My Sunday morning D&D campaign adopted some house rules a few weeks back, taken from the blog Protecting the Private Life. We didn’t adopt all of the rules in that post, but we did add levels exhaustion as a consequence of being knocked unconscious, and it has worked out well. But we’ve also boosted magical healing as our own concoction, which has proven even more successful.

The deliberations

The decision to adopt the rule around exhaustion (the first listed under combat in the linked blog post) was a bit contentious—much more so anyway than in my office group—with the primary worry that exhaustion would make healing even less useful. The rate of damage far outstrips the rate of healing in combat, unless the healer waits for their ally to drop to zero hit points, since any hit point damage beyond that is (mostly) ignored, after which the healer uses minimal resources to bring the target back to consciousness to fight again.

We agreed that waiting for your allies to drop to zero hit points before you heal them, especially when there’s a paladin in the party who can do this dozens of times for one hit point each time, sucks. (Or at least I argued vociferously enough that it bores me as the DM for combat to keep running that way. Maybe some people just stopped arguing back after a while.) We definitely agreed that healing sucks, and healing will suck more when this admittedly cheesy strategy is penalized by adding exhaustion effects to getting knocked out.

The new rules

In addition to adding exhaustion as a consequence of being knocked out at zero hit points, we boosted healing magic accordingly:

1. When a target is healed with cure wounds, they may expend a number of hit dice equal to the level of the spell to heal as if they had just taken a short rest. This is in addition to the healing from the spell.
2. When a target is healed with healing word, they may expend hit dice to heal just as with cure wounds, but their hit die type drops by one category: d12’s become d10’s; d10’s become d8’s; d8’s become d6’s; and d6’s become d4’s.

So if a fighter with 16 Constitution gets healed by a cleric with 20 Wisdom, the fighter is getting healed for 3d8+5 from the spell’s normal effects, plus up to 4d10+12 more. That’s a lot of healing for one spell, even from a level 4 spell slot, but it expends extra resources (hit dice), and it succeeds in making healing an attractive and satisfying strategy.

We haven’t decided yet on how to handle higher level spells like mass healing word or circle of healing—neither has seen any play in any of my groups to date—but I would be inclined to allow the target(s) to expend a number of hit dice equal to the number of dice rolled from the spell. So mass healing word would only allow one hit die to be expended if cast at its minimum spell slot.

We’re also unsure about the paladin’s lay on hands class feature. So far we’ve left it alone; none of us feel like paladins need any help in 5th Edition.

The conclusion

Healing has become more exciting and dramatic. When a caster drops a high level spell slot to heal an ally, the contribution to the battle feels on par with an offensive spell at the same spell level. As a subjective but indicative metric, I feel a sense of dread as the DM (who has to sometimes curb his protective instinct over his monsters) when a player calls out that they will cast cure wounds through a level 3 spell slot.

Players also heal more proactively now, in order to keep the PCs not just alive, but healthy, and safe from those exhaustion effects. More importantly, it has added a strategic question of when to heal and when to ride it out, hoping that 19 hit points will get you through the fight.

As the DM, I never used to bother having my NPCs use healing magic in battle—because it always sucked, especially for monsters that die at zero hit points and don’t have the luxury of death saving throws—and admittedly I still haven’t, but maybe I’ll shift that strategy soon. After all, monsters have hit dice too, don’t they? That CR 2 priest NPC with cure wounds and level 3 spell slots can make a hill giant a whole lot tougher.

I wouldn’t recommend these changes if you don’t also add the exhaustion effects to getting knocked unconscious. You will end up with fights where the healer still waits for someone to get knocked before even considering using a spell slot. Healing would probably be too powerful in this scenario.

Has anyone else been struggling with the weakness of healing in 5th Edition? Would you try these rules at your own table?