On Healing during Combat (A D&D 5e Rant)

In a kill-or-be-killed type of situation, when do you take the time to stop hitting your opponent and heal yourself or your teammates? In my opinion, the only time you should heal during combat is when an ally has dropped to 0 HP, and then you should only cast a 1st-level healing word spell, assuming you have access to healing magic. Here’s why I think this is.

With D&D’s 5th edition mechanics, healing in combat, most of the time, is inefficient. One of the reasons for that is that monsters can typically out-damage your healing. A level-1 character can typically heal using cure wounds (1d8+3, average of 7.5 HP healed), healing word (1d4+3, average of 5.5) or a healing potion (2d4+2, average of 7). If you have a party of four level-1 characters, a medium encounter against one monster means you’re facing a CR1 monster. A typical CR1 monster includes a bugbear, which can deal 2d8+2 (average 11) damage per round; a brown bear, which can deal 1d8+4 + 2d6+4 (average 19) damage per round; or a dire wolf, which can deal 2d6+3 (average 10) damage per round. All of these are well above the average amount a character can heal in a round, which suggests that a PC’s action in a round should focus on eliminating a threat, because an action used to down an enemy one round earlier can prevent around 11 points of damage to a character, whereas healing someone could only help them withstand around 7 more points of damage. As a different example, let’s consider an encounter that consists of four monsters instead of one. Four kobolds (CR ⅛) can deal up to 4 x 1d4+2 (average 18) points of damage per round. If you have access to a spell slot, instead of trying to heal with it, you’ll likely do a better job of protecting your party by casting a spell like thunderwave, which can deal 2d8 (average 7) damage to many opponents, potentially killing all the kobolds (who have 5 HP) before they even make an attack roll.

Now healing spells become more efficient as you increase in levels. At level 11,  you can cast the spell Heal, which gives a character a flat 70 HP. An appropriate solo monster at that level would be CR13 (according to Xanathar’s), like an adult white dragon, which, when using its action and 3 legendary actions to simply attack one character, can deal an average of 88 points of damage in a round.1 

Another reason why using your action in combat to heal is inefficient is that the amount of HP you have doesn’t matter, as long as you are above 0. PCs are just as strong when they are at the brink of death as when they are at full health; ending a fight at 10 out of 50 HP means the same as ending the fight at 40 out of 50 HP. So instead of topping off an ally in the middle of combat, it’s best to simply defeat all opponents as quickly as possible, to avoid taking more damage. It’s best to save the healing for when the fight is over.

The state of your health in a fight matters only when it makes the difference between consciousness and unconsciousness, because being unconscious means a character is no longer participating in a fight, which makes it more difficult for the remaining characters to overcome the encounter, and it also makes it more boring for the player who has to sit out the fight. You also don’t want to run the risk of a PC dying. If one of your allies is at 0 HP, that’s when it matters that you take the time to heal them. Although this might be counterintuitive, it’s best to let that ally reach 0 HP before healing them in a fight. As explained earlier, even if you take the time to heal an ally during combat, the monsters you’re up against could easily deal more damage than what you were able to heal. Also the amount that you heal only matters if it makes the difference between consciousness and unconsciousness. 

Imagine this scenario: you have 20 HP left out of 40. You’re worried, so you heal yourself for 10 HP. The ettin you’re fighting then deals 15 damage to you, bringing you down to 15, and then your allies kill it and the fight is over. The time you took to heal yourself in combat did not make a difference in keeping you conscious. Your round would therefore have been better spent dealing damage to the ettin, giving your party a chance to finish it before it makes another attack. 

Consider this alternate scenario: you have 2 HP left. You’re worried, so you heal yourself for 10 HP. The ettin you’re fighting then deals 15 damage to you, dropping you to 0 HP and rendering you unconscious. The time you took to heal yourself was a complete waste, since the attack would have knocked you down either way. You would have had a better chance of surviving by helping your team finish the monster off (or trying to escape). 

Finally, when healing preemptively, there’s also the possibility that the monster changes target, rendering the preemptive heal completely useless for that encounter. So your round would have been better spent acting towards the defeat of your adversary.

The only case where preemptive healing is meaningful in combat is when the amount healed is greater than the number of HP you have left after an attack. If you had 10 HP, and you heal yourself for 10 HP, then get attacked for 15 points of damage, you’re left standing with 5 HP. That’s a case where the preemptive heal was necessary to prevent your dropping unconscious. However these types of healing are very hard to predict and there’s a high likelihood that you’ll fall into one of the previous three situations where the heal was a waste of time for the purposes of that encounter.

The reverse, healing a character after they have been dropped to 0 HP, is much likelier to be beneficial, and that’s especially true if you use a spell like healing word. The true value of healing in this situation is not to give your ally more HP, but to “cure” them of unconsciousness. Using only a bonus action to do so means that you can still use an action to help bring the encounter to an end (thus, potentially preventing more damage to your party from ne’er-do-wells). It’d be a waste of an action to cast a spell that grants more HP than a 1st-level healing word, because it’s likely that the monster can do more damage than what you can heal, and any damage that goes beyond bringing down a character is meaningless.

Say that you are fighting a hill giant, which can hit on average for 18.5 points of damage per attack. The first time you encounter one, you might only have access to 2nd-level spell slots. You might be tempted to help a downed ally by casting a 2nd-level cure wounds, thus granting 2d8+4 (average 13) HP. The hill giant can still knock them back down to 0 with one hit. Alternatively, you can bring that ally back with a 1st-level healing word, granting only 1d4+4 (average 6.5) HP. They’ll still be knocked unconscious with the next hill giant attack. The difference is that you didn’t waste your action on the healing, meaning that you could use it to attack or cast a cantrip at the hill giant. You also didn’t use up a higher-level spell slot. I could also mention that healing word has the great advantage of being usable from a distance, therefore not compromising your positioning in the encounter.

Some would argue that it’s useless to bring an ally back with a healing word, because they could get downed again too quickly. Consider the previous scenario with the hill giant. Yes, your ally did get downed again, but ultimately, the damage from the attack in excess of their current HP was nullified. If your ally hadn’t taken that attack, someone else in the party would have lost about 18.5 HP. Essentially, you were able to prevent the loss of 18.5 HP on another party member by casting a 1st-level healing word on a downed ally, which is more than you could recover with a 2nd-level cure wounds. 

The only time that casting healing word is a waste of a spell slot and of a bonus action might be if the ally that was brought back gets knocked out before their turn by an area of effect that would have included them whether or not they were conscious. Even then, at least bringing them back reset their death saving throws count. Had you left them in the dying state, then the damage from the area of effect could potentially be the additional death save failure that makes them perish. So healing word can still find some use in that case as well.

In summary, unless you can guarantee that your healing will make the difference between consciousness and unconsciousness (which you likely can’t), then it’s best to wait until an ally has dropped to 0 HP before healing them. Also, it’s best to restore HP using a bonus action, rather than an action, so you still have your action free to expedite the end of the encounter.

Hg

5 July 2023

1This damage vs healing analysis is incomplete. One would need to consider more factors like a monster’s chance to miss, area damage and potential overhealing. However, I don’t believe these extra details change the main point, and so I’ve moved on to my other arguments.