If a 4E character got car bombed, he would NOT be in need of medical care. Every 4E character there is can surge away any and every wound. No 4E character ever goes to step (2) of the mechanical or narrative path above. Yes, you may choose to describe broken bones or other terrible wounds. But if you do you become obligated to describe a fighter not ignoring the wound but completely and fully surging it away. The broken bone mends then and there for no narrative reason.
Or you can choose to NEVER describe a serious wound. And, I do agree that a serious wound to Bryon is different than a serious wound to an action TV character. You do have *some* narrative space to work with. But you absolutely have less space because you MAY NOT describe any wound which requires outside medical treatment.
The TV Cliche doesn't have to worry about pacing at the table. It doesn't have to care about the characters. The TV Show, and the Game serve two entirely different purposes/audiences. The purpose of the TV Show is to tell a narrative that keeps the
viewer involved. The purpose of the game is to provide an entertaining past time that keeps the
players involved. The players are NOT the viewers of the show, the characters they play are the show. Seems like a lot of DMs are forgetting this.
In a TV Show with an ensemble cast, sidelining a character for a day, a week, or a season has no repercussions to the "writer". The actor might be bored as hell, or out of a job but that doesn't matter. It might even advance the "narrative". In a game, even though you have the "trappings" of an ensemble cast, each character is actually the main PROTAGONIST in his own show. Sidelining a character for a day, a week, or a season has a very distinct repercussion to the player that is playing that character.
Having Starbuck "die" and disappear for 4 episodes is not an issue for BSG the TV show. You still have "60" other characters to focus on and continue the "game". The purpose of the show is to entertain the outside viewer, not to be entertaining to Katee Sackhoff, the actress playing Starbuck. However, let's go in a different direction, how entertaining would The Dark Knight movie be, if Batman gets injured in the first 10 minutes of the movie and the only thing we see for the next 80 minutes is him on bed rest?
The game's purpose is to provide entertaining adventures to "go adventuring" in. When the characters are adventuring the needs of the players are being fulfilled by the main purpose of the game. When the characters are on bed rest, what purpose is being fulfilled? Because going adventuring is not it.
You mention that "TV show healing"
is so common place that it is not even given a second thought.
Then what purpose is served by giving game healing a second thought? Realism? Or is it just to fulfill the narrative that the DM has thought about? The narrative the DM has thought about, hopefully, takes into account the needs of the players. Just as a TV Show writer is taking the needs of the audience into account.
If you are going to have "TV Show healing" in the background, why can't game healing be the same. You want to describe serious wounds go ahead. When are serious wounds taken care off? Off screen, off camera, in the background.
In 1e, according to the rules you had no option, you went to 0 HP or lower and you were out of commission for at least a week, even if brought up with magic, except for a heal spell. Any HP loss no matter how "severe", which is never defined, would be entirely "healed" in 4 weeks. Why 4 weeks? It was an arbitrary number, just like there were level limits for non-human characters. Probably because the game designer thought that getting the characters back to adventuring would be a good thing. Instead of the boring drag of watching him drooling at "General Hospital". He arbitrarily came up with the number 4 weeks. Why? Because the game designer thought that this made the game better.
In 3.x, the penalties for going to 0 HP and lower were removed. There was no longer a comma and a week minimum rest. The "accelerated" healing was completely dependent on magic, with magic being easily available within the assumptions of the game. What they did was shift the resource from one of time, to one of finances. If you could afford the potions, and/or the "heal stick" then the HP loss was simply a speed bump, and one that was not significant to any degree. They introduced a "mechanic" that allowed you to completely obviate the obstacle. Once again, why? Because the game designer thought that this made the game better.
4e simply decided to divorce healing from magic. Finally, we don't NEED to have a divine caster tied to the party, or a "heal stick". Honestly the "heal stick" did more to break my suspension of disbelief than anything else. The description of HP loss is just as it has always been entirely up to the DMs, and players to take care of. Instead of providing "perceived" obstacles that are not obstacles at all they decided to leave the option open. While you're adventuring you take damage. At the beginning of each extended rest you regain resources to keep adventuring (the purpose of the game). Why? Because the game designer thought that this made the game better.
The thing that 4e provides within the design space is ways to actually make long term HP loss mean something. IF the DM and players want to go that route.
What I find disingenuous is that some accuse 4e of removing this perceived "realism" from the game, when the game has never had this "realism" to begin with. Look at the actual description of Hit Points and try to ascribe any measure of "realism" to it, and you'll be hard pressed. What 4e finally did was acknowledge that HP are an esoteric, abstract resource that encompasses a measure of being able to "kick ass" due to the binary measure of D&D combat. Then the game provides a way to replenish this resource without resorting to magic. The DM and players can choose to make the game harder, or easier by very simple tweaks.
I've written extensively of this "historical" game issue and have even provided multiple ways for the DM to go back to putting "healing" obstacles in the game if he wants to.
You can see additional thoughts here.