Heal represents medical knowledge, specifically medical knowledge in a putative fantasy/early renaissance milieu. It covers very simple surgery, knowledge of anatomy (for humanoids), and first aid.
What can you do with this skill?
First Aid (Triage): This misnamed action is used to keep your party mates from dying after the mean old ogre bashes their skulls in. It’s misnamed in the sense that if you’re going to call an action based on the Heal skill Treat Deadly Wounds, shouldn’t it be this one? And maybe all wounds aren’t deadly, but in my personal life I always err on the side of caution and assume that any wound I have is an intelligent, malignant entity personally trying to kill me for shits and giggles. Maybe that’s an overreaction (it is), but I’ve not been killed by a wound yet, Praise Pelor.
So yeah, anyway, I call this use Triage.
Given that renaissance medicine is not exactly cutting edge, should there be a penalty for failing this roll? It is quite arguable that some ignorant medieval sawbones could do a lot of damage while they’re messing around with your bleeding guts. Then again, the treatment of direct damage/trauma is not the same as treating diseases or poison. Human beings learned long ago that when the skin is broken and the red stuff is gushing out that there are some relatively straightforward things to do to get the problem solved. Maybe the flip side question should be considered: is the roll needed at all? Well… yes. I feel that we can’t allow automatic stabilization because that’s what the damn Stabilize spell is for. Also, 6 seconds to stop someone’s inexorable slide into death? No thanks. These are just my personal opinion, of course (and are therefore right…), but if your buddy gets his skull fractured by a 500 pound ogre wielding a club which can be favorably compared to a tree trunk, I don’t think that 20 feet of bandages and the Renaissance version of a Tylenol are going to do the trick. I question whether you can even save his life with six seconds of work in stressful combat situations.
Yes, I understand the rule is there to take some load off of the cleric and to let buddies help each other. I’m not saying that the fighter should just let his buddy die because Heal should be harder. So maybe we should make the DC more fluid. Something like, say, DC 10 + hp below 0? That seems reasonable. Yeah.
Long Term Care: Do we need a check for this? No. Either you have the Heal skill, and can do this, or you don’t and can’t (although you can assist a competent healer).
Treat wounds from caltrops, spike growth, or spike stones: Blah blah blah no. See above. Honestly, pull the fucking caltrop out of the foot and bandage it. This isn’t Knowledge (rocket science).
Treat Deadly Wounds (First Aid): Okay, so here’s the one with which a bone to pick I have. Where do I begin? Well, for one thing, this usage of the Heal skill just plain sucks. Leaving a cut open to fester and properly cleaning and dressing a cut are not the only choices available, even in a Germ Theory of Disease free quasi-medieval/early Renaissance setting where (if we’re close to historically accurate) everything looks like it’s been sprayed down with shit. There’s a whole spectrum of choices, from “let the gods decide if I live or die”, through “wash it off with some water and put a poultice made of dung on it” all the way to “let me clean and stitch your cut, you ignorant savage, or it’ll fester and you’ll die”. Maybe we can make this usage account for these options.
Also, how come you can only do this once per day? The game goes out of its way in newer editions to ramp up the available healing (Pathfinder gives Clerics channeling, and made Lay on Hands way better); apparently, however, they draw the line at actual study of medicine and anatomy, which will apparently only teach you how fragile and difficult to heal the human body is, and that if you’ve tried once, you may as well give up. I see no reason that this can’t be done once per battle (afterwards). As an abstraction, this basically says that you can fiddle with the wounds all you want, but once per battle will be the net effect of all that messing around. And there really should be a die roll for results in there somewhere. I propose this:
First Aid DC
|15||1d3 + Int modifier|
|20||1d4 + Int modifier|
|25||1d6 + Int modifier|
|30||1d8 + Int modifier|
This is, as is evident, stepping up the die type with every 5 points scored on the check – until the rather exalted heights of 35+ are reached, in which case we give out a +2 for every 5 scored. Good luck getting there.
Also, treating deadly wounds takes one hour. That’s too damn long. Who wants to wait an hour for that? Ten minutes is a long time, but it seems more reasonable, so we’ll go with that.
Also, this use should be called First Aid, so that’s what I’ll call it, ‘cause that’s what it is.
Finally, there ought to be some penalty for failure…maybe. As an optional rule, you can require a DC 10 + situational modifier roll to avoid getting an infection if the “doctor” fails by 5, and a DC 20 + mods roll if they fail by 10.
Treat Poison: Works fine as is, mostly. It’s not like you need a chemistry degree to know that poison is bad, or to have an idea of its effects. Also, presumably one could just ask the gods what cures what, and let’s not forget all of the Alchemists’ fine work in the area. There is, therefore, no reason that information on poison couldn’t be compiled and disseminated.
That being said, a screw up here could be pretty bad. What if you give the poison victim the wrong counter agent? What if you’re not supposed to suck the poison out because you mistook an injury poison for an ingested one (or your clever foes knew you’d make the mistake of assuming that just because they poured some poison on a sword in full view of the party that it would actually do something when it struck? Yeah, I’m a bastard). So let’s say that failing by 5 gives the “patient a -2 to the next save, and failing by 10 (you quack!) doubles the damage, cumulative with the save penalty. That should keep your junior interns from haranguing any and all poison victims they find. Also, you get one shot at this – the patient uses the bonus/penalty from the use of this skill for every save made thereafter. You can only suck out so much poison before the body needs to get up off of its poisoned ass and start helping itself.
Treat Disease: No Germ Theory of Disease, and it does matter. Do the gods understand the workings of disease? Who knows (you, the DM, that’s who.)? It’s important to remember that disease killed a metric fuckton of people, more than war ever did or could. It still kills people today, by the trainload. So how does this measure up with your experience playing D&D/Pathfinder/whatever?
Disease is, however, also a really boring way to lose your character, and no version of the game has ever really been good at portraying disease or its effects. Some diseases can be kinda exciting, like Ghoul Fever, but for the most part they are dull, dull, and no fun, and also dull. Disease is the backstory, the thing that you quest to cure in others. In a magical world where Clerics can cure disease, how do epidemics happen? These are really questions that deserve a whole article unto themselves, and I’ll do that some other time. As it stands, use the rules as written, they’re actually pretty good.
Having plague doctors run around in cool masks and perform strange procedures and ceremonies was great for the art and history books, however, it didn’t exactly do anything for the poor fools dying of plague. So let’s take a page from Treat Poison, above. Fail by 5, and you’ve done something stupid that weakens the patient. Fail by 10 and boy howdy, you’ve really screwed the pooch this time. Double all damage/penalties, if possible, cumulative with save penalty of -2. One shot only, as above, but you must treat the victim for the entire sickness to keep giving them the bonus. Once you’ve screwed up, you can just ignore the patient; you’ve probably killed them anyway, you brute, and it’s not like your presence actually helped the poor souls.
Know the special powers and vulnerabilities of Humanoids: Here’s a massive dissociated mechanic for you. “Hey, guess what? I learned that the Duchess of D’mass has taken a secret lover, and also that Dark Creepers explode in a burst of light when they die!” That’s local knowledge, right?
Heal is pretty much the knowledge of how the humanoid (really any, but let’s stick with humanoid for now) body works, and how to fix it. Doesn’t that sound like a more relevant skill than Knowledge (local) when it comes to knowing the strengths and weaknesses of humanoids? I thought so. Also, where exactly is “local”? I would guess that this nebulous term could be anywhere, so one could have Knowledge (Dipshit Falls, Nebraska), or Knowledge (Pooch Screw, Oregon). I would hazard a guess that the strengths and weaknesses of humanoids thing was added to make local knowledge more useful when the campaign left Dipshit Falls, and to give some way to make Knowledge (local) work like most other knowledges (engineering and nobility, for example, do not give you the strengths and weaknesses of golems or princes, thought an argument can be made…). But Heal is really a better fit. You could call it Knowledge (human anatomy) or some such like that, but Heal is a good name. And really, knowing how to suture up your buddies in no way is related to local knowledges (such as the fact that Pooch Screw is actually in Montana).
Also, Heal is based off of Int. Yeah, that was not an error up there. Have you ever been healed by someone using intuition? How did that go? You let me know when you recover. If I wanted someone to faith-heal my character, I’d go to a Cleric; that’s what they’re there for. When someone’s fiddling around in my insides, I want the smartest guy around, damned by gods or no. And you have to be a pretty smart goddamned person to make a career out of operating on people when the alternative (presumably painless, undeniably quick magical healing) is so much better.
Final Analysis: Heal needs some changes, obviously. It’s kind of baffling that they went to so much trouble to up the available amount of healing, but made the Heal skill so bad at it. Taking as a given that the reason for this was to avoid stepping on the Cleric’s toes, it still doesn’t work; I don’t think 1d3+ after any given battle is going to make magical healing superfluous. Magical healing is simply better; it’s faster, more certain, and can do more (no Heal checks to reattach limbs). But if you don’t want to require a Cleric, or send a party out absolutely coked to the gills by healing potions, you have to provide another way. There’s no disconnect between gaining hp back and bandaging up after a fight; we actually have to assume that the hp abstraction covers only gross physical damage and associated pain, endurance, and luck/training/pure grit or the abstraction breaks down. Isn’t that enough? Still, it’s not unreasonable to say that a Healer’s Kit contains some crude painkillers (or some highly refined alchemical ones…), supplies to clean and bandage/suture, and some miscellaneous supplies. A reasonably clever adventurer could patch themselves up after some strenuous negotiations. And screwing up a healing can have some disastrous results. Just ask Khal Drogo.