Ratskinner
Adventurer
I have some views on how this can be handled - whether they are more widely workable solutions I don't know.
On "How well is he doing?", I use the 4e bloodied condition as a solution. You can tell when he's bloodied. (And this can be narrated pretty easily for most opponents - for stone golems and the like it gets a bit trickier, but they're not that common as enemies.)
On the description that is then invalidated by later events - the "long middle" - I find that this pushes narration away from "The orc hits you and your guts start spilling out", towards a more comic-book or "PG cinema" style of narration - more emphasis on the action, less on the actual injury. A post upthread mentioned greataxe criticals as an objection to warlords, but in AD&D or 3E if you narrate a greataxe critical against a PC in any graphically vivid way you're then going to have to confront the issue that anyone can stabilise that wound, and that the PC in question will be up and about even without medical attention in a time ranging from a few days (3E) to a few weeks (AD&D).
Oh I don't think the problem is edition-specific by any means. I've had it for a while now. I agree about pushing the narration, but I find that troubling (a supers game I knew once called it "costume damage"). I'll talk more about this below.
I think that what I described is not just gamist (at least in the sense of "step on up"). Feeling the desparation of your PC via a mechanically mediating device is key to combat in Burning Wheel, for instance, and that is a narrativist system by default (though no doubt hackable to a certain sort of gamism).
I also don't think that it's not fiction-oriented: part of the point of the mechanical mediation is to bring the fiction to life for the players via the sort of proxy experience I am pointing to. But I don't disagree that it is (or can become) limiting - there are stories and thematic material that 4e will never support, for instance (and likewise Burning Wheel).
I don't think I'm disagreeing with that (except about Burning Wheel, maybe ). In fact, I think you're describing exactly what I was talking about.
I'm not 100% sure I know what you mean by "prioritising story". I think that in a certain sense of that phrase 4e prioritises story (eg by trying to ensure that its mechanical systems engender the relevant experience, so that your paladin plays as a stalwart ally, your fighter as a master of the battlefield, your warlord as an inspirational leader, etc) but I'm assuming that's not the sense that you have in mind. I don't know FATE well enough to just read your intentions off your reference to it, but are you envisaging a wider range of conflict situations than just combat as being viable? And/or a wider range of player narrative/metagame resources than 4e's power system?
What do I mean by "prioritising story"....hmmm....
This is one of those areas where Forge terminology fails me a bit (or perhaps fails ::shrug:. So I hope you'll indulge me a bit of rambling. I enjoy the stories that come out of gaming, for me, they're almost the whole point. I get irritated anytime a system is slowing down the process of getting a story out of my table-time (or otherwise hindering it). So I think I'm generally Narrativist in inclination. On the other hand, I'm not terribly attached to the "addressing Premise" part of Narrativism, at least not in the very serious sense that it seems most people take it. I want the details of the story, and I like them to matter. A mechanic like HP, which in effect punishes someone who would be trying to pay attention to the fiction/story details...is no end of irritation to me.
I brought up FATE because, FATE makes paying attention to the details important, in a way that D&D rarely does (and then its usually not through the rules). FATE's mechanics rely on the details in the fiction (without relying on detailed fiction).* This has the side-effect of providing for the wider range of conflicts that you mention. I'm not sure that I'd say FATE provides a wider range of player narrative/metagame resources, but its resources are flexible in a way that 4e's aren't. That is, a FATE character (or even environment) can have an aspect or stunt of almost unlimited meaning, but all the aspects and stunts work within fairly narrow parameters mechanically\numerically. Meanwhile 4e has a non-infinite range of races and powers, but they each work slightly differently. So...::shrug:: The important part for me is that through the use of FATE points and free invocations on those aspects (some of which players can create on the fly), FATE provides players with a much more fiction-centered experience. Which, I think, takes place through a vector more like an author creating a story, rather than the vector you describe for 4e. Although the use of dice still keeps things fairly uncertain, giving it a touch of viewership/readership (YMMV).
In contrast with HPs, FATE's Conflict system provides for consequences as freeform descriptors of the bad things that happened when you lose any kind of conflict. ("twisted ankle", "embarrassed in front of Angela", etc.) They are utilized in a manner similar to aspects (except usually invoked by opponents). So how you lost, or what happened actually matters, which, to me, makes it very flexible and yet compelling. It isn't restricted to "costume damage" (unless you make it that way intentionally for a specific game). It even preserves player agency because you author your own consequences. I find this much more appealing than the HP mechanic which effectively is a colored energy bar floating above a character's head.
Now having written all that, I don't get to play FATE every night. I'm in an OSRish group and I often get to play other games, both role and board, with them and my kids. It's not like I can't enjoy games with different playstyles and agendas. (Although I really question the point of Tabletop Sim games when computers are around.) I'm not a Narrativism Puritan. Which is why I'm feeling odd about 5e. I already have FATE Core (well, its in the mail) which does that story-driven thing better than D&D is ever likely to do it (mostly because it clings to its sacred-cow mechanics). I might be perfectly comfortable with a very gamist 5e with much simpler mechanics that 3e or 4e, even though it wouldn't be my ideal game. So while I'd like to see a 5e go the "story" way, I'm not sure I'm even willing to put up much of a fight for it.
*by which I mean, if the presence of that banana in your backpack is unimportant...I don't have to know that it cost you 2sp and is three days from spoiling beyond edibility, or even that its there.