Robin Williams death shows the challenge of healthcare: Sometimes nothing helps

The death of Robin Williams shows even with excellent access to healthcare, sometimes nothing can treat illness. “Innovation” is not a silver bullet.

Zelda Williams posted this remembrance of her father Robin Williams on Twitter.

All day long every week I get emails about how healthcare is changing and who is making it better and how they are doing it.

Lots of startups are focusing on mental health: making it easier to get therapy, taking away the stigma associated with depression and other illnesses, moving counseling online.

I often try to create a picture of how all these services would fit together in the real world and form a new way to treat health problems. In 15 years or so, a care plan for a person at risk of depression or suicide could look like this:

While Robin Williams may not have had genetic testing or pharmacogenetic testing done, he certainly had access to care and enough money to get whatever innovative treatments might have helped him. Sadly, nothing prevented his suicide.

This is why healthcare is so difficult and changing healthcare does not always have a satisfying ending. It is also why even innovation can’t make a difference to every single person living with a particular illness. Some people with diabetes will never manage their blood sugar. Some people who are overweight will never start walking to lose a few pounds. Some people with mental health problems will choose not to take their meds for very personal reasons that no one else can understand.

One element of chronic illnesses — like depression or heart failure or diabetes or AIDS — is the unrelenting burden of care. Very few “innovations” take into account the ongoing demands of managing a complex condition — day after day after day. The problem is not that people won’t take care of themselves or don’t understand how to or don’t have access to help. It’s that they get worn down by the disease. Even one moment of doubt or one missed dose can have devastating consequences.

This complexity should do two things for anyone working to change healthcare. It should keep us all humble, knowing that there is no silver bullet that will hit the triple aim. It also should not stop us. Just because all these improvements we are talking about – better care coordination, genetic testing, online counseling – will not help everyone does not mean we shouldn’t pursue them. We have to focus on the people we can help.

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