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I recently created a Mercy Monk with a Field Medic background/career, though the more I thought about what his job would entail, the more I started to wonder about the mechanics of long-rest healing in D&D and how that would influence so many aspects of the world.

For instance, if all it took to recover from broken bones, gaping wounds, and being on the verge of death was nothing more than a good night's sleep and a single HP, then the people would become bolder and structure their lives and wars around making the most of all but their last Hit Point. They would lack the healthy fear we have as humans that becomes the foundation of our survival instincts, and would no longer be intimidated at the threat of violence. Rather than focusing the base potion on regaining as much vitality as possible, they would most likely focus their studies on sedative and trying to cheat how many hours rest one would need to be right as rain again.

However, I noticed that this is not actually the case. There are many healing spells available to plenty of classes and only a couple of spells to put one to sleep. Taking a dagger to a villager's throat can bolster your Intimidation/Persuation as the person threatened and their friends would all have that healthy fear that's adverse to losing even a single HP if at all possible. And more importantly is that we have Healer's Kits that are designed with splints and gauses that would otherwise prevent the further loss of your health...

Now I do admit that I could be thinking way too hard on this contradiction, but without finding a definite answer in the PHB or on this site, I thought it would be best to ask outright if the ability to heal using a long rest is something unique to adventurers, or if the whole concept of medicine follows a different mindset than ours (in real life)?

Nobody the Hobgoblin
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Victor B
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    Your points about the brutal truths of war are interesting, but the later paragraph about dagger to the throat would make more sense if it addressed that point that sentient creatures feel pain on injury. That seems like an important factor as well as (lack of) long-term injury or death. – Peter Cordes Nov 14 '22 at 16:32
  • @PeterCordes Actually wasn't thinking of the pain, but simply trying to find a threat of impending doom. However, looking at how we already judge our pain, we can learn to "bare with it" or numb it from our minds if we deem it a minor consequence compared to our success. The more long-term consequences you remove (such as healing a gaping hole with a long-rest) the more pain the person would naturally ignore. – Victor B Nov 14 '22 at 19:26
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    Arguably not worthy of an answer, but worth noting: the effects of Exhaustion and being raised from the dead do not disappear after a single night's sleep. – Xavon_Wrentaile Nov 14 '22 at 23:47
  • Not 5e, but there are a multitude of 'crunchy' systems out there that track bodily injury in much more detail. My favourite recollection was from a MERPS campaign where one character had a series of spectacularly unlucky rolls when fighting a troll and ended up paralysed from the neck down for a couple of sessions. That player was Not Happy, however, so perhaps it's not for every table. – Joe Bloggs Nov 15 '22 at 11:06

2 Answers2

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Hit points do not represent pyhsical wounds

Page 196, PHB explains that hit points are an abstraction:

Hit points represent a combination of physical and mental durability, the will to live, and luck. Creatures with more hit points are more difficult to kill. Those with fewer hit points are more fragile.

Even spells like cure wounds, in spite of their name, do not talk about actually closing wounds just about restoring hit points.

Therefore, one way to think about this is that characters and commoners that have not lost all hit points have not suffered a grievious wound yet. They maybe received some superficial scratches. "It's only a flesh wound!". They are running out of luck of not being hit by arrows under fire. They are running out of resolve.

For real wounds, you also can look to the Lingering Injuries table (DMG, p. 272), which creates the kinds of wounds you would expect from physical injury. Suggestions when you could receive those include a critical hit, or when you are dropped to 0 hit points, but not killed outright.

Nobody the Hobgoblin
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  • Thanks, that Lingering Injury Table actually gives a lot of answers and can be used for my doctor to diagnose most issues, in case he comes across a boy who fell out of a tree for example. But to be thorough with the table, does a healing potion constitute "Magical Healing" (such as for a limp)? – Victor B Nov 14 '22 at 04:57
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    Yes, a healing potion is magical, so it constitutes magical healing. (At least the one from the PHB, which says it is magical, the only such item on the equipment list). Note that 50 gp is a lot of money for a commoner, though, probably not something a peasant would be able to afford. – Nobody the Hobgoblin Nov 14 '22 at 05:00
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    @VictorB See: Are common potions of healing considered magic items?. – Thomas Markov Nov 14 '22 at 09:16
  • @GroodytheHobgoblin It's true that most peasants couldn't afford it, which would then bleed into world-building, as gifting them with a low-level healing spell/potion would be seen as more of a miracle or a king's ransom than using one on an adventurer. Something a long-rest or basic healing can't do. It also hammers home (to me) how even a level 1 cleric would be seen as a divine messenger able to lead peasants into a cult. Therefore a level 1 rogue would already be a master by NPC standards and a lvl 1 monk would be a kungfu master. (sorry for the tangent) – Victor B Nov 14 '22 at 19:10
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    I've always thought they should have called them "Hero Points". They represent your ability to heroically avoid injury. Always dodging or blocking just right, nothing can scratch you. Until you run out of Hero Points. Then the next hit actually kills you. D&D in particular tends to have two states: perfectly fine and dead. Other RPG systems attempt to more accurately convey injury though I think it's a matter of debate as to whether it actually makes the game more fun or interesting. – JamieB Nov 14 '22 at 22:31
  • @JamieB: Some damage sources are harder to explain away that way, especially fall damage, or an ambush while asleep (auto-crit from within 5ft), or acid while inside a creature's stomach. Yes you might land perfectly but use up some "luck" doing it, but it's not plausible for that to happen consistently. As KRyan commented, the less you think about HP, the better for immersion. – Peter Cordes Nov 15 '22 at 01:49
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RPGs are not world simulators

Specifically, 5e D&D is not a world simulator. It is an adventure simulator. It isn't even a simulator; it is more guidelines.

Treating it as a world simulator leads to strange things becoming canon, like the commoner railgun, which lets you turn commoners into a cannon.

The goal of the rules is to provide for the commonest cases where a party of PCs interacts with the world, not a full model of how the world works.

The advice is that HP loss is something that PCs can recover from with a long rest. This tells you something about what HP loss represents; the DM can choose to discard this, can choose to use gritty realism and make long rests take a week, can choose to use this to interpret was HP damage represents (grazes etc), or can decide that PCs are so badass they can take a cut to the bone in their arm and recover completely in 8 hours. Or they could make every being in the universe heal up after 8 hours from non-fatal wounds.

To a great extent, 5e doesn't force you to pick any of these. Do whatever is best for your table. It has advice, but it also tells the DM to make their own choices.

Decide what is best for your world

If you want commoners to heal over 8 hours, go for it. If you want lingering injuries, use them. If you want HP to be actual wounds that take up to a week to heal, use gritty rests, and lingering injuries for worse ones.

My advice is to use gritty rests (with some tweaks; let exhaustion be healed 1/night, for example), pace your adventures based off gritty rests, and use lingering injuries as needed (especially on NPCs).

For PCs, embrace that by level 5 they are MCU Captain America level near-superhumans1, and go up from there. So a lingering injury at level 11 might come from a bomb that blows up an entire castle, or a dragon that crits you and drops you from 50% HP to KO, then breathes acid with you in their mouth before you recover.

1 Take a level 5 battlemaster fighter, put them in a 20' by 20' room with a dozen Guards. The fighter will clean house; this is the "elevator fight". (MCU needs 1 minute short rests and 1 hour long rests admittedly)

Yakk
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    See also: D&D is not a physics simulation – Nobody the Hobgoblin Nov 14 '22 at 16:49
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    Thanks for the reference to the Commoner Railgun: https://tabletopjoab.com/the-legend-of-the-peasant-railgun-in-dd-5e/ – Sarah Messer Nov 14 '22 at 18:45
  • "This tells you something about what HP loss represents" that's kinda what I had a hard time wrapping my head around, especially when it concerns immersion. For instance, ~A villain took an orphanage hostage and will cut (1HP) a random child every hour that their demands aren't met.~ Calculating that it would be rare for any of the 20 kids (10HP each) to die before a long-rest heals them wouldn't make the party rush to their aid. That empathy must be in some long-term consequence that HP doesn't account for, even in the non-gritty D&D. I was missing that piece of the puzzle. – Victor B Nov 14 '22 at 19:54
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    @VictorB Also, 1 HP isn't a nick. 1 HP is the minimum amount of threat/damage that could possibly cause a normal human with no pre-existing condition to fall down and die within a few minutes. A full strength punch, for example, by an average strength human does 1 point of HP damage. It is rare for someone to fall down and die from a punch, but it does happen. – Yakk Nov 14 '22 at 20:16
  • “RPGs are not world simulators Specifically, 5e D&D is not a world simulator.” The second statement is true; the first statement is not (generally, as a rule) true. Some RPG systems very much do have a conceit of attempting to simulate reality. Of course none are perfectly successful (that would be physically impossible), but some do try and a realism-based approach to arguing for particular outcomes is entirely expected and considered desirable. – KRyan Nov 14 '22 at 20:29
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    @VictorB Hit points are inescapably an abstraction. They cannot be understood as any one consistent and specific thing. They are purely part of the game. The best understanding for them may be thought of as “plot armor,” but even that fails to really capture what they are (and how amorphous they can be about it). If your aim is immersion, you should as much as possible not look at hit points at all. You just have to kind of turn a blind eye towards them in order to have immersion. (Or play another system that is less abstract about injury, but almost all of them are, at least a little.) – KRyan Nov 14 '22 at 20:31
  • @Yakk I was using a cut (not a nick) for a visual threat that should motivate the party, while the damage calculation contrasts it. – Victor B Nov 15 '22 at 22:10