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Assurance: "...You can forgo rolling a skill check for that skill..."
Risky Surgery: "...+2 circumstance bonus to your Medicine check to Treat Wounds, and if you roll a success, you get a critical success instead."
Risky surgery requires you to "roll a success", assurance forgoes a roll. So no, they do not combine.
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Assurance: "...You can forgo rolling a skill check for that skill..."
Risky Surgery: "...+2 circumstance bonus to your Medicine check to Treat Wounds, and if you roll a success, you get a critical success instead."Risky surgery requires you to "roll a success", assurance forgoes a roll. So no, they do not combine.
I disagree. A success is defined as "rolling high enough to beat the DC". By your interpretation, Assurance would never work for anything.
In my opinion, Risky Surgery does indeed work with Assurance. It's basically a skill feat for 1d8 extra healing. Nothing game-breaking, and probably even hardly noticeable after the early levels.
Assurance: "...You can forgo rolling a skill check for that skill..."
Risky Surgery: "...+2 circumstance bonus to your Medicine check to Treat Wounds, and if you roll a success, you get a critical success instead."Risky surgery requires you to "roll a success", assurance forgoes a roll. So no, they do not combine.
I'm pretty sure it's still considered a roll when you use assurance. The rules refer to rolls a lot whenever they're referring to checks, usually you roll a die so they tend to refer to that.
On page 445 of the CRB it says this:
This step can be simple, or it can create suspense. Sometimes
you’ll know the Difficulty Class (DC) of your check. In these
cases, if your result is equal to or greater than the DC, you
succeed! If your roll anything less than the DC, you fail.[\quote]I don't think this indicates that if you use assurance you simply don't get the failure effects of a check because you didn't "roll" less than the DC, Paizo just isn't very precise when referring to rolls vs checks in general. Unless there is a good reason to think they mean specifically a dice roll I think it is best to consider "result" and "roll" as interchangeable.
It works, but you don't get the +2, as you forgo any bonuses when using Assurance.
It's still risky because the damage you do could be greater than the extra healing.
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Yeah, that should work (though, as others note, you forego the +2 bonus).
Honestly, spending two Skill Feats for a minor upgrade like this, which you can't even use on people with 8 or less HP without risk, seems fine. Using Assurance on Treat Wounds in general makes it lag in terms of average healing for surety. This Feat improves the situation, but let's examine it.
You can readily use this combo for, effectively, 3d8 healing from level 2, but could instead be gambling for 2d8+10 via going for the Expert difficulty at a +10 or so vs. DC 20...+12 if you use Risky Surgery for what amounts to 3d8+10. That averages 13.5 for the Assurance version, but 13.7 for just Risky Surgery alone, and that gap grows bigger and bigger because Assurance basically always lags a Proficiency category behind just rolling (okay, at 6th level specifically it doesn't, that is the only level...it might be better to use Assurance for a few levels in there just because the jump from DC 20 to DC 30 is so high but you could, in that case, also just be rolling vs. DC 20 and auto-succeeding on anything but a 1), and the odds of success at on-level rolls with a maxed out Skill only go up from there.
It's a decent option if you need to be sure to heal something, and a very good combo if your Wisdom isn't great, but it's not that big a deal in terms of actual amount healed.
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Assurance Feat 1
Fortune, General, Skill
Source Core Rulebook pg. 258 2.0
Prerequisites trained in at least one skill
Even in the worst circumstances, you can perform basic tasks. Choose a skill you’re trained in. You can forgo rolling a skill check for that skill to instead receive a result of 10 + your proficiency bonus (do not apply any other bonuses, penalties, or modifiers).
Risky Surgery Feat 1
General, Skill
Source Advanced Player's Guide pg. 208
Prerequisites trained in Medicine
Your surgery can bring a patient back from the brink of death, but might push them over the edge. When you Treat Wounds, you can deal 1d8 slashing damage to your patient just before applying the effects of Treat Wounds. If you do, you gain a +2 circumstance bonus to your Medicine check to Treat Wounds, and if you roll a success, you get a critical success instead.
I've had a couple people bring this tactic to a table, and while I've allowed it so far as a GM, I'm not at all keen on it. Both mechanically and fluff-wise the two things seem at odds with each other.
Yes, there is some risk with Risky Surgery that you'll put the patient into the dying condition if they have 8hp or less (but since this is Treat Wounds rather than Battle Medicine, its a pretty minor risk, as the implication is that you're doing this while you're out of danger from enemies and have plenty of time available, and there are plenty of other ways to stabilize said patient immediately in an out-of-combat setting unless they're also wounded 3 [or 4 for the Diehard folks]).
Realistically, most of the time all you're doing is gambling 1d8 hp for a +2 to your chance to get them 4d8 healing (as any success will be a critical success). In the abstract, you're basically doubling the risks and benefits of Treat Wounds from -1d8 on critical failure, +2d8 on a success and +4d8 on a critical success to -2d8 on a critical failure, -1d8 on a normal failure, +3d8 on a success, with a roughly 10% shift in your odds towards success. We all know that in any single throw of the dice, -1d8 can end up being more than +3d8, but in aggregate, it should even out. You are quite literally, taking a risk, though a calculated one.
When using Assurance, you're not making a roll, and there's no risk involved at all - the result is known. You simply get the numeric result of 10 + your proficiency modifier (and they don't say "treat the roll as if you had rolled" they say "forgo rolling to receive a result"). If you're trying to use that in conjunction with Risky Surgery, I think everyone can agree that Risky Surgery's +2 is null and void, as Assurance explicitly says to ignore any other bonuses or penalties besides the user's proficiency modifier. But Risky Surgery also says to treat a rolled success as a critical success. You're not rolling anything - there is literally no "risk."
Mechanically it doesn't seem to jive (though we can argue over whether we're quibbling over words unnecessarily due to imprecision on the part of the writer, or if the distinction between "roll" and "get a result" is intentional). Fluff-wise if you're using Risky Surgery and Assurance together, you've literally just taken a risk in a situation where the outcome is assured. That's... I guess inane is the best word for it?
And let's be honest, if the combination is legal, its a one feat investment to increase the amount you heal with Treat Wounds, not two. Plenty of people will still take Assurance (Medicine) as a feat, even if they can't use it in conjunction with Risky Surgery. Assurance (Medicine) is still desirable without it, because players out of combat want to be sure that their Treat Wounds won't hurt their patients and/or end up being a wasted use of 10 minutes if time is a factor. And players in combat with Battle Medicine will still want it because they don't want to hurt their ally or waste a precious action in a combat situation that's dangerous enough that one or more fellow party members are either on the ground or perilously close to getting there.
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My own thoughts:
- The 'risk' is you could roll 'snake eyes' on your bonus 2d8 for a crit and an 8 on the damage die, meaning you end up doing less healing than you normally would have. In fact, below level 6 you could possibly end up doing more damage than healing (granted, this is really unlikely, but if you roll all ones on your healing and an 8 on the damage, your patient nets a 4 HP loss).
- Using Assurance generally means you are using a sub-par Treat Wounds since you can't auto-succeed on the Expert version until level 6, the Master version until level 14, and the Legendary version until level 22 (a.k.a. never).
- At a certain point, our GM just hand-waived away the actual checks/rolls anyway since it no longer added anything to the game (whether it took 3 checks or 4 to get the party to full didn't really matter).
- Note that this feat specifically works with Treat Wounds but not Battle Medicine.
- As for this only being 'one feat' I think it is more accurate to call it 'one more feat' since being a decent healer already calls for Assurance, Continual Recovery, Ward Medic, and probably Battle Medicine, which means adding Risky Surgery will probably mean you have spent half your skill feats on this (assuming you are not a rogue/investigator), or slightly less than half if your background gives you one of these. This is not a small investment for most classes...
Personally, I've come to the conclusion that assurance still counts as 'rolled' for feats like this because otherwise, it really wouldn't work with anything in the game. Of course, I haven't seen anything from the developers to clarify their intent on this...
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I think Assurance works with Risky Surgery to provide an "auto crit".
I think it is broken and Risky Surgery should be errata to state that Assurance can't be used with it. If I was to guess, whoever created Risky Surgery never played a character with Assurance and didn't realize what it would actually mean.
It is what it is.
Average healing by someone who is well built is impressive to see.
I think Assurance works with Risky Surgery to provide an "auto crit".
I think it is broken and Risky Surgery should be errata to state that Assurance can't be used with it. If I was to guess, whoever created Risky Surgery never played a character with Assurance and didn't realize what it would actually mean.
It is what it is.
Average healing by someone who is well built is impressive to see.
Again, it's literally a skill feat for 4,5 extra healing. That's nearly nothing after level 5. Continual Recovery, Ward Medic and Assurance are much more "broken" than Risky Surgery will ever be.
I honestly think it has a bigger impact on higher levels when you don't use Assurance and use the conditional +2 to hit the next DC step to increase healing. But even that is of questionable use since you can't use it for Battle Medicine and Treat Wounds is often done when time is not an issue (assuming anyone invested in Medicine has Continual Recovery).
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I think it is broken
Why do you think it's broken? At the cost of two feats the numbers it provides just don't seem unreasonable to me.
If I was to guess, whoever created Risky Surgery never played a character with Assurance and didn't realize what it would actually mean.
It is what it is.
Average healing by someone who is well built is impressive to see.
What does it "actually mean"? By using Assurance you're losing the +2 from Risky Surgery, you're losing your Wisdom bonus, which I assume is decent on "someone who is well built" for Medicine checks, you're losing the +1 item bonus you could get from Expanded Healer's Tools, and you're effectively getting a 10 on the die roll, which is a below average result.
Without assurance, you're probably looking at at least +3, maybe +7 in additional bonuses to the roll, and you have a 50% chance of getting 11 or higher on the die, versus a 45% chance of rolling 9 or less.
As far as I can tell "what it actually means" is a safe, but slightly low result. Are you seeing something I'm not?
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To me, the point behind Risky Surgery is the risk. With Assurance, you can remove the risk entirely for double the healing benefit (less the initial damage). This is what seems broken to me because it is counter-intuitive.
Anyone who is going to be a dedicated battle field medic, they need the Continual Recovery, Ward Medic, and Assurance. I don't see Risky Surgery as a must-have feat for the dedicated healer.
Like a lot of things in 2e, it is a question of choices. Taking Risky Surgery means a character can't take something else until later.
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To me, the point behind Risky Surgery is the risk. With Assurance, you can remove the risk entirely for double the healing benefit (less the initial damage). This is what seems broken to me because it is counter-intuitive.
I guess I think of "broken" as meaning "too effective" rather than counter-intuitive. It really doesn't strike me as counter-intuitive, either, but I get why it might strike someone the other way.
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My own thoughts:
- The 'risk' is you could roll 'snake eyes' on your bonus 2d8 for a crit and an 8 on the damage die, meaning you end up doing less healing than you normally would have. In fact, below level 6 you could possibly end up doing more damage than healing (granted, this is really unlikely, but if you roll all ones on your healing and an 8 on the damage, your patient nets a 4 HP loss).
- Using Assurance generally means you are using a sub-par Treat Wounds since you can't auto-succeed on the Expert version until level 6, the Master version until level 14, and the Legendary version until level 22 (a.k.a. never).
- At a certain point, our GM just hand-waived away the actual checks/rolls anyway since it no longer added anything to the game (whether it took 3 checks or 4 to get the party to full didn't really matter).
- Note that this feat specifically works with Treat Wounds but not Battle Medicine.
- As for this only being 'one feat' I think it is more accurate to call it 'one more feat' since being a decent healer already calls for Assurance, Continual Recovery, Ward Medic, and probably Battle Medicine, which means adding Risky Surgery will probably mean you have spent half your skill feats on this (assuming you are not a rogue/investigator), or slightly less than half if your background gives you one of these. This is not a small investment for most classes...
Personally, I've come to the conclusion that assurance still counts as 'rolled' for feats like this because otherwise, it really wouldn't work with anything in the game. Of course, I haven't seen anything from the developers to clarify their intent on this...
Crunching the actual numbers, yes, the odds of doing more harm than healing in total on a success if you're shooting for DC 15 (once you're shooting for DC 20+ there's literally no chance, and that can start as early as Level 2 for Rogues and Level 3 for anyone else) are literally less than 0.2%. The odds of your 1d8 doing more damage than the extra 2d8 you'd be getting by turning a success into a critical success is just under 11%. Probability wise, the risk and reward aren't so much in the ~83.6% chance of improving on the amount of healing you get on a success, it's in increasing your odds of turning a failure (that is, not getting a success at all) into a critical success.
If you add Assurance into the mix, there is literally no chance of failure (unless the player is math challenged enough that adding 10 to their proficiency modifier and determining which DC level it meets or exceeds is a struggle). At that point the only thing remaining is the ~83.6% chance of increasing the amount of healing you're dishing out vs. the ~10.9% chance of decreasing it. I'm not a medical professional, and I know there are risks in any and all surgical procedures - anyone out there know whether a procedure with an over 80% chance of making the patient better, an 11% chance of making the patient worse, and virtually no chance of causing fatal complications constitutes "risky" surgery? ;)
Personally I agree with Gary that the two things seem very counter-intuitive when put together, and therefore shouldn't be. Blave, I'm not trying to argue that it's game-breaking in the power level of the benefit it provides (the feats you mentioned can be amusing to watch when they make a 3rd level Rogue a more effective out-of-combat healer than a 3rd level Cleric), and 4.5 extra healing is indeed a drop in the bucket at higher levels (though we all know that those drops sometimes make all the difference). That said, the fact that a particular hunk of cheese is small doesn't mean it shouldn't still be counted as a member of the dairy food group. ;)
I'd say some of this is on those members of the 2nd edition design team who decided that wands of Cure Light Wounds were the scourge of the Pathfinder universe in 1st edition. Their effort to make healing more scarce has made Medicine the Perception skill of 2nd edition, made Battle Medicine almost ubiquitous as a 2nd level skill feat choice, and has left players looking for any edge they can get in terms of being able to successfully dish out healing-on-demand to themselves and their fellow party members, even if they're not a Cleric or Bard, and even if their Wisdom is on the low side. Assurance allows you to play the numbers game in a way that takes out any anxiety or uncertainty, and then people look to build out the power of their guaranteed healing from there, even if the build-outs don't make the most sense, or end up triggering semantic debates like this one.