat in a game might not be such a bad way to start.
[If you prefer to read this in Japanese, the original version (日本語版) is here.]
Tsutomu Tomita, MD, PhD – Internist and clinic owner based in Shizuoka, Japan
