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5E In-Combat Healing: How and Why?

FrogReaver

Explorer
Conventional Wisdom dictates that performing the traditional role of in-combat healer is typically a waste in 5e. I'm here to challenge the conventional wisdom. However, this post is meant to be the starting point for that discussion and not the final word.

With any analysis I think it's helpful to define what success looks like. In 5e I success is best defined as having no PC deaths. I think part of the problem with the conventional wisdom on in-combat healing is that the definition of success used to reach that conclusion is flawed. Success under conventional wisdom is almost universally based on the idea that the adventuring day is a marathon and that the only way to lose is to exhaust your resources to fast. Thus, tactics that minimize resource usage by using your resources to maximum numeric effect (such as the classic whack-a-mole healing) are very highly regarded.

We do want to use our resources in ways that maximize their numerical effectiveness. However, that's only part of the picture. Not having enough resources to finish the marathon race of an adventuring day is actually a very small picture of what causes PC death. In most situations where PC's find their resources too depleted they have an option to opt out of adventuring further and instead rest. Even when they ultimately are able to rest they often do so with many PC's still perfectly capable of continuing on with the adventure. It's often only maybe half of the PC's having their resources depleted that cause the need for a rest in the first place.

Then, there's also the concern of spike damage taken from a lucky crit, an unlucky failed save or a lucky run of successful attacks (or possibly some combination of these things). So why worry about damage spikes when a PC downed to a damage spike event can simply be healing worded back to his feat? Because it's easy for accidents to happen. AOE damage can easily finish off a downed PC. The DM having an enemy continue to attack the downed PC. The downed PC being brought back up only to be hit and fall unconscious again before his turn (thus wasting the PC's action) and when even 1 pc starts not having an action then fights can turn very difficult. Having strong in-combat healing helps mitigate these risks.

So while there are better tactics like whack a mole healing that potentially could benefit you in long marathon style adventuring days. The reality is that these type of adventuring days are rare and that PC's and or the party as a whole are much more likely to have issues with spike damage during the adventuring day.

Relevant tactics: Reserve your highest level spell slots for in-combat healing. Each will heal a large enough chunk with cure wounds to be an effective in-combat heal. Especially if you are a life cleric. Life clerics consistently heal around 50% of an at level fighters max hp with a single cure wounds spell using their highest level spell slot. That's enough healing in a single action to make it worthwhile as an in-combat heal.

I recommend to not use healing word beyond first or 2nd level. I recommend healing allies in combat only when the threat level of the enemy is reasonable capable of downing them before your next turn.

Note the nice thing with healing is 5e is that much of the between combat healing can now be accomplished by healing dice in short rest periods. This should be your preferred method for having allies get their hp back between fights.

Occasionly you might want to use a lower level healing spell between fights. Avoid using low level healing spells in fights except as a last resort. Instead use a low level buff or debuff spell at the start of combat and heal with your big spells at the end.

Strong spells like spirit guardians can still have a use for aoe coverage in certain situations. That said, in many situations you will be better off saving the spell slot for healing as opposed to using spirit guardians. It's often the less spikey slightly more resource costing tactics that will help prevent character death.

Thoughts?
 

Leatherhead

Adventurer
Disclaimer:
I hate combat healing, and especially whack-a-mole healing.

But I have to question how people see it as a legitimate combat role beyond making sure people don't bleed out. It's not like you can just sit back and do nothing other than toss out hp like they are part of a raid in an MMORPG. Combat in 5e is more akin to Rocket Tag. You are expected to last 3 rounds before one side is a decisive winner, and the other is laying crumpled on the floor or otherwise taken care of. Furthermore, NPCs aren't exactly mindless, if they know you can heal, they will move you to the top of the priority list if the combat drags on. And finally, monster damage quickly outpaces what you can mitigate using a upcasted Cure Wounds (its only +1d8/level!) Any buff or ability that you can use to negate just a single round of damage is worth far more than fixing it after the fact.
 

FrogReaver

Explorer
Disclaimer:
I hate combat healing, and especially whack-a-mole healing.
I'm not advocating for whack-a-mole healing. I'm advocating for combat healing to be 2-4 big heals in combat per day.

But I have to question how people see it as a legitimate combat role beyond making sure people don't bleed out. It's not like you can just sit back and do nothing other than toss out hp like they are part of a raid in an MMORPG.
I think you are bringing to much prior baggage into my proposal. Nothing I suggested is like MMORPG healing.

Combat in 5e is more akin to Rocket Tag. You are expected to last 3 rounds before one side is a decisive winner, and the other is laying crumpled on the floor or otherwise taken care of.
That's why I propose rocket healing.

Furthermore, NPCs aren't exactly mindless, if they know you can heal, they will move you to the top of the priority list if the combat drags on.
You are a cleric. You have good AC and moderate hp. You can take the dodge action if focused. You can also heal yourself just as well as you can heal allies.

And finally, monster damage quickly outpaces what you can mitigate using a upcasted Cure Wounds (its only +1d8/level!) Any buff or ability that you can use to negate just a single round of damage is worth far more than fixing it after the fact.
Let's use the basic life cleric as our base (Since you are essentially arguing that cure wounds doesn't heal enough) At level 5 the figher's hp will be around 12+8+8+8+8 = 44. A cure wounds spell cast with a level 3 slot will heal 4.5+4.5+4.5+4+5 = 22.5. Further you are only using the healing spell on the PC that needs it. If every PC gets damaged a little in combat you ignore that. If one PC takes massive damage that's when you use your massive heal.

The numbers on healing appear lower than damage numbers because you don't have to take chance to hit into account. 22.5 Healing is equivalent to 8d6 damage save for half (after accuracy is taken into account).

Ultimately, I seldom see front line PC's being 2 turned even without healing in the party. So I don't believe that enemies are on average doing half your hp in damage per round. They may do half when they hit, but that's only when they hit.
 
I usually compare D&D main characters (the heroes of the story) to old-fashioned Hollywood action movies. The characters can take insane amounts of damage, heal really fast and manage to get up in a fight even when they seemed down for the rest of the fight. With that attitude, the whack-a-mole isn't so bad and in-combat healing (healing word) is valuable.

Whether high-level healing is worth it, I am not so sure. Killing an enemy also removes damage from the game, because that enemy will not deal damage anymore the next round. In the action-economy, I always feel that healing is a waste of time. When there is a brief intermezzo between fights however, healing is very valuable. I never did the math, but I generally feel safer when the enemies are slain. :)
 

TwoSix

Lover of things you hate
I just don't see a way that in-combat healing can be an effective strategy within the current rule set and general metagame assumptions. It isn't just a question of resource efficiency. It's that the penalty for hitting 0 is too small, the window from being unconscious to dead is pretty large, and that at most tables, the penalty for actually dying isn't that severe. (Have a new character ready for next session!)

If characters dies at -10 HP, and replacement characters always started at level 1 with no magic items, and the entire metagame would shift to favor healers, high AC characters, and temp HP granters.
 

CapnZapp

Adventurer
Thoughts?
While there certainly is nothing wrong with a game encouraging combat healing, the 5E devs went another route.

That is, 5E was deliberately tweaked to limit combat healing. I wouldn't go into why, since that's not what you want this thread to be about.

What you *do* want to discuss can be one out of two things, as far as I can see:

1) How to make combat healing work given the current game, no changes made. Unfortunately here I have no suggestions, so I'll simply leave you to it.

2) How to tweak the game's parameters so in-combat healing is once more a thing. Be sure to tell me if this is the case.

As for whack-a-mole, I detest the way the game is currently set up to encourage you to do Healing Word on just-fallen allies, making you huge savings in surplus damage. I had to add as a house-rule that you count negative hit points (down to -10). This significantly hampers the whack-a-mole tactic, since a first level slot's worth of Cure Wounds or Healing Word is not enough to reliably take you all the way from -10 hp to a positive number.
 

Mistwell

Adventurer
In-combat healing saved our party from a TPK just two sessions ago. A mass heal spell (not sure which one - I think it was the Cleric's use of their daily ability) brought back our fighter to enough hit points to go another two rounds from being unconscious, and boosted our bard who had accidentally been caught in melee and was near to going down, enough that he could get out of there and cast offensive spells again rather than heal himself. It turned the tide of battle, without question.

We were fighting underwater. Withdraw was not an option as our foes all swam much faster than us and would have hunted down anyone fleeing easily. If that healing hadn't happened, everyone would have fallen.

So I agree with the premise - in-combat healing can be very helpful overall.

In addition, if you count Polymorph being used on your allies who are about to go down to turn them into things like a Giant Ape with lots of hit points as "healing", it can essentially double the fighting span of a front line fighter-type for the cost of one spell.
 

Tony Vargas

Adventurer
Success under conventional wisdom is almost universally based on the idea that the adventuring day is a marathon and that the only way to lose is to exhaust your resources to fast. Thus, tactics that minimize resource usage by using your resources to maximum numeric effect (such as the classic whack-a-mole healing) are very highly regarded.
I'm not sure I agree that's what's going on: It may be more a matter of casters having better things to do with their high level spells than heal up a damage sponge significantly, rather than just stand him up with a low-level slot, tempting the monster to waste another round knocking him down again. Yes, the damage sponge may lose actions or get killed, but you can always wring him out on the next short rest or just get a new one.

(oh and that trick about putting a sponge in the microwave to disinfect it - doesn't work on damage sponges, can even get a little messy)

We do want to use our resources in ways that maximize their numerical effectiveness. However, that's only part of the picture.
There's also effectiveness that doesn't readily map to hps (DPR/healing) but can still turn an encounter or a whole session or adventuring objective.

I just don't see a way that in-combat healing can be an effective strategy within the current rule set and general metagame assumptions. It isn't just a question of resource efficiency. It's that the penalty for hitting 0 is too small.
Or healing just doesn't heal /enough/ to be worth the slot cost? Relative to what other spells can do when you can cast spontaneously, that is. Healing has the opportunity cost of /everything else you might cast with that slot/.

That is, 5E was deliberately tweaked to limit combat healing. I wouldn't go into why,
::Hrm::fast::cough::combat::wheeze::

the way the game is currently set up to encourage you to do Healing Word on just-fallen allies, making you huge savings in surplus damage.
Potentially, depending on how the numbers don't add up - bit like Overkill, really... OK, exactly Overkill, but on the monsters' side of the damage-trading economy.
 

TwoSix

Lover of things you hate
Or healing just doesn't heal /enough/ to be worth the slot cost? Relative to what other spells can do when you can cast spontaneously, that is. Healing has the opportunity cost of /everything else you might cast with that slot/.
That's a small part of it, but not the major portion. Even if cure wounds healed for double its current amount, you still wouldn't cast it until the target was near death. It's just more efficient that way.

The best way to get people to want to heal is to penalize being injured. Maybe bring back the 4e bloodied condition at half HP,and have bloodied targets attack with disadvantage. (That might be too harsh, so you could adjust the threshold to a third or a quarter if you wanted.) Or to make it more player targeted, have characters die at negative max HP, but they keep taking damage when they fail death saves. (Maybe 2 damage times character level ever failed death save.)
 

Dausuul

Legend
This is really more dependent on the DM than anything else. The DM's choice of monsters and tactics will dictate how dangerous it is to employ the "whack-a-mole" strategy. If monsters fight "honorably," focusing their attacks and AoEs on enemies still standing, then whack-a-mole is the logical PC response. If monsters fight "viciously," diverting attacks to finish off downed PCs and deliberately catching them in AoEs, then it becomes imperative to avoid going down in the first place, which changes the healer's incentives.

So which makes more sense for the monsters, fighting honorably or fighting viciously? I like to take my cues from player behavior on this. Players typically fight honorably: They focus fire on active threats and ignore monsters that have been reduced to 0. Since monsters rarely have healing magic, this is a sensible strategy. However, as soon as the players see a defeated monster pop back up to rejoin the fight, they turn vicious and start slitting throats.

I figure that monsters are used to fighting other monsters most of the time, and have tactics optimized for that. They have no way of knowing the PCs have a healer in the party until they see the healing happen. So I mimic PC behavior. You can use "whack-a-mole" once... but as soon as you do, the monsters turn vicious, and heaven help the PC who goes down then. And if the monsters have advance knowledge of your capabilities, they will be vicious from the start.

(I would add that I don't think whack-a-mole is driven by any desire to optimize use of spell slots. It's actions that are being optimized here. Actions are the currency with which you buy victory, and a healing spell is an investment: Spend an action now, to earn back actions later when a teammate is up and fighting instead of down and bleeding out. If your expected return on that investment is less than the action you spent on the spell, it's a bad use of your action. Whack-a-mole is a way to guarantee a return.)
 
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Tony Vargas

Adventurer
That's a small part of it, but not the major portion. Even if cure wounds healed for double its current amount, you still wouldn't cast it until the target was near death. It's just more efficient that way.
Yes, you may goad monsters into Overkill and 'waste' their damage or 'gain' let's-pretend-healing damage due to heal-from-0.

The best way to get people to want to heal is to penalize being injured. Maybe bring back the 4e bloodied condition at half HP,and have bloodied targets attack with disadvantage. (That might be too harsh, so you could adjust the threshold to a third or a quarter if you wanted.)
Sure, bloodied, even without disadvantage, did that for most characters - monsters could be more dangerous when you were bloodied, for instance, without having to actually gimp you into some kind of death spiral.

But, I don't think penalties are necessary: just getting rid of heal-from-0, just counting the negative hps, alone would do it, because the 'bonus' is gone.
Of course, a lot of casters would let their dropped allies sit there and bleed rather than waste a decent-level spell, anyway...
 

TwoSix

Lover of things you hate
Yes, you may goad monsters into Overkill and 'waste' their damage or 'gain' let's-pretend-healing damage due to heal-from-0.
Yep. The 0 hit point cushion means a kobold doing 1d3 and an ogre that does 2d10+8 are the same level of threat when you're at 1 HP. If the ogre had a decent chance of killing you outright (by pushing you close to negative max), then your attitude to healing shifts.

Sure, bloodied, even without disadvantage, did that for most characters - monsters could be more dangerous when you were bloodied, for instance, without having to actually gimp you into some kind of death spiral.

But, I don't think penalties are necessary: just getting rid of heal-from-0, just counting the negative hps, alone would do it, because the 'bonus' is gone.
Of course, a lot of casters would let their dropped allies sit there and bleed rather than waste a decent-level spell, anyway...
Yea, it's probably not necessary to use bloodied. You could go with a "carrot before stick" approach, and have your common combat heals give a buff + heals. Like cure wounds gives the target advantage on their next attack. Or healing word only gives the target casting mod HP back, and the dice roll becomes temporary hit points. But that was probably too much like 4e back in 2014. :)
 

CapnZapp

Adventurer
The answer is: In combat healing has its place and can be a valuable tool.
Yes.

This says very little, however.

It neither confirms not contradicts the notion that in combat healing needs to occupy a larger place and be more valuable before it gets used with any frequency.
 

CapnZapp

Adventurer
Of course, a lot of casters would let their dropped allies sit there and bleed rather than waste a decent-level spell, anyway...
Well, the cost of not helping your allies will sooner or later be losing a battle...

Except if we give these casters the benefits of the doubt they might do so because that spell can end the enemies.

Which of course is my way of saying that in 5E it is a common occurrence that you're better off killing the enemies than healing your friends even as a Cleric; that the former ends up saving more of their precious hit points than the latter.

Counter-intuitive some might say. Not really I would say.
 

LordEntrails

Explorer
... It's that the penalty for hitting 0 is too small,
Agreed.
... I detest the way the game is currently set up to encourage you to do Healing Word on just-fallen allies...
Yep, but...
...The best way to get people to want to heal is to penalize being injured. ...
Yep, and their is an optional rule for this in the DMG...
This is really more dependent on the DM than anything else. ...
Exactly.

Actually 2 optional rules that really fix most of this.

1) Re-roll initiative. The healer can now never be certain if they are going to be able to heal before the allies turn, so they start acting proactive/protectively.

2) Lingering wounds. Now their is a penalty every time a character goes to 0. One that lasts. So again they players start worrying about it and the healers start being protective healers.

Protective healers require in-combat healing.

And, if the DM starts being a little more ruthless, or just stops protecting unconscious characters, now AoEs starts including downed character when applicable and the troll/ogre/orc/etc bashes the downed PC 2 or 3 times because they might not be smart, but they are wise enough to know that if they leave the paladin/barbarian/etc unconscious on the ground one of his stupid friends is going to use magic to make him jump right back up. Instead they just did a lot of work to get that guy down, and they sure as heck are not going to let him get back up.

Kobolds and goblins? Sure, they don't know better, but you don't survive a handful of fights with adventurers and not know what's going to happen if you don't kill them.

"Damned things are like roaches, smash them once and they will just get back up. You got to stomp them, then stomp, stomp, STOMP!" - Ergo, the Ogre
 

Stalker0

Adventurer
To me the two simplest rules to fix this:

1) a penalty when falling unconscious. That way you always take some pain.

2) a person who falls unconscious always loses their next turn, no matter when healed. This means initiative is less relevant. Right now if I drop and the healer goes before my next turn, I’m barely inconvenienced. But if I lose my turn regardless of when I’m healed, it’s a big deal.
 

FrogReaver

Explorer
Whether high-level healing is worth it, I am not so sure. Killing an enemy also removes damage from the game, because that enemy will not deal damage anymore the next round.
Assuming know you have a sure fire 100% guaranteed chance to end the combat then ending the combat is better than healing. That's generally not the case though. There is always a bit of a fog of war if you will. I can attack and try to kill the enemy now, not knowing if I will even hit it, if I will do enough damage to kill it etc or I can guarantee that my injured ally that might be hit and dropped to 0 hp the very next round is instead guaranteed another round or 2 before that happens.

Of course what if the enemy is still another 2-3 rounds from death. Should you still attack and risk your ally dropping? Is that really the better tactic?

(Keep in mind this about a large 1 action in combat heal vs trying to cast low level healing spells every round (I agree those aren't worthwhile)

In the action-economy, I always feel that healing is a waste of time. When there is a brief intermezzo between fights however, healing is very valuable. I never did the math, but I generally feel safer when the enemies are slain. :)
The tactics I'm proposing are not asking you to stop attacking for most of any given fight. Instead my tactics only have 1 requirement. 1) Hold some high level slots for in combat healing for when an ally has potential to drop the next round and use them at that time for healing.

Is it better to not heal an ally in that kind of situation? I don't think so.
 

FrogReaver

Explorer
I just don't see a way that in-combat healing can be an effective strategy within the current rule set and general metagame assumptions. It isn't just a question of resource efficiency. It's that the penalty for hitting 0 is too small,

D&D is a team game. When you heal your team isn't hitting for 0.

the window from being unconscious to dead is pretty large,


Sure, but why take that chance in the first place when you don't have to?

and that at most tables,
the penalty for actually dying isn't that severe. (Have a new character ready for next session!)
It's not mechanically severe. Assuming you enjoyed your character then losing him is a fairly severe consequence.

If characters dies at -10 HP, and replacement characters always started at level 1 with no magic items, and the entire metagame would shift to favor healers, high AC characters, and temp HP granters.
Sure. I'm not really looking for ways to alter the game. I'm taking the stance that in-combat healing in 5e is underrated provided you adopt the tactics for doing it that I've outlined in this thread.

You can definitely do it wrong. Trying to use your low level slots in combat to heal is doing it wrong. Using your in combat turn to heal and ally that isn't in any danger of dropping next turn is also doing it wrong.

Instead the way to make in-combat healing work, is to
1) Limit the number of actions you spend healing
2) Only use in-combat healing when it's going to immediately reduce the risk of an ally being downed next turn.
 

FrogReaver

Explorer
While there certainly is nothing wrong with a game encouraging combat healing, the 5E devs went another route.

That is, 5E was deliberately tweaked to limit combat healing. I wouldn't go into why, since that's not what you want this thread to be about.

What you *do* want to discuss can be one out of two things, as far as I can see:

1) How to make combat healing work given the current game, no changes made. Unfortunately here I have no suggestions, so I'll simply leave you to it.

2) How to tweak the game's parameters so in-combat healing is once more a thing. Be sure to tell me if this is the case.

As for whack-a-mole, I detest the way the game is currently set up to encourage you to do Healing Word on just-fallen allies, making you huge savings in surplus damage. I had to add as a house-rule that you count negative hit points (down to -10). This significantly hampers the whack-a-mole tactic, since a first level slot's worth of Cure Wounds or Healing Word is not enough to reliably take you all the way from -10 hp to a positive number.
It's weird that you don't ever engage with my challenges and instead just reassert the conventional wisdom on the matter as if it's a god given fact of gaming.

I proposed a particular tactic to in-combat healing. Why is it that you think that tactic won't provide the results I'm claiming it will?
 

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