D&D 5E Realistic health rate

[77IM]

Look at the Lingering Injuries rule in the DMG.

For a simplified version, I'd try:

Whenever you drop to 0 hit points, your maximum hit points are lowered by 1d6. A long rest recovers 1 maximum hit point.​

This means that after a serious injury, it is easy to bounce back to "nearly full" and remain a useful adventurer, but it can take a long time to bounce back to truly 100% full.

Imagine two PCs in the same fight. One loses a bunch of hit points but stays above 0, so they're weary and bruised, but sleeping that night they will heal all the way up and be as good as new. The other PC drops to 0, gets healed, and drops to 0 again! They come out of the fight bloody and with a limp. Their maximum hit points are reduced by 7 (2d6). Sleeping that night will heal them all the way up, recover one lost hit poitn, so they start the adventuring day with full hit dice but are already down 6 hit points. That's not great but by 5th level or so I think most PCs would continue adventuring even when missing 6 hit points. However the alternative, if they really want to heal all the way up, is another 6 nights of sleeping.

I guess the problem I have with most "slow recovery" rules is they just slow everything down. A game is a series of interesting decisions so I'd rather have the option to press on be a viable choice and not suicide, which is why I prefer injury rules (it's easier to work around an injury than to work around not having any hit points). As an added bonus, any injury rule that triggers on dropping to 0 discourages deliberate yo-yo tactics. (Too often in 5e, it is more efficient to wait for your ally to drop to 0 before healing them, which strikes me as weird.)

 

[abirdcall]

Quite a bit changes because of spell durations and such. You can't expect to keep hex, magic weapon or even animate undead up for multiple fights for instance. If you are using spells to rest or create food or travel they're getting used up 7x as fast etc.

Like most of the variant rules in the DMG it's overly simple with lots of negative impact.

I use it with no problem.

It's a narrative tool. It makes it easier to use different pacing models and maintain narrative consistency.

I have come to really like short rests because of the flexibility they give. Having 2 different levels of recovery allows for different pacing.

The long rest resets the tension.

 

[Jaelommiss]

For a simplified version, I'd try:

Whenever you drop to 0 hit points, your maximum hit points are lowered by 1d6. A long rest recovers 1 maximum hit point.​

This means that after a serious injury, it is easy to bounce back to "nearly full" and remain a useful adventurer, but it can take a long time to bounce back to truly 100% full.

I love the look of this. I would, however, make a couple of tweaks. Instead of losing 1d6 HP on going down, HP maximum would be reduced by any excess damage beyond 0. If an attack brings a character to exactly 0, then there would be no loss of HP max. If the same character has 1HP before getting hit by a dragon's breath weapon, then the additional damage takes longer to heal.

I would allow HP maximum to restore at a rate of proficiency modifer per day instead of a flat 1. That way higher level characters would heal faster to make up for a greater potential max HP reduction. This could be halved to slow healing while still granting a benefit to higher level characters.

Finally, I would allow magical healing to increase max HP instead of restoring HP, up to the target's regular maximum.

Consider a Joe the Fighter. He has a regular maximum of 70 HP. A hydra knocked him unconscious with a bite, however there was an additional thirteen points of damage. His maximum falls to 57. A cleric casting cure wounds rolls for a total of 8. The cleric could either restore 8HP to the fighter or increase his maximum HP to 65. That night Joe regains regains a further 3 max HP, bringing him up to 68 (1 and 66 if halved).