Medicine Skill Is Subpar

[Drejk]

I hoped that the 2nd edition would expand the role of non-magical healing and give some more support to non-magical healers...

Well, let's say that aside of alchemical healing, it isn't nearly as good as I hoped...

The basics: Medicine skill allows single untrained use - Administer First Aid. Like the old Heal skill it allows stabilizing dying creature and stopping bleeding. So far so good, it's really a common sense necessity or the low level characters would die even more than they do.

Fine... Except... Now it requires healer's tools. The new actions rules will help alleviate that a bit, but only to a degree: stride toward the dying comrade, drop weapon and shield (free action), pull out the healer's tools, administer the first aid... Valeros The Third should pray that you won't need to walk more than your stride range or maneuver around enemies to reach him.

This requirement seriously undercuts the utility of untrained Medicine skill use, forcing everyone to carry a healer's tools, and spend more actions than is sensible to disarm themselves, ready tools, and then rearm themselves. And before anyone says that it's unrealistic to administer first aid without healer's tools, I'd counter with the fact that it's equally unrealistic to prevent someone from dying without medical training in the first place.

Possible solution: Either drop the healer's tool requirement, or add a clause allowing the character to use improvised materials to administer first aid, by using available pieces of cloth, etc. Possibly by adding clause that doing so without healer's tools, gives the subject infected 1 condition that would bestow penalties to saving throws against disease and reducing natural healing until properly treated.

I'd also like to propose an additional improvement of this action for trained characters:

Critical success: (trained in Medicine only) The creature at 0 Hit Points gains 1 Hit Point and removes 1 level of dying condition.

The advanced: Those trained in Medicine can use it to... Treat Disease and treat Poison. That's it. No long-term medical care for wounded, no treating deadly wounds...

Oh, yes, you can use Medicine skill to actually restore Hit Points... By picking Battlefield Medic feat. Which, unless you are Rogue, you need to be 2nd level and means you won't pick any other skill feat until level 4th.

The Battlefield Medic feat has it's issues too:
It requires DC 20 check. Fine at higher levels, not so fine at levels 1-3, when you would be the most reliant on the healing provided by that skill. Additionally, to get the most of it you better have master/legendary proficiency in Medicine, which leads us to the final issue with medicine skill:

Medicine is a Signature skill for exactly those classes that need it the least: Alchemist, Cleric, Paladin (via Hospice Knight feat), Sorcerer (Angelic bloodline), all of which have access to other forms of healing, instead of classes that would have better use for the higher proficiency tiers in Medicine skill.

That is especially bad in case of Legendary Medic feat which allows those with signature medicine do what they might be able to be doing anyway with their spells and alchemical concoctions in the first place.

Lack of long-term care and treating deadly wounds is exacerbated by the fact that natural healing rates vary much more wildly than in 1st edition: Constitution bonus (minimum 1) × character level, which might mean that downtime and camping is unnecessarily extended for the group waiting for the low Constitution characters to catch up with the party juggernauts.

Proposed solution is to add Treat Wounds exploration/downtime activity: a character trained in Medicine can spend 1 hour to treat wounds of a willing or incapacitated living character and make a Medicine check to restore a number of hit points equal to result of the check –10 or maybe half the result, the exact balancing of the amount restored would have to be tested; making the result of the check directly influence the amount of healing provided would reward good Medicine skill and good roll unlike the unwieldy way the Battlefield Medic handles it at the moment. Each creature could benefit from Treating deadly wounds once before resting.

Battlefield Medic feat grant the character option to use Treat Wounds as an action in combat. Possibly with another skill feat allowing the medic to use it once on the subject as an action and once as a hour-long activity.

Another feat could allow the medic to incorporate Treating Wounds activity into their daily preparation routine and make it affect up to six or more targets

All the non-magical classes should have a class option or feat that would allow them to pick Medicine as a signature skill, or it could be made into a general/skill feat available to all.

"Legendary Medic" feat should be actually a Master Medic because it's benefits should be available to non-magical healers earlier than 15th level. The actual Legendary Medic should really be Legendary, like reviving someone who died a few rounds ago.

Another action that could be added to trained Medicine skill could be Treat Shock: make a Medicine check to reduce dying condition - maybe I missed something but as far as I can tell, the only way to remove dying condition at the moment is to spend whole round with 1 or more Hit Points at the rate of one level of dying condition per round. This action would allow to remove it faster, letting the patient suffer another critical hit sooner than usual.

[Lucid Blue]

I actually like that Medicine is toned down by default. For those of us not running gonzo high fantasy, it's a bit more grounded.

I'm actually going to have to houserule Combat Medic down to something more realistic. People wiping away severe sword wounds with a bit of gauze in 2 seconds flat is absurd!

[Mike 429]

Drejk wrote:

I hoped that the 2nd edition would expand the role of non-magical healing and give some more support to non-magical healers...

Well, let's say that aside of alchemical healing, it isn't nearly as good as I hoped...

The basics: Medicine skill allows single untrained use - Administer First Aid. Like the old Heal skill it allows stabilizing dying creature and stopping bleeding. So far so good, it's really a common sense necessity or the low level characters would die even more than they do.

Fine... Except... Now it requires healer's tools. The new actions rules will help alleviate that a bit, but only to a degree: stride toward the dying comrade, drop weapon and shield (free action), pull out the healer's tools, administer the first aid... Valeros The Third should pray that you won't need to walk more than your stride range or maneuver around enemies to reach him.

This requirement seriously undercuts the utility of untrained Medicine skill use, forcing everyone to carry a healer's tools, and spend more actions than is sensible to disarm themselves, ready tools, and then rearm themselves. And before anyone says that it's unrealistic to administer first aid without healer's tools, I'd counter with the fact that it's equally unrealistic to prevent someone from dying without medical training in the first place.

Possible solution: Either drop the healer's tool requirement, or add a clause allowing the character to use improvised materials to administer first aid, by using available pieces of cloth, etc. Possibly by adding clause that doing so without healer's tools, gives the subject infected 1 condition that would bestow penalties to saving throws against disease and reducing natural healing until properly treated.

I'd also like to propose an additional improvement of this action for trained characters:

Critical success: (trained in Medicine only) The creature at 0 Hit Points gains 1 Hit Point and removes 1 level of dying condition.

The advanced: Those trained in...

Take a look at the Background of Labor which gives you Robust Recovery (pg. 170) which has the prerequisite expert in Medicine. As a first level character unless your GM allows you to spent 2 of your skill points at character creation on Medicine to go from trained to expert so that you have a better chance of healing a wounded character. From Medicine (pg. 153) Treat Disease spending the night (8 hours) you lose the benefit of rest, for a night, to try and help a sick companion. Free Hero Point please as you have sacrificed your hit point recover and or spell recovery. To give a companion a better chance on a die roll to give them a (+2 circumstance bonus or +4 circumstance bonus) to tending to the sick or disease companion to give him a fighting chance to make his Fortitude save. At the lower levels, low magic setting, and or in a magic dead zone this skill could be helpful.

[kingbeandip]

It's always really bugged me that Medicine by default can't restore HP. In fact, in 5e I homebrewed a rule to allow any any character to attempt to restore HP. And it has worked really well. I think instead of skill feats granting access to healing, they should greatly enhance it.

>> My homebrew rule is that a character may spend 5 minutes to attempt a DC 10 medicine check and restore 1d6 HP to the target creature.

I would allow characters trained in Medicine to do this, and then have skill feats that make this much better, potentially giving master or legendary-trained characters the ability to heal outside of combat as effectively as a cleric can during combat. (It would still of course be absurd to perform surgery during combat, which is exactly what clerics can do almost instantly with spells.)

[The Narration]

Letting any trained character Treat Wounds out of combat (as they could in PF1) and then having Battlefield Medic let them do it in combat seems sensible to me.

And the DC really needs to come down. A DC 20 wasn't unreasonable in PF1, but bonuses are lower in PF2 and critical failures are a thing.

[Zwordsman]

I thought battle medic was just one action to heal. and that is why its a dc 20? It was made to be an emergency patch in battle, not out of battle.

I do think the game needs a base treat deadly wounds, at a speed of something like 1min or 5mins

[Red Griffyn]

Lucid Blue wrote:

I actually like that Medicine is toned down by default. For those of us not running gonzo high fantasy, it's a bit more grounded.

I'm actually going to have to houserule Combat Medic down to something more realistic. People wiping away severe sword wounds with a bit of gauze in 2 seconds flat is absurd!

Please don't nerf battle medic in your game. Before level 10 there is a substantial chance of failing or critically failing which can cause more damage. Without the Assurance feat at L14 (if you bump to medicine to legendary) it is quite difficult to hit the DC. It is a really weak feat as it stands.

L1 - DC 20 vs. Maximum +5 (5% crit sucess, 30% of success, 50% chance to fail, 20% change to crit fail).

L5 - DC 20 vs. Maximum +10 (5% crit success, 55% of success, 45% failure, 5% crit failure)

L10 - DC 25 vs. Maximum +16 (10% crit success, 60% of success, 40% failure, 5% crit failure)

L14 - DC 30 vs legendary level assurance (auto 4D10)

As you can see, the feat barely works half the time until L14 and it is for quite a small amount of hp (1d10 or 2d10). By L14 4d10 is on average 22hp once per person once a day. At that level a fighter will have a minimum of 140 hp (likely closer to 190 with con/racial) That is barely 10-15% of their HP once a day. They will obviously take more damage in one encounter then this feat combo can even heal. Healing in this game is at a huge premium so you shouldn't penalize your guys for trying to save youf cleric/druid/bard/alchemist from investing all of their resources into keeping people topped off.

[Drejk]

Zwordsman wrote:

I thought battle medic was just one action to heal. and that is why its a dc 20? It was made to be an emergency patch in battle, not out of battle.

I do think the game needs a base treat deadly wounds, at a speed of something like 1min or 5mins

That is exactly my point. Battlefield Medic feat covers treating wounds in combat. There should be an out of combat option for those trained in Medicine that does not costs a feat.

[MrShine]

Great post Drejk, in full support of everything you suggested. I really want there to be viable non-magic healing, that can actually restore hitpoints to some degree.

And I'm very much in favour of the "make Legendary [skills] feel Legendary" - I mean, people are flying around, teleporting across the planet, raining meteors down from space... why can't someone have a trick to bring someone back from the brink of death? (Or in this case, from slightly beyond...) I've seen some first responders do some crazy, uh, stuff IRL, it wouldn't be a stretch of the imagination at all imo

[Jason S]

I like the idea of there being a Treat Wounds out of combat trained use that works like Battle Medic and takes 10 minutes.

I agree that Battle Medic needs to be better. I did the math and at level 2 with a trained PC with 14 Wis, it heals an average of 0.5 damage. But I don't like the idea of it taking only 1 action, I find that to be silly.

[Zwordsman]

Drejk wrote:

Zwordsman wrote:

I thought battle medic was just one action to heal. and that is why its a dc 20? It was made to be an emergency patch in battle, not out of battle.

I do think the game needs a base treat deadly wounds, at a speed of something like 1min or 5mins

That is exactly my point. Battlefield Medic feat covers treating wounds in combat. There should be an out of combat option for those trained in Medicine that does not costs a feat.

ah I should've used a quote. That was directly replying to the person who wrote before me.

I was trying to add to the concept that the feat is purely for in battle events.

I am in support of allowing the skill check to do it normally.

Well. I actually thinkt he skill check version should heal more. as you have time to do it well and proper. Something like Static Level in HP + dice healed, which results in the bulstered effect. And one of the higher level medicine skill levels (master maybe) or a feat that requries master, allows for a 2nd application in one 24 hr period. Because you are that good at it.

and the battle medic version be what it is, maybe slightly easier DC, and NOT count against the 1/day usage of treatment via medical skill for hp. Instead, maybe once a battle. but. the healing is TEMP Hp representing a quick suture, or using Goo from a tangle foot bag to "paste" the wound shut. applying a tourniquet, whatever flavor fits the character using it. In my case, using Alchemical reagents to heal people.

I have no problem with it being 1 action in that situation. In fact. I think it would be rather cool if you could spend 2 or 3 extra actions, at once, to lower the DC you need to roll against. That would also let the feat be dynamic.

In this way, the feat would actually be meaningful and interesting, make sense that the DC was semi hard. AND allow for out of combat medical support via mundane (but eventually so skillful its like magic) ability.

[Vidmaster7]

It does need to be improved. I'm having some Deja vu however can we add that to things it can cure?

[Drejk]

Jason S wrote:

I like the idea of there being a Treat Wounds out of combat trained use that works like Battle Medic and takes 10 minutes.

I agree that Battle Medic needs to be better. I did the math and at level 2 with a trained PC with 14 Wis, it heals an average of 0.5 damage. But I don't like the idea of it taking only 1 action, I find that to be silly.

With the use of healer's tool it would also require two free hands which requires dropping/sheathing weapons and pulling out the tools.

Funny enough, as written, it does not require tools—the feat does not mention them, and the skill itself does not require use of healer's tool, only the specific applications.

Of course if there was Treating Wounds activity being part of trained Medicine skill, and Battlefield Medic would allow using it as an action instead of 10 minutes/hour time, then the Treating Wounds requirement would apply to it as well.

[Drejk]

Vidmaster7 wrote:

It does need to be improved. I'm having some Deja vu however can we add that to things it can cure?

Healing mental conditions? I'd say that it requires an expert or even master proficiency and a Counselor feat.

[Vidmaster7]

Drejk wrote:

Vidmaster7 wrote:

It does need to be improved. I'm having some Deja vu however can we add that to things it can cure?

Healing mental conditions? I'd say that it requires an expert or even master proficiency and a Counselor feat.

I really do need to get that master prof in that.

[Cantriped]

I too am disappointed by the lack of a 'Long-Term Care' Trained Action for Medicine. It feels like an ommision.

There is also a Nature-based feat for Healing, with a similar once, per person, per day clause as the Medic feat. They stack nicely but it is quite an investment to be a healer.

[pi4t]

I also find mundane healing to be far too weak. I wrote up my thoughts in this thread.