In 4e, hit points are super abstract. I've completely embraced this and just love it.
This is a good summary, although I don't agree with the word "evolve".D&D started by including very little concept of a wound and has been evolving away from it.
D&D has never had a death spiral of penalties that apply as a character starts to take damage. Regardless of edition, characters remain fully capable of action until 0 hp is reached unless subjected to a very small set of magical abilities like a Sword of Sharpness or Staff of Withering.
I'm away from my library at the moment so the following evoltion may be a bit off:
1e has a large penalty for falling unconcous and it can take months of bed rest for a high-level character to recover hit points non-magically. Certain magical items could inflict lasting wounds/maimings.
2e removed the penalty for unconscousness and increased the healing rate. It is possible to recover hit points in the field and trained care and bed rest offered a substantial boost to hit point recovery. Non-magical healing under good care would probably be less than a month.
3e substantially boosts the healing rate. Non-magical healing would take less than a week under good care. Items that can inflict lasting wounds/maimings are removed.
4e has a full recovery every night.
And this is pretty much the basis of my "sometimes" answer. Does hit point damage indicate physical wounds? Usually, but not necessarily. Thus the same is true for healing spells.Umbran said:"Wounds" as such, are generally a flavor element in D&D, not a mechanical one. So, closing those wounds is similarly a flavor element. I do what makes for the best flavor at the time.
Does anyone actually narrate healing?
Yes. Most predominantly in PbP games, but it also happens occasionally in the face to face games as well.