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RPGBOT.Podcast S2 E6 – Mundane Medicine in Fantasy Games

Show Notes

In this episode of the RPGBOT.Podcast, we discuss mundane medicine in fantasy games which typically also offer magical solutions to healing. We look at medicine skills across several RPGs and examine where different RPGs do things well or poorly, and what you can do make mundane medicine meaningful in games like DnD 5e.

Special thanks to October Sky for the question of the week this week.

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Materials Referenced in this Episode

Transcript

Randall 

Welcome to the RPGBOT.Podcast. I’m Randall James, your homeopathic herbalist, and with me is Tyler Kamstra.

Tyler 

Hi everybody.

Randall 

And Random Powell.

Random 

Howdy.

Randall 

Alright, Tyler, what are we gonna do today?

Tyler 

Today we’re going to talk about healing. More specifically, we’re going to talk about mundane medicine. So if you’re familiar with dungeon fantasy RPGs, D&D, Pathfinder, etc, you are familiar with having someone in the party who can cast healing spells. But beyond magical solutions to problems, there’s also mundane healing, which is a topic that a lot of groups just overlook. Like, I have a Cleric, why do I need to know how to use band aids? So we’re going to explore today both the mechanics of mundane healing, how to make those mechanics interesting and useful, and how to make it a fun storytelling device.

Randall 

Okay, so I’m gonna ask your question I’m pretty sure none of us actually prepared for: what is the etymology of the word mundane? What does this actually mean?

Tyler 

Boy, you’re asking the wrong podcast, man.

Random 

Etymology? I don’t know that I could get there. For how we’re going to use it in this context, it’s mostly just not magical. In various dungeon fantasy games, there’s a lot of healing that you’re going to find that is not strictly magical, but also still not what we’re mostly talking about. We are really largely going to be talking about how do I take the skill medicine usually and/or some items and apply them to put hit points back on or perhaps fix conditions? Compare this to..

Randall 

Now to make the joke, right quick, I found this bactine in a dungeon, but I don’t know how to use it. So I guess you’re gonna have to deal with it. I do want to say, I really just asked the etymology question to make Tyler insert that in the show notes. That’s all.

Tyler 

Oh. Okay.

Random 

Perfect. So you know, speaking your bactine, right, this is the thing that fighters do. They chunk some bactine as a bonus action. And somehow this heals them. You have that sort of thing. You have your characters, well, not generally characters, but some, some monsters will have things like regeneration. All these things that are just supposed to represent a natural ability for a body to heal itself, which is not what we’re talking about. We’re really just going to focus on applied healing that doesn’t come from a magical source.

Randall 

Okay, and so to, you know, shed some light, what we’ll do. We’re going to talk about 5e, we’re going to talk about Pathfinder 2. We’re actually going to roll through what are the ideas that we can draw from a lot of different tabletop games. And then on the back end, we want to pick our heads up and say like, Okay, what were actually the good ideas and what could we leverage to make this more interesting?

Tyler 

Yeah, exactly. We’ve done kind of a survey of a bunch of different rule sets to look at their options for healing. Unsurprisingly, the rules for healing are as diverse as the rule sets themselves, so every game will have a different answer to how healing works. Listeners are probably most familiar with fifth edition D&D, possibly Pathfinder 2, maybe some other rulesets if you’ve explored beyond those horizons. Since fifth edition D&D is kind of the staple baseline for a lot of people playing TTRPGs, let’s start there. Open up your player’s handbook. Go to the playing the game section, using ability scores, we’re all pantomiming flipping open books. Imagine the sound of pages turning. The section on the skill medicine is basically one sentence. And it amounts to you can use a medicine check as an action to stabilize a dying creature with a DC I believe it’s 15 medicine check. And that’s it. End of medicine.

Randall 

Okay, I think it’s worth calling out. Give me one or two other things that I could do to stabilize a creature that don’t require me to use the medicines kill.

Tyler 

Healing Word is probably the one that that people go to most frequently, you can do it from across the room. Pops people back up in a fight. Costs a first level spell slot, works great. You can also use a healer’s kit, which doesn’t require a check and uses the same action. So you pull out your first aid kit, you slap someone with a bandaid, no check required, they are stabilized. There’s also the Spare the Dying cantrip which will stabilize people by touching them. But like healer’s kits exist, why would you bother?

Random 

Yeah, honestly I think the biggest one with the healers kit is the fact that you have to hold right click on them the entire time. It’s just really time consuming. You’re going to get pounced.

Randall 

Perfect. So what we’re really saying is the medicine skill, very strong in 5e. Super irreplaceable, right?

Tyler 

Oh, yes, most essential skill in the game.

Randall 

Okay, good.

Tyler 

Yeah, the the fact that the medicine skill in 5e is so useless is actually the impetus for this episode because this has been done right in so many RPGs, to see the number one RPG get this so incredibly wrong and then just never even tried to fix it. It’s not that hard, guys.

Random 

So you say that, but it’s interesting. It’s not like they were good at it in previous editions either. I mean, you know, think back to 3.5. There was heal.

Tyler 

Yeah. Ironically, the one thing that it can’t do is heal injuries.

Random 

Well, it

Randall 

No, no, you can’t. What?

Random 

A skill called Hill. Wow. A skill called heal. Yep. I take that applause. A skill called heal could not put hit points back on to somebody except as part of sleeping overnight. And in 3.x, when you slept overnight, you didn’t get all your hit points back. You got back your hit dice in hit points back.

Tyler 

Yeah, so if you’re, like, if you’re a Barbarian and you get dropped down to one hit point, if you need to heal naturally, it’ll take like weeks sometimes at high levels.

Randall 

Okay, well, let me let me clarify that. So I have five hit dice, and I have let’s say like 30 HP. I gain five HP.

Random 

Yep.

Tyler 

Yep.

Random 

Now, if someone if someone makes a heal check as part of tending wounds overnight, they can take some number of creatures and I think it’s six and double that.

Randall 

Double! Okay.

Tyler 

If you don’t have a Cleric in the party, you just pay an NPC nurse to tend your wounds overnight while you heal, basically.

Randall 

Wow. Okay, that’s, that’s bad. Okay. I mean, I don’t wanna say it’s bad, right? I’m sure it fit the system. And it was great.

Random 

No, I didn’t. That’s exactly my point. It was really dumb!

Randall 

No, that’s bad then. That’s bad.

Random 

So and this is why, like, the the absolute scarcity of reasonable healing for the scale of hit points that player characters have is why a divine caster was required. Something that could cast healing magic, because if you don’t have it, especially in older editions, I mean, you were just hosed. Because if you had a bad fight, one, maybe more characters are out for days. And then you just what do you do? Do you just sit and wait for days? Fifth Edition, god bless ’em, when you sleep overnight at least you get all those hit points back.

Randall 

Wait, wait, wait, I’m, I’m not done. I’m not done. So, so like you say, okay, divine caster is a must have. So let’s say I’m a party of four, we go in, we all really get messed up does the divine caster basically have to save all of their spell slots just to heal the party?

Random 

So they thought of that. Clerics in particular, a good-aligned Cleric or a neutral Cleric who chose this option could drop any prepared spell for a cure. Just I’m going to drop this and turn it into a Cure Wounds of the appropriate slot, explicitly for that reason. However, what this did mean is that if your primary divine caster was a Druid, yes, you just had to prepare and hope.

Tyler 

Yeah.

Random 

Because they couldn’t do that.

Randall 

Or it’s actually it leads to like almost something that’s malicious, right? Because you basically, like I sure hope you people get messed up in this fight, because otherwise I wasted the spell slots for nothing.

Random 

Oh, and so there was an alternate class feature you could take. I’m pretty sure this was PHB 2. So what druids could do normally in the same way that Cleric could drop for cures is druids could drop for summon nature’s ally, basically just borrow an animal at higher levels, borrow a dinosaur, it shows up for a round a level and then leaves and you could drop that for spontaneous fast healing instead. That was a often selected option once it came out if your Druid was your primary divine caster because otherwise, yes, you would run into exactly that issue. Also, wands of vigor. Because yeah, wands of vigor were goofy in 3.x. But we’ll get to that.

Tyler 

Yes, the 3.5 answer to hit point restoration was always wands because a wand of the first level spell was super cheap. It costs less than half of a plus one weapon and you had plus one weapons by like level three. So yeah, you just basically have a stack of wands of cure light wounds that you would go through to restore hit points instead of spending actual spell slots on it. But the heal skill in 3.5 was still useful for some other things. Treating disease, treating poison, treating specific status effects like caltrops if you stepped on caltrops, DC 10 heal check to undo the status penalty from caltrops. So there were some specific uses that made heal useful in ways that sometimes could replace magical healing because spells like remove poison and cure disease were expensive and you probably didn’t want to prepare those everyday if you weren’t expecting to run into something that’s going to poison you or make you sick. So heal was a very nice way to solve those problems without resorting to magic, without buying scrolls or potions or whatever, which got expensive very quickly. Now, Pathfinder first edition built on those rules, basically copy pasted the core heal rules from 3.5 and expanded on them to add more options. Like eventually, they added higher DC heal checks that you can use to actually restore hit points. It took some frustratingly large amount of time, but if you optimize the heal skill, you can actually restore a ton of hit points pretty quickly. So having heal was a good cheap substitute to dumping goald into magic wands,

Randall 

But you are dumping your… like the opportunity cost of climbing the feat trade to get to that versus taking other things.

Tyler 

Yes, exactly.

Randall 

Okay, so you’re, I don’t want to say dooming a character. But you are kind of like, hey, yeah, this is, yeah, this is your lot in life. And we all appreciate it.

Tyler 

Yeah.

Randall 

Okay,

Tyler 

So we’ve talked a bit about how 3.5 heal, Pathfinder one heal could… they couldn’t really restore hit points, at least not until late and Pathfinder first edition. They could treat medicine, er, they could treat disease, they could treat poison, they could help you recover HP naturally. You can’t do any of those things in fifth edition. There are a handful of monster abilities which specify that you can, I may be remembering this wrong. But I remember that… words are hard. I remember there being a few monster abilities that you can use medicine to remove some part of the condition or something like that. But the rules of the medicine skill itself don’t provide that capability. So the only core function of the medicine skill is made outright useless by the existence of the healer’s kit. Now people will sometimes look at the medicine skill and say, Okay, if I want to get into medicine and do non-magical healing, I’m going to take the healer feat. So let’s look at the healer feat real quick. So it has two functions function. One is when you stabilize somebody with a healers kit, which they’ve already acknowledged that the medicine skill is useless just by saying you have to use the healer’s kit to do this. Instead of just stabilizing them, they pop up at one hit point. Which is pretty nice, because that’s kind of like using Healing Word on somebody. It does take your action. But that’s besides the point. And then the second effect is as an action, you can heal somebody for some number of hit points, which is intended to be used in combat, like somebody is really hurt, somebody’s unconscious, I can restore a bunch of hit points, get them back into the fight. But the problem is, it’s 1d6 plus the number of hit dice they have. So it is a tiny, tiny, tiny, tiny amount of healing that, like, it’ll get them up from unconscious. But you have the first bullet point for that. And the difference between one hit point and like 10 Hit Points doesn’t really matter after very low level. So the healer feat is really frustrating. And if you can cast Healing Word, you’re already better than the entire feat.

Randall 

And I guess just to be clear, like who’s eligible to pick up the healer feat? Is this only available to a certain class? Or is this like an optional feat that anybody can pick up in lieu of..

Random 

No, it’s just a feat like it’s in the core rulebook anyone can take it.

Randall 

It sounds like when we think about opportunity costs, this would be pretty low compared to almost anything else available to you. Unless you got handed this feat for free.

Tyler 

Well feats are really expensive in fifth edition. Like, you’re you’re taking that instead of a potentially much better feat or inability scor increase. And the benefits really just aren’t very good.

Randall 

Yeah, so this would be super low compared to anything else that we would consider taking.

Tyler 

Yeah, absolutely. Like there is a fun abuse case where the thief rogue can use their fast hands feature to use a healer’s kit as a bonus action. But, like, even then, it’s still not very good. Unless you plan on having your allies fall unconscious every turn, you’re like bonus action stand back up bonus action stamp back at every turn.

Randall 

Well the good news is though that if you’re using this, if they get hit again, they probably are falling down again and therefore being able to do it every turn is probably beneficial.

Random 

On the other hand, you know, that’s still expending a resource and in fact it’s expending money, which is your money.

Randall 

Money has no value in 5e any anyway.

Random 

Well, yes, and… wonder how many times I’m gonna rant about that same thing. Realistically…

Randall 

It’s a boring way to play the game. I mean, I think that’s the…

Random 

Yeah, it’s even even as this Rogue abuse case, it’s still not as good as Healing Word. and also if you’re a Rogue and you’re using your bonus action to stand somebody up, why aren’t you using your bonus action for anything else cunning action can do?

Tyler 

Yeah.

Randall 

All right. At this point, I’m sad. So tell me about a tabletop system that actually makes medicine that makes sense and makes the game better.

Tyler 

So there are several. So I’ve got my big stack of books on the floor over here that I’ve been looking at all day looking for various clues of how medicine works. Pick any RPG that isn’t Dungeons and Dragons. The short answer, like…

Randall 

I’m going to pick one. You ready?

Tyler 

Go for it.

Randall 

FFG Star Wars.

Tyler 

Perfect. Okay, so in Final Fantasy, er, fantasy flight’s Star Wars RPG, all three of the rule sets, the rules for medicine are identical. You make a medicine check and you restore some number of wounds based on the number of successes you roll. You can also reduce strain, which is the, like, I’m tired bar. And if you get a triumph on the roll, you can, you can heal severe injuries, which are like I have a broken leg, I’ve a broken arm. I’ve been temporarily blinded in one eye and things like that. So medicine is very, very effective and very, very important. And, like, there are huge numbers of specializations around medicine in the game. Your character could just be a doctor in space. And that could be your whole deal. Like I heal people and I go on wacky adventures with my friends ind my spaceship.

Randall 

Sorry, I, like, you have the Star Trek. And it’s like, Damn it, man. I’m a doctor, not a miracle worker! Like that sort of…

Tyler 

That’s about right. There is also one interesting mechanic which I want to come back to later when we’re talking about, like, adapting stuff to other places. In Fantasy Flight Star Wars, if a character is more severely injured, it actually gets harder to treat them. So you have this concept of a wound threshold, which, think of it like your hit point maximum in 5e. If you’re below half of your wound threshold, it’s pretty easy to heal you. If you get in the the bottom half of your wound threshold, it gets harder. If you’re, you’re like basically out of hitpoints, which is like I am barely still conscious. It’s really, really hard to heal you. So, like, you want to treat people’s injuries as quickly as possible after you get out of a fight or whatever because the more severely injured they are, the harder and harder it gets for them to come back.

Randall 

That’s actually that’s a really interesting idea that I’ve literally never considered right we think of HP as being this linear thing where Yeah, five points of healing leads to five points of improvement on HP. So what you’re saying is they effectively applied a function where it’s like, the more HP you’ve lost, the five HP will not go as far.

Random 

Yeah, did you know if someone is bleeding out of several enormous puncture wounds, slapping a bandaid on it… less helpful than you might think.

Randall 

No, that’s exactly my experience, right? Oh, I’m sorry, your leg fell off. I’m gonna squeeze some back pain on the back of this stand back up. Let’s get in the fight.

Tyler 

Guys. I may have just had a really obvious realization, but do you think the name bacta came from bactine?

Randall 

Anyway.

Tyler 

All right, I’m sorry.

Random 

Listeners, that pause was just all three of us staring at him.

Tyler 

Am I just now having that realization, and I’m the only one late to the party? Alright. All right, so moving on to other RPGs: Shadowrun. Another RPG that Randall and I really, really want to play.

Randall 

Correct.

Tyler 

So Shadowrun calls their their medicine skill something super cool. It’s called “biotech.” Because it covers both medicine and cybernetics, so it’s more like attaching cybernetics than repairing them or whatever. But it does basically the same thing. You do first aid, you roll a check, the number of hits you roll on the die you were restore that many points of wounds. I’m forgetting what Shadowrun calls them. Oh my goodness. But you heal people. And then you can also do, like, the longer form version where you use a med kit, which like if you’re familiar with Star Wars, a med kit is basically a portable first aid kit. In Shadowrun, a med kit is basically a self-contained surgical station. So you do surgery, you roll a biotech, check your store a bunch of hit points, but it’s basically you just you roll the… you roll your check, you restore hit points, you’re done. There’s other stuff you can do with it. Like you can attach cybernetics, you can perform surgery, like other cool stuff. Disease and poison are less of a thing in Shadowrun as far as I know. I’m sure there’s probably

Randall 

Some version of it. Cyberpoison.

Tyler 

Cyberpoison. Yes. I have a cold and also a computer virus.

Randall 

Yeah, it’s like poisoned you’re just drugs we haven’t figured out how to take yet. Yeah, I’m actually I’m thinking about that. Like, that’s actually kind of a fun idea. Like I’ve got, like, yeah, you know, I’m this super awesome hacker, but uh, just lay down. I’m gonna get out my surgery kit, I’m gonna fix you up real good, it’s gonna be great.

Tyler 

Oh, god, no.

Randall 

And it works! It’s great. It’s good. One, the interesting thing there to me would be that like, I am equally likely to improve the state of your physical tissue as I am to fix your infrared eyeball that’s glitching.

Tyler 

In Shadowrun, yeah. So so if you have a party that has people with cybernetics, you’re probably going to want some mechanical skills around, too. Back in 3.5 warforged were technically constructs. So they… wizards got a repair construct spell, which was equivalent to the cure wound spells. So if you had warforged in the party, the Cleric, er, the Wizard is also your healer. Bring skills that cover your party’s needs.

Randall 

No, that that definitely makes sense. All right. I, you hit on something interesting, I kind of want to dive a little bit deeper on. So you brought up the idea of like, again, the more injured you are, the harder it is to heal you. And I think that like nonlinear function is really interesting. And as long as we don’t have to go back to THAC0 tables, I think this should be something we should bring forward with us. I know, so 5e has this idea, like there is an optional rule or a variant on lingering injuries. And if you read that, it’s like, you know, you get stabbed in the eyeball and you lose it, but if you use a regeneration spell, we can bring it back or you lose a limb. And so like you don’t have a hand anymore, but if you use the regeneration spell, we can bring it back.

Tyler 

Lingering injuries are a great way to make wounds feel more serious,.tTere is kind of a careful balancing act you have to do,because lingering injuries will naturally punish the characters who are getting attacked more frequently. So your frontline Fighter, whoever’s being your party’s tank, they are necessarily going to take most of the damage and therefore most of the debilitating injuries. So over time, like, if you’re not high enough level that you can cast the spells to repair those lingering injuries, your martial characters will be punished for the existence of the system and your caster standing in the back, they’re fine.

Randall 

In a in a roleplay sense, that actually makes perfect sense, I do want to call out. So what the variant recommends, like, two of the examples they give for why a lingering lingering injury might happen. One is on a critical strike, you should have some percent chance that this is going to happen. And I would argue you should make that super low. But I do think it’s interesting. The second is if somebody falls but doesn’t actually die outright. And so while they’re making their death saves, you might say hey, by the way, you got you got poked in the face. Sorry about that.

Random 

Tyler brought up a really good point. This is going to unnecessarily punish martial characters who already don’t scale as well as casters do. And on top of that, in the same rant that I had about flanking, this punishes the players. You’re never going to do a lasting injury to a monster. Or maybe you do but even if you do, it’s only going to matter until you kill them which you’re already in the process of doing anyway.

Randall 

I was gonna say death is pretty… Yeah.

Random 

Exactly. The, the best status injury you can inflict is dead.

Randall 

Write that down.

Random 

When you consider a system like that… You really have to set the expectation with your players that like, hey, we’re gonna be doing this, it’s gonna be harder for you, is that something you guys are going to enjoy? Because if you don’t go in with that social expectation, you’re just gonna have unhappy players. And in particular, you’re you’re already taking away from the people who already get the short end of the stick. I definitely like the thought of bringing in some way to make it so that yeah, the further down you are, then maybe it’s a little bit harder. And while we can maybe borrow a mechanic from fourth edition that I think is maybe a variant but not really in fifth edition, which is the bloodirf mechanic. This is a thing that most DM’s will still describe anyway, because I think one of the books talks about describing even if it no longer is a key word mechanic, bloodied. Bloodied from fourth edition just means something is below half HP. That’s an easy way to describe like, ah yes, you know, the monster definitely seems like it’s slowing down. It’s got a few wounds on it, you can tell that it’s unhappy. Maybe if you’re healing a bloodied character, maybe that requires a medicine check to get full effectiveness out of the spell. Something like that. Something that’s not going to punish people who already are in a bad place basically is my point.

Randall 

No, I definitely take it I think there’s, there’s a couple things here one, so as a DM if you are at or if you’re adding the lingering injuries to your game. What has to come with this is basically the free availability, like, you talking about having an NPC nurse that can just use heal so you can get double your hit dice at least back in 3.x. In this case, there has to be, like, somebody who cast regeneration standing on the side of every corner, it’s like a missing eyeballs, missing eyeballs. Bring out your dead, I’m not… boy, okay?

Random 

Which means that there’s just 13th Little clerics wandering around all over your world and hoo boy, why do you still have problems?

Randall 

It’s like, well, they’re very busy giving people back their eyeballs

Random 

Well there you go.

Randall 

I do want to offer a fix for the fact that this is much worse for our Fighter versus our Wizard, but I’m gonna ask your question ahead of time. What is the hit dice for Wizard?

Tyler 

d6

Randall 

Okay, what’s the hit dice for a Fighter?

Tyler 

d10

Randall 

I want to square they hit dice. And I want to have a one out of over hit dice squared likelihood of receiving a lingering injury.

Tyler 

That’s an interesting idea. So for Fighter will be a one in 100. For Wizard or b one in 16?

Randall 

One in 36.

Tyler 

Hang on, I’m counting on my fingers.

Random 

Don’t worry, I’m gonna give you the benefit of the doubt that you were going off of the 3.5 Wizard and it was a d4 hit dice.

Tyler 

I totally was! Thank you!

Randall 

Okay, we fixed it. Math. Math is strong. Strong is math. Tyler? Tyler trong. But yeah, so right, you’re on a critical hit, you would be three times as likely to have this lingering injury.

Tyler 

That would definitely tip the scales. But I would also ask if it’s going to happen one in 100 times…

Random 

No, no, it’s going to happen. One and 100 crits.

Tyler 

Oh. Er, yeah…

Random 

I mean, at that point, you’re going to see it maybe twice in a campaign.

Randall 

Alright, I’ll adapt. I’ll adapt. Squared over four.

Tyler 

Okay,

Randall 

Just increase the overall rates, but you’re still making it more likely for the squishy people to have it happen, which again, it all feels realistic. Alright, well workshop it. I’m just saying I feel like there’s a way to bring this in and make it feel like, okay. But to bring it back to Monday medicine and the fact that in 5e, the medicine skill absolutely sucks. One of the great examples in the in the lingering injuries, is you have a limp, you just have a limp now. And they call out specifically it can be made to go away with a magical healing.

Tyler 

Yeah, which exactly… exactly describes the problem that we’re discussing today. If everything is solved magically, why even bother having the medicine skill exist? Like, I get D&D is very high fantasy typically. Most people don’t run their game. This is like a low fantasy. Very few people can cast spells. Most people don’t run those games. Because even in those games, you have one person in the party who can cast Cure Wounds, a lot of your problems are magically solved. So medicine as much less useful. But why couldn’t they have said yeah, this is like a, it takes a DC something medicine check over the course of a week to do physical therapy and stretching or something.

Randall 

Yeah, no, to me, to me that makes perfect sense. Or or say that, like you have to expend a healing slot of x. And so we can do this in a natural way over time. Or you can’t just heal somebody for, you know, 4 HP and all of a sudden their limp is gone. You have to burn something higher level.

Random 

There are definitely places where proficiency in medicine has done a character good for me. Not in healing people.

Randall 

Oh, okay. Yeah, this might make sense then. Keep going.

Random 

That would be ludicrous. No. So things like determining cause of death for a corpse that you find. Things like determining maybe what kind of poison someone is suffering from based on symptoms, or what disease. There’s a lot of plot-related reasons why you might use proficiency in medicine. And, you know, I know that this sort of strays from our, our charter about, you know, how do we take mechanics and make them, you know, more interesting, but honestly, writing to medicine in fifth edition is entirely possible. And so just, there is my sidebar, like, if if you are a creative player or a creative DM, you can figure out how to make medicine worth it when somebody is taking it, even though it’s not a mechanically great choice for healing. There’s still good things to do with it. You know, and in fact, way back in episode one, we you know, when we were just when we were talking about what’s that red stuff on the door? Right? And you know, I said, if it was blood, I would have absolutely allowed medicine proficiency to apply when when someone was trying to identify it, right? So there’s things you can do, just not things that are very crunchy. But I’ll ask the question, can you come up with a scenario where you would allow a medicine check, where neither nature nor arcana would would cover? You know, if it’s the tissue of the body, if it’s like a bacterial infection, if it’s something like this, I can imagine Nature. If it’s a poison, I feel like it’s going to be either nature or arcana, right?

Tyler 

Well, arcana is typically things that are magical or magic adjacent. So you could… you could cover poison with proficiency in a poisoners’ kit, you could cover diseases, you could argue nature would work, definitely. Super frustrating. There, there is actually a raw answer to identifying cause of death. And it’s not medicine for some reason.

Randall 

What is it?

Tyler 

I’m pretty sure it’s survival.

Randall 

That kinda makes sense. Okay, yeah. They didn’t survive.

Random 

Here’s a thing that I would say: you’re gonna get different answers. And so if you think about what somebody… so if you are proficient in nature, as opposed to proficient in medicine, proficient in medicine is going to tell me, what do these symptoms look like? And how do I treat them? You know, whereas a knowledge of nature might tell you what bacteria would I find that would be common to this area? So, like if I see somebody has died and is foaming at the mouth, do I know bacteria?

Randall 

Hydrogen peroxide?

Random 

Exactly, you know, the Fighter. He chugged bactine. I don’t know why, but… Right. So there’s really, this leans heavily on the improvisation skills of the DM. But that’s one of the things that I highly, highly recommend that you practice and get good at, if you are going to DM is don’t just think, you know, don’t be tied to especially in pre-written modules, you know, you’ll often have things like, ah, if the player succeeds on a DC 15, arcana check, they will know that blah, blah, blah. Which is great, but you know, what if somebody doesn’t make that? Or what if, you know, somebody doesn’t have that skill? Well, then what could you do to get them close using what they have? Because no one is going to enjoy not finding out something just because they didn’t roll well, or just because they didn’t optimize in a way that would be useful in this particular case. So if you can figure out something to make the skill useful, like medicine, that’s gonna end up feeling really good for them.

Randall 

Okay, so I kind of want to put a bow on the compliment part of this compliment sandwich that we’re giving the medicine skill. Pathfinder 2 has a lot of good ideas for what we can do with medicine, right?

Tyler 

Yes. Medicine is one of the most important skills in Pathfinder second edition. In a game that in that involves a lot of crawling in dungeons, back to back fights, you’re, you’re not going to have enough spell slots to heal your party to get through a day. Like, clerics get the ability to channel energy, which can heal, like, your party members. Actually, I guess technically, that’s PF1. But in PF2, they get extra spell slots that can be either heal or harm if you’re good or evil aligned. But anyway. Clerics get a bunch of magical healing. Still not enough. You’re gonna need medicine. And there’s this whole expected mechanic that that’s not really called out rules. Intentionally so, maybe. But the basically the way it works is you have a fight. After a fight, everyone takes a break for a minute, like people spend 10 minutes refocusing to get back their focus points. Somebody goes around and uses medicine to get her body back up a few hit points. So this kind of post combat phase is really important to survival and PF2. But beyond that PF2 also does a really good job about spelling out a specific action for anything that you might want to do with any given thing. So for medicine, there’s first aid, stabilize creature, treat disease, treat poison, staunch bleeding. So like, there are very clearly enumerated like. Here is a thing you can do with this skill. Here’s the things you can do if you’re not trained, here’s the things you can do if you’re trained. Here’s how all of these things work. Like it’s all very clearly enumerated, and it covers pretty much all of the obvious things that you would want to do with a mundane medicine scale, like one of my party members is taking ongoing bleeding damage, because they’ve been stabbed with some special weapon that does that. So I’m going to use my medicine skill, stop bleeding. Or after a fight, I’m going to patch up everyone in the party. You know, bandages, high fives, ibuprofen, get everybody back up and ready for the next fight. So medicine is very useful. It’s important to any party. Anyone in the party can do it with a reasonable degree of proficiency. So it’s available to any party. So it’s central, it’s accessible, and it’s effective and it’s well described. Yeah, that was actually a crazy thing. So Tyler recently ran for our regular D&D Group, a Pathfinder 2 one shot. And yeah, like we got through a fight. And at the end of it, we’re looking around like, okay, we’re all kind of banged up. And right, our Game Master is offering, it’s like, you can just give each other first aid. And right, yeah, first aid is this skill. Right? Not the skille, the… The action is… I think it’s a treat wounds.

Randall 

That’s it. There we go, treat wounds. And what was it, it was like a DC 15 medicine check? And if you hit that, we got the roll, hit dice, I think.

Tyler 

It was, it’s like d8 plus some number. If you roll a critical success, which is you, you either roll a natural 20 or succeed by 10, then you get double that, I think. And if you roll a failure or critical failure, bad stuff happens. So, like, there is technically a small gamble until you get really good at medicine. But it’s… I mean, it’s going to work out in your favorite 95% of the time.

Randall 

Now, except for Precious. Poor Precious. But no, it was a really cool… I can’t think of the word that I want to use.

Tyler  

Mechanic?

Randall 

Mechanic! Mechanic is the word. Yeah, it was a really cool mechanic that like, oh, like we can do this. And nobody has to burn spell slots, and we’re not carrying healing potions. Like we can actually just heal up, you know, the damage that the thorn bush did to us, or whatever it might have been at the time.

Tyler 

Yeah, I do really like that a lot. But if you’re coming from other games, and you come into Pathfinder, and look at medicine, and say, Hey, this is kind of annoying, and it’s basically just a tax on every party’s resources that someone that has to be good at non-magical healing. There’s a variant in the game mastery guide that kind of addresses that. So it’s, it’s just called “stamina.” The basic premise is you split your hit points roughly in half. Half of it is actual hitpoints. Half of it is stamina. Stamina is regained very easily but you can only regain it by by using the take a breather action between fights, essentially. And then your regular hit points work just like standard hit points do. You can restore them with medicine, your cure spells. But basically what it means is, if you don’t go below half hitpoints in a fight, you just kind of catch your breath for a few minutes after every fight. Much less taxing on your resources. I don’t know that it actually changes the way the game plays all that much. Like, it just means you have to put less resources into medicine and healing potions and things like that. But it does kind of reduce that reliance on that one central skill without really changing the game.

Randall 

Yeah, I guess with with treat wounds, it was I think you needed to spend at least 10 minutes doing the treat wounds action. And so if you had a timer…

Tyler 

It was 60, er 10 minutes, and then there’s a 60 minute cooldown. So you can only do it to one person once per hour. But yeah, it takes 10 minutes to actually do the treating wounds.

Randall 

Oh, cool. And then you couldn’t do it again for a certain period of time. And so if there was no time pressure in your in your current session, done, that’s fantastic. And it’s not so taxing. But if there were time pressure, yeah, I’d like that wouldn’t be available to you. And that would be pretty painful. Even if the time pressure was, you know, look, we have to be somewhere in two hours. You would only at most be able to apply this maybe once per party member or something like this.

Tyler 

Yeah.

Randall 

Okay. Gotcha, gotcha. All right. Are we are we ready to ask the question? How do we? How do we make 5e better?

Tyler 

Yeah, I think so. So we’ve touched on a little bit. Already, we’ve talked about using medicine for things like identifying injuries, we could very easily bring back the concept of using medicine to treat both diseases and poisons. My recommendation would just be, like, make a medicine check against the DC of whatever thing is affecting the target. So say they have like filth fever or something and it’s DC 13 to get healthy. Make a medicine check against that and then maybe they make another save. Maybe they make the save with advantage. Something along those lines. Or maybe you just use the medicine check in place of rolling the save to make them get better.

Random 

Yeah.

Tyler 

Fourth edition actually had one of one of the options you could do with the medicine skill was you can allow people to make a saving throw, which if you’ve played any edition of D&D Except fourth edition sounds crazy, but in fourth edition saving throws were a thing that you did at the end of your turn to remove ongoing effects. So like someone is on fire or actively bleeding you can make make a medicine check and they get a roll to remove that effect again. I hate that they reused the term saving throw for a different concept but… fourth edition.

Random 

Yeah. One of the other things that we talked a bit about this is definitely a little more on the punishing side but I think that you could definitely balance around this. So we’ve talked previously about forcing healers kits to allow for spending of hit dice, this is actually a optional rule. And that could be a very easy way to turn it sort of into as necessary and central as it is in Pathfinder two. Unfortunately, it still doesn’t provide a lot of the same benefits, you know, you’re still not really healing people. If you wanted, especially given how much of a bounded system fifth edition is, I honestly don’t see a problem with just doing something like, if you take the feat, then rather than spending a healer’s kit to get like a d6 plus, you know, some tiny amount or something, just roll a medicine check, they get that many hit points back. It’s like, it’s not all that many. But it’s still enough to make it feel like, maybe this is worth it. Because, you know, if especially if you considering like a first level spell slot you’re going to get back five hit points maybe, you know, especially at original casting, you’re getting two and a half plus probably three, so about five. But you know, if you’re rolling a medicine check, particularly if you you know, start stacking things like guidance, maybe you want to make this roll with advantage. And then you know, you’re slapping, like 15, 20 hit points back onto somebody, that’s, that’s not going to really break anything. And it’s a really easy way to make medicine feel useful.

Tyler 

Now I’d I’d want to play with those numbers a little bit because that, like that seems like it’d be really, really good at low levels then kind of falls off at higher levels. But I think the concept is really good.

Random  

Yeah.

Randall 

Yeah, I kind of I had an idea of like, almost borrowing Pathfinder two’s, like crit success, success, failure, crit failure model, where like, you roll a medicine check and then we apply a modifier to your hit dice that you will then roll. So during a short rest, you can roll your head dice on a critical critical success medicine check that somebody else applies to you when you roll your hit dice. Crit success, take Max hit points,

Tyler 

That would be cool.

Randall 

On a success. Oh, go ahead.

Random 

Oh, no, go ahead.

Randall 

No, I was gonna say on a success. Maybe you double the role. That maybe, maybe, maybe

Tyler 

That’s lower average. Math is hard.

Randall 

Okay. So maybe, yeah, maybe on crit success, maybe you get double Max hit points. We’ll workshop this.

Random 

Oh boy. Radiant servant of pelor. He’s back boys.

Randall 

On success, you get this. On failure, you would get half. And then finally, finally, on critical failure, you would get nothing. Like, it doesn’t matter, you you declared you were gonna burn to hit dice, you burn two dice? Maybe the answer is critical success, you get the double. Success, you just get the hit points. And so what you’re really banking on is that it’s more likely that somebody will critically succeed, because they did take medicine as a profession skill.

Random 

5th edition has always been really generous so I think maybe applying a little bit of harshness is fine here. I actually, I like the thing that I talked about a little bit ago, where, you know, let’s say if somebody is bloodied, if you want to use even healing magic on them, you need to make a heal check to make it as effective. And so you know, let’s say like, heal check, DC is 10 plus the number of hit dice? No, that would end up scaling impossibly hard. There is some target that you can find there. And so like, if you try and heal somebody and you don’t succeed on that, your healing spell still goes off, but maybe it’s only 50% effective. Something like that. And so like applying that, not just to like spending hit dice, but actual healing would be a really interesting way to work in that sort of Final Fantasy. Nope. You made ne do it, too. Fantasy Flight. You know, equivalent to adding adding more dice or, you know, just adopt the Fantasy Flight dice system and bring in you know, your your triumphs and your your successes and your fails. And just let the dice tell a story. And that’s a great time too, right?

Tyler 

How many… how many triumphs are on my d20?

Random 

I mean, I guess it depends. Are we having Guys and Dolls d20s? Because then it’s as many as you want.

Randall 

Or we can just bring in Shadow Run and we can let everybody have infrared eyeballs. I’m all for this. But anyway…

Tyler 

it’s technically what darkvision is.

Randall 

Okay, no, fair enough. Well, we solved it. Yeah. So I think where we’ve landed is 5e medicine is This skill kind of sucks. There’s a lot of things you can do that make it so slightly less. There’s a lot of other cool systems out there that if you want to poke at, like if medicine is your jam, whoo, boy, is that the wrong ruleset for you. All right. This week’s question of the week comes to us from October Sky via email. What are the pros and cons of using D&D versus Pathfinder?

Tyler 

Well, that’s a complicated question. So I’m not going to say that either system is better, because I honestly don’t think either one of them is better than the other. They are different. That’s very diplomatic of you know, right.

Random 

But if one of them was better, it was…

Tyler 

It would be DnD 3.0, the original of what I learned when I was 12.

Randall 

The original! DnD 3rd edition.

Tyler 

Okay, so both of them have merits. Fifth edition D&D is rightly popular because it is accessible, it’s playable, it’s easy to learn. It’s, I won’t say it’s easy to master, but it’s easy, easy to become proficient in very quickly. And one of my favorite things about the design of fifth edition is most of the complexity is opt-in. So there are in every class a handful of options which are inherently low complexity, easy to play, so they’re accessible for newer players, for people who don’t want to engage with the crunch too much. So that’s like circle of the land Druid, champion Fighter, evoker Wizard. So those options that don’t give you a ton of buttons that you have to push and manage. But there’s also the way way more complicated options in any given class. So on the same classes, like circle of spores Druid, really cool, really fun, really complicated to play. Eldritch knight Fighter really cool, really effective, you have to track a spell list and then basically anything but evocation on a Wizard is going to be kind of complicated to play because spellbook. fifth edition is nice because you can opt into the complexity if you want to and still play alongside people who are playing those less complicated characters. So if you have newer people in the party playing with veterans, that’s really appealing. If you have people who just don’t engage with the dcrunk, crunch and prefer the play. I said crunk. Weird. If you haven’t…

Randall 

Nobody heard it until you said crunk again, I just want to point that out.

Tyler 

If you have people on the party who prefer the more play acting aspects of the game, those low complexity options are really, really helpful. Pathfinder second edition is really great if you’re comfortable with the mechanics of an RPG and you enjoy deep rich choices in how you build and customize your character. So every decision point in your character is meaningful. There’s no… There’s no feat taxes, like there were in, like, PF1 D&D 3.5. I shouldn’t say no, there are a handful, but it’s very easy to avoid them. If you want to make a meaningful choice about how your character works every time you gain a level, PF2 is awesome. Also, all of these specific actions you can take with any given thing are spelled spelled out in very specific detail. So like 99% of the time, whatever you want to do is covered in the core rules like yeah, just use the treat wounds action to restore hit points with medicine. There’s there’s very little mechanical improvisation that the GM has to do. Like you don’t have to look at the rules and say “there’s no rule to cover this situation. What do I do?” because generally, they’re all covered there. So PF2’s mechanics are a little deeper, they are harder to get into. And they won’t appeal to players who are who prefer to emphasize the play acting parts of the game quite as much. But it’s a really good system if your table is comfortable with that level of crunch.

Random 

Yeah, I will say… veteran listeners will have heard this. I tried to read through the PF2 Player’s Handbook. It’s 600 something pages. It’s it’s not so much a learning curve as a learning cliff. Now, if you have someone to guide you through, you’re absolutely going to get that feeling where your choice matters: agency. You are going to get a ton of agency which is one of the things that game players love most. That’s just good game design. That’s a known thing. But you do end up kind of in guardrails in PF2 because everything is so spelled out, it removes a lot of the necessary flavoring that fifth edition is going to bring to every table because, you know, in fifth edition, because players are inherently creative, they want to do these things. DM’s are going to adjudicate that a little bit differently every time, right? Because fifth edition does just provide itself as more of a framework and some good, you know, things for adjudicating certain actions, and then it leaves a lot of it to DM interpretation, you’re going to get those differences, whereas in PF two, I would imagine that you’re going to end up with a lot of the same mechanically feeling games every time, which is not necessarily a bad thing. But that’s, you know, that that is one of the things that you’re going to run into just because of the sort of meta, well, what’s the the things that PF2 uses? Tags? All of these things, have all of these characteristics and, you know, that’s, that’s going to mean that a lot of times people rather than trying to think about, you know, how might I make this interesting, they’re just going to lean on the fact that it is so cleanly spelled out. Which is fine. And you know, that that doesn’t let you get into this, this real crunchy gain that you can have. I’ll say where Tyler definitely provided some some pros of both. Some cons of Pathfinder, that one. Some cons the D&D, it can feel a little bit like, you know, especially as a first time DM, it can feel like you don’t have enough to go on sometimes. You know, particularly if, because so many people are coming into tabletop role playing games right now through fifth edition. You know, let’s, if you are this group of five people who one person says, I’ll do it all I’ll write up a story. You can definitely end up with some inconsistently applied stuff. Here is a fun exercise. Go back and watch or listen to the very first episode of Critical Roll when they transitioned to fifth edition from Pathfinder. They get a lot of stuff wrong. And this is Matt Mercer. Right? Like this is a world renowned DM, as far as you know, such a thing as possible. Just getting stuff wrong, because there isn’t that real handhold guide rail. And so maybe that’s, that’s not for you. Maybe you know, if you are someone who wants that to feel more comfortable, that’s fair. And yet, I think that obviously, as everyone who has made them very popular would agree, it, that didn’t make it a bad story. Right? So like Tyler were saying, if you are you know, more on the the planning side of it, fifth Edition, very definitely your jam.

Randall 

Alright, I’m about to make a weird Venn Diagram of people very angry.

Tyler 

Okay?

Randall 

All right. Looking forward to it.  Okay. So I think playing D&D 5e is a lot like picking up the bass for the first time. Right? It’s super easy to like, play. Basically, you can get together with people in jam, there’s a lot of people who want bassist out there, you can always find a table. Like there’s there’s a lot of room for it. But when you see someone who’s exceptional, who studied who’s really spent the time invested the energy into it, like when you hear flee from Red Hot Chili Peppers play when you when you hear like Les Clay Pool play, right, you’re like, okay, that person knows bass and it’s really super awesome. Low barrier to entry, easy to have a good time with your friends, and you can really admire expertise, especially if you know a bit about it. Pathfinder two is like picking up the mandolin. Because you walk in, and you’re like, hey, I want to play the mandolin and everybody else is like, I’ve never seen one of those. That’s a beautiful ukulele. Why so many strings? And you’re trying to explain like, no, no, it’s great. It pops up in a lot of music. What music? I don’t know that music. And it’s like, it’s hard to find anybody to even engage. And then when you do finally find everybody, like they have really long fingernails, they love bluegrass when you were trying to play some country, the whole thing gets really awkward all of a sudden, and I don’t want to talk about it anymore.

Random 

Boy, I’m gonna I’m gonna find that clip on r slash suspiciously specific at some point.

Tyler 

All right, all right. So… jeese. Ah, that got weird. So I will say there are less people playing PF2 than 5e. Pathfinder has pretty much always had a smaller audience than Dungeons and Dragons. Part of that is name recognition. Just when most people think about tabletop RPGs they know it as Dungeons and Dragons and… I don’t know if there’s anything else of the kind. So Pathfinder second edition will probably have a smaller community. Organized play is the thing. Pathfinder society is very active. They put out content constantly. Most likely, if you’re playing in a home game, you’re going to bring your group to Pathfinder second edition. Say, hey, I know you guys really like fivey i know you enjoy the crunch, and want to try something new. Pathfinder two isn’t that far off. It’s very similar thematically. A little different mechanics. Worth exploring. Lots of great ideas in the game. And if you’re going to get started in PF2, just grab the beginner box and we have a beginner box walkthrough guide on the website, which fills in some of the gaps and basically just rounds off the sharp edges on the beginner box that I’m hoping will be very helpful.

Randall 

Yeah, and other groups had a lot of fun playing Googoo Dolls lately. Maybe you should bring in some mandolins, I don’t know. All right, our next episode will be random encounters: the search for more Random. I’m Randall James you can find me at amateurjack.com and at @JackAmateur on Twitter and Instagram.

Tyler 

I’m Tyler Kamstra. You’ll find me at RPGBOT.net Facebook and Twitter at RPGBOTDOTNET and patreon.com/rpgbot.

Random 

And I’m Random Powell. You might encounter me, it’s about a 20% chance. But when you do that’s probably because you were here on RPGBOT either reading some of my articles, which, new one currently being written. Look forward to that, or here on the podcast. Or you may have run into me at places where people play games as Hartlequint or liquid.

Randall 

Alright. All hail the Leisure Illuminati.

All 

We understand that sometimes having your vehicle repaired can be stressful.

Randall 

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Tyler 

The bacta thing. It’s from Monty Python?

Random 

Dan is probably the least qualified here to answer Star Wars trivia.

Tyler 

I think I was just trolled by our producer.

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