Scaling the Heal Skill

[Surrealistik]

A houserule I'm using in my current PbP game to make pumping the Heal skill attractive (rather than it being swapped out the moment you can consistently roll a 15 or better via innate Wis/level bonuses).

Note that the scaling of benefits is partly to compensate for the especially situational nature of the Heal skill; unlike most skills, it rarely finds any kind of appreciable general application.

Another consideration is that there is precedence for benefits scaling with performance: Acrobatics for example, and Athletics.

Let me know what you think:



Trained Only:


Grant Second Wind (DC 10): The subject regains +2 extra hit points from spending its second wind for every 5 points you exceed the DC.


Grant a Saving Throw (DC 15): The subject gains a bonus equal to +1 for every 5 points you exceed the DC to the granted saving throw, or the granted saving throw bonus.


Stabilize the Dying (DC 15): If you exceed the DC by 5 or more, the subject can make a saving throw at the end of each of its turns until it takes damage. The subject gains a +1 bonus to this saving throw for every 5 points you exceed the DC beyond the first 5. On a saving throw result of 20 or higher, the subject can spend a healing surge.



Trained Only:

Rushed Healing:

A character can choose to hastily administer emergency medical attention. For every +10 DC a character increases the DC of a Heal check by in this way, decrease the action cost of the Heal check by one step as follows:

A Standard Action becomes a Move Action.
A Move Action becomes a Minor Action.
A Minor Action becomes a Free Action.

Special: A character may only make a Heal check as a free action once per round. If that Heal check fails, that character loses a minor action or his next minor action.


Trained Only:

Study Anatomy:

A character can use the Heal skill to garner valuable information about non-construct enemies.

Minor Action: Garnering such knowledge requires at least a bare modicum of study. The character must be able to see the creature it is studying, and the creature must not be a construct. This can be performed at no action cost once per encounter on the creature the character is studying if he succeeds on the Monster Knowledge Check for that creature.

The character makes a Heal check as if he were making a Monster Knowledge Check. If the character meets or exceeds the moderate DC for the monster's level, he knows the monster's origin and type, as well as its current and maximum hit points. If the character meets or exceeds the hard DC for the monster's level, he also knows the monsters defenses, resistances, immunities and vulnerabilities.

Short Rest: A character can do the above once per short rest on the fresh corpse of a non-construct creature. If the character does the above, he gains a +5 bonus to the Heal check, and also learns, at the DM's discretion, what the creature's powers do if that character meets or exceeds the hard DC for the monster's level.

[Sipex]

It looks solid. Some may argue the 'Stabilize the Dying' modification is overpowered but I honestly don't think so.

Makes sense though, there aren't really any uses for healing beyond those unless you need to make a knowledge check.

[Epinephrine]

I'd just scale it the same way that 'aid another" scales - i.e., add 1/2 level to the DC. No bonuses, just higher DC.

[Surrealistik]

I'd considered that Epi, but the Heal skill is already insanely situational, rarely seeing any kind of general use (unlike most other skills), so I figure it best to make it shine a little brighter on those rare occasions it does actually come into play.

There is also precedence for benefits scaling with performance: Acrobatics for example, and Athletics.

[Kurald Galain]

Well, see, the decision here is whether or not to retrain out of the Heal skill. So basically, if you don't, you get each benefit once (+2 extra HP healed, or +1 on the save). That's not particularly worth it.

The problem is that all those uses of the Heal skill are a standard action, and a pretty ineffective one at that. Grant second wind is only used when an ally who contributes more to the combat than you is down and the healer is out of heals; it matters whether the ally gets above zero, not whether he gains 10 or 12 hp. Grant a saving throw I've only seen used against domination effects. And stabilize is only needed when the ally has already used second wind (which is very rare in and of itself, except on a dwarf) and the healer is out of heals, and combat is not going to end the next round. That's pretty rare again, and those extra saves aren't really useful in that situation.

(edit) bottom line is that when characters are down and dying, the most effective strategy for the rest of the party is to go into "panic mode", throw in a nova strike or two, and make the enemy go down fast. Not to waste a standard action on a sub-par healing effect.

I think a better approach would be to write some worthwhile Skill Powers for the heal skill.

[Epinephrine]

Diseases get pretty nasty, I ran Age of Worms a while back and ended up converting much of it to 4e. Getting infected with a high level disease can really suck if you don`t have a player with a high heal check.

A level 13 Son of Kyuss can cause level 16 Touch of Kyuss, which requires a 20 on the check not to get worse, and a 26 to get better. If you are level 12 or so you`ve only got 6+Wis as untrained (so maybe a +12 if you have a wisdom-based character), which isn`t that great, considering that while at the first stage you only gain half health from any healing effect. Cure disease can work, but without training in Heal even it can be risky - if you only have a +10-+12 Heal you have a 20-30% chance of killing the PC, and a pretty good chance of dealing his total HP in damage with the cure. The party never untrained Heal, with disease as a very real threat.

[Kurald Galain]

Diseases get pretty nasty, I ran Age of Worms a while back and ended up converting much of it to 4e. Getting infected with a high level disease can really suck if you don`t have a player with a high heal check.
That's correct, but most parties do have precisely one person with a high heal check, and there's little reason for anyone else to invest in it.

It strikes me as a more fundamental issue: for several skills in 4E, it only matters what the highest skill mod in the party is, so everybody who's not the best has no incentive to take that skill. So they all take e.g. athletics, endurance, and stealth instead.

[Epinephrine]

That's correct, but most parties do have precisely one person with a high heal check, and there's little reason for anyone else to invest in it.

It strikes me as a more fundamental issue: for several skills in 4E, it only matters what the highest skill mod in the party is, so everybody who's not the best has no incentive to take that skill. So they all take e.g. athletics, endurance, and stealth instead.

Ah, yes - it`s true that you only need one. I assumed that he meant that the trained person was swapping out, I think I automatically assumed that there wouldn`t be more than one.

[Surrealistik]

Well, see, the decision here is whether or not to retrain out of the Heal skill. So basically, if you don't, you get each benefit once (+2 extra HP healed, or +1 on the save). That's not particularly worth it.

The problem is that all those uses of the Heal skill are a standard action, and a pretty ineffective one at that. Grant second wind is only used when an ally who contributes more to the combat than you is down and the healer is out of heals; it matters whether the ally gets above zero, not whether he gains 10 or 12 hp. Grant a saving throw I've only seen used against domination effects. And stabilize is only needed when the ally has already used second wind (which is very rare in and of itself, except on a dwarf) and the healer is out of heals, and combat is not going to end the next round. That's pretty rare again, and those extra saves aren't really useful in that situation.

(edit) bottom line is that when characters are down and dying, the most effective strategy for the rest of the party is to go into "panic mode", throw in a nova strike or two, and make the enemy go down fast. Not to waste a standard action on a sub-par healing effect.

I think a better approach would be to write some worthwhile Skill Powers for the heal skill.

I think you misunderstand; for _every_ 5 points the DC is exceeded, the benefit applies and is cumulative.

Additionally, the Skill Power approach does not bring the actual skill up to par with competitors like Acrobatics and Athletics, which already have excellent Skill Powers.

While I acknowledge Heal is useful for combating diseases, it is unfortunately a _very_ conditional application (again, compare and contrast to Acrobatics, Athletics).

[Kurald Galain]

I think you misunderstand; for _every_ 5 points the DC is exceeded, the benefit applies. The benefits are furthermore cumulative.
Sure. But the only decision point is whether you have the skill trained - and that makes a difference of precisely 5 points, once.


Additionally, the Skill Power approach does not bring the actual skill up to par with competitors like Acrobatics and Athletics, which already have excellent Skill Powers already.
Why not? If you write a good skill power, then it will be. The apparent problem is that WOTC didn't want the heal skill to upstage actual healers, and as a result, it's not very good.

[Surrealistik]

Sure. But the only decision point is whether you have the skill trained - and that makes a difference of precisely 5 points, once.

Skill pumps via items and the like. That said I really should have clarified that these are trained only benefits, derp.


Why not? If you write a good skill power, then it will be. The apparent problem is that WOTC didn't want the heal skill to upstage actual healers, and as a result, it's not very good.

The problem is Atheletics/Acrobatics are superior skills to begin with, and they have excellent skill powers. Heal with only excellent skill powers, but a vastly inferior skill effect still makes for a comparatively inferior skill overall.

[Kurald Galain]

Skill pumps via items and the like.
I don't think there are any skill pumps in 4E that are worth the cost, not even on a good skill; certainly I've never seen anyone use them - neither Skill Focus nor items, because people want to spent the feat or item slot on something else. The bonuses are simply too small, and the consequences of failing a skill check are pretty low anyway.
Exception 1: good items that coincidentally also boost a skill, such as the Cloak of Survival. Exception 2: unslotted or off-hand heroic items when you're high enough level to buy them from pocket change.


The problem is Atheletics/Acrobatics are superior skills to begin with, and they have excellent skill powers. Heal with only excellent skill powers, but a vastly inferior skill effect still makes for a comparatively inferior skill overall.
Sure, but that's still an improvement over what it is now.

[Surrealistik]

I don't think there are any skill pumps in 4E that are worth the cost, not even on a good skill; certainly I've never seen anyone use them - neither Skill Focus nor items, because people want to spent the feat or item slot on something else. The bonuses are simply too small, and the consequences of failing a skill check are pretty low anyway.
Exception 1: good items that coincidentally also boost a skill, such as the Cloak of Survival. Exception 2: unslotted or off-hand heroic items when you're high enough level to buy them from pocket change.

I dunno, I'd say Athletics, Arcana, Bluff, Diplomacy, Stealth, Intimidate can all easily be worth it on certain builds, Perception much more generally (at least with respect to item pumps).

In either case, these as scalable, Trained Only benefits definitely gives players a strong incentive at a minimum to not swap Heal out, while rewarding skill pumping.


Sure, but that's still an improvement over what it is now.

True, but I'm looking for a way to meaningfully bolster the skill end of Heal.

[The J Pizzel]

And stabilize is only needed when the ally has already used second wind (which is very rare in and of itself, except on a dwarf) and the healer is out of heals, and combat is not going to end the next round. That's pretty rare again, and those extra saves aren't really useful in that situation.

Seriously. This happened last night. Our pally went down while taking 5 ongoing. His negative bloodied value is -11 and he was hit down to -7. So he's down and his turn comes up before the healers. So when he takes the 5 ongoing, he's dead. But wait, there's two allies before him and both just happen to be adjacent. One rolls the heal check grant a free saving throw and he passes it, the other to stabilize the dieing. It was beautiful. Thunderous applause from the group for keeping the pally alive.

But to your point, a lot of coincidences had to occur to have to fall back on that.

[Sipex]

Interesting.

On that note, I haven't played 1st level in forever, is 22 HP normal for a pally?

[Surrealistik]

A low Con one? Yes.

Yeah, Heal is situational, and that's acknowledged. The idea is to make it impactful to the point that you will actually want to retain it as a trained skill. Alternately, I am toying with the idea of maybe even allowing a trained player to improve the action economy of Heal.

Perhaps making stabilize and save granting move actions? Already there's a feat which makes stabilization a minor (Combat Medic).

[Epinephrine]

Interesting.

On that note, I haven't played 1st level in forever, is 22 HP normal for a pally?

Well, I assume he has 23 HP.
And no, it sounds like he dumped Con, which is odd for a defender to do.
They have 15+Con, so an 8 Con would be 23, which is a bloodied value of 11. I'm surprised that he wouldn't have at least a 10 Con, though, I think I'd drop my 8 elsewhere.

If he's a hybrid, he could easily have 22 or fewer.

[kyoryu]

Well, I assume he has 23 HP.
And no, it sounds like he dumped Con, which is odd for a defender to do.
They have 15+Con, so an 8 Con would be 23, which is a bloodied value of 11. I'm surprised that he wouldn't have at least a 10 Con, though, I think I'd drop my 8 elsewhere.

If he's a hybrid, he could easily have 22 or fewer.

An 8 Con Defender? Crazy.

[NecroRebel]

Having low CON on a defender isn't really terrible. While those lost hit points hurt, certainly, if you're a Straladin or other STR-based class you don't lose any fort for it. As you level up, your CON becomes less and less important anyway, so maybe it's planned for higher levels?

Also, if the character has two primary stats, like a paladin who wants to take and use both STR- and CHA-based powers, you might not have the stat points to keep 2 stats high, your secondary stat medium, and then stuff like CON at a decent level.

[Surrealistik]

The Con hit always hurts given the loss of both healing surge value, and healing surges (particularly given powers like Lay on Hands), though the pain diminishes later on, it does remain nonetheless.

Anyways, I'd prefer if we stayed on topic :P

[NecroRebel]

The Con hit always hurts given the loss of both healing surge value, and healing surges (particularly given powers like Lay on Hands), though the pain diminishes later on, it does remain nonetheless.

Anyways, I'd prefer if we stayed on topic :P

Oh, I understand that; I just mean that I can see the logic behind a low CON score on a pally. If they want to use Str and Cha powers, they want those at at least 16, riders usually key off Wis so that's best at 14 or more, you want a positive initiative on defenders so Dex goes 12 or higher... Not many points left for Int or Con, even if you have a Str/Cha race.



I think the way to make the Heal skill stay useful over time would be to make it possible to voluntarily increase the skill DC to use them as lower actions. Maybe +10 for move, +20 for minor, and +30 for free? DC25 isn't too bad at Paragon tier on Wis-focused characters, and even at epic levels DC45 is quite tough. Action economy is a big deal at higher levels, though, so the DC increases would have to be pretty high.

Edit: Oh, and you'd have to limit it to 1 attempt/round, too, otherwise as soon as people could hit the free-action one they would every time.

[Epinephrine]

Ok - you've essentially buffed the heal skill a bit, rather than granting a new function for those trained in Heal.

Training in Acrobatics allow you to make a roll to prevent damage from a fall; this is something available only to those trained. Can you come up with an effect that only those trained should have? Do you let players know how injured enemies are, other than "bloodied" and non-? Could it provide information on health status of enemies, or identify resistances/vulnerabilities, or likely effects of powers? What an enemy's weakest defense is?

A healer learns a lot about anatomy, about poisons, about the types of injury a claw, stinger, sword, or mace causes. It wouldn't be absurd to let trained healers have a good guess at the conditions a power could inflict, or to identify weaknesses an enemy may have. In my game I let the players make heal checks to gauge how injured enemies are (to the nearest 10% or so). I hadn't thought of having it fill in for knowledge about monsters, but it would make some sense for a healer to be able to look at a creature's weapons and judge whether they use them to hamstring (slow), grab, daze, etc.

[Surrealistik]

Yeah, I definitely think improving the action economy is necessary. In addition to the current benefits in the OP:

Rushed Healing:

A character can choose to hastily administer emergency medical attention. For every +10 DC a character increases the DC of a Heal check by in this way, decrease the action cost of the Heal check by one step as follows:

A Standard Action becomes a Move Action.
A Move Action becomes a Minor Action.
A Minor Action becomes a Free Action.

Special: A character may only make a Heal check as a free action once per turn per round, and must have at least a minor action available to do so. If that Heal check fails, that character loses a minor action.

@ Epi: The buff to both stabilization and save granting is considerable, even if it's situational, it's really strong when it matters, and it is substantially greater than what a untrained user of the Heal skill can do. I agree with creating new options for the Heal skill though. I've always liked having characters use it to make relevant biological/medical/anatomical observations, though I've yet to codify that into a mechanic.

[Surrealistik]

Trained Only:

Anatomical Analysis:

A character can use the Heal skill to garner valuable information about non-construct enemies.

Minor Action: Garnering such knowledge requires at least a bare modicum of study. The character must be able to see the creature it is studying, and the creature must not be a construct.

The character makes a Heal check as if he were making a Monster Knowledge Check. If the character meets or exceeds the moderate DC for the monster's level, he knows the monster's origin and type, as well as its current and maximum hit points. If the character meets or exceeds the hard DC for the monster's level, he also knows the monsters defenses, resistances, immunities and vulnerabilities.


I suppose we could expand the restriction so it dealt with living creatures only.