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[Brisbane Dave]

Greetings.

First off, great game. I actually took a day off from work so I could have more time to play.

I went to check the development page to see what other suggestions have been made already but I gave up after browsing around a little. Maybe that should be my first suggestion: an index for the development page. Does it have a search feature?

But my real suggestion is to add medical professions. I've read a few posts now where people have mentioned that how dwarves heal up is less than ideal, and I tend to agree. I'd like to be able to do more than decide to lock up hopeless cases.

So, my idea is two new skills, surgeon and physician. Dwarf surgeons would amputate mangled limbs, dwarf physicians would be of little practical use in curing anything but their visits to injured dwarves would inspire a positive thought. Possibly visits from either or both types would impact the time spent healing, depending on practitioner skill. Surgury attempted by a dabbler could kill the patient, too. Obviously, getting a limb cut off or undergoing another operation while conscious and without any pain killer beyond alcohol would inspire unhappiness, so the physician balances the surgeon.

Another possibility is prosthetic limbs, which would, you'd think, be made of wood, but given that this is a fantasy game could be forged. Sounds sort of cool. I don't think they should be as effective-- as in better than natural limbs-- as they are in IVAN, if you know that game.

Also, after the dwarven economy starts, dwarves could spend money visiting healers for services physicians and surgeons historically provided-- bloodletting, cupping, tooth removal, etc. I suppose shaving is out in this case. This could be a safer way to raise skill levels.

I suppose this is a good example of what's called bloat, but I was rather taken with the idea. Apologies if there's already a better plan in place to deal with the healing problem.

[ReWolf31]

Hmm i'd prefer the profession to to merged into a single profession, say, doctoring, which could cover physician and surgeon + visiting doctor, etc. nice ideas though.

(and there's a 'search' thing in the top-right hand corner of the webpage    )

[Tamren]

I suggested this earlier in that massive post on nobles most of you didnt have the patience to read.

But anyhow, in it it made doctors and physicians nobles. They would be assigned to your fortress soon as you have a small population.

For now, we should keep this simple. Doctors heal people, the physicians help dwarves overcome previous injury.

Dealing with the plague would not be fun at all, and overcomplicating this with dentists and other specialists would detract from the gameplay.

[Brisbane Dave]

ReWolf, you might be right about one skill being better. Still, there's already a good deal of complexity in the game, and I like how the two skills balance each other. It's also more or less how the medical profession was divided during the middle ages. You could always give both jobs to one dwarf.

Tamren, I disagree with the idea of making a doctor noble. I don't see a snooty dwarven noble patching up lowly peasants. Also, in pre-modern times, healing wasn't  a particuarly exalted job. Surgeons were called barbers and did many of the things modern barbers do, in addition to surgury and dentistry, and they held much the same social status then as barbers do now. Physicians had higher status, but no better than, say, a merchant. I'm going by stuff I read a long time ago, so I suppose I could be off base.

If there weren't already too many nobles, a royal physician might make a good addition to the entourage of royal nobles. It could make interesting demands like gathering a particular plant. But a royal physician would only treat royalty.

I don't know why you brought up the plague, but I agree that it doesn't sound like a fun addition to a game. Anyway, if the healer dwarves were as useful as historical doctors, they be of no use at all.

I haven't read your post because I never saw it. I might like to, though, if you linked to it.

[slMagnvox]

Welcome to the forums Dave.

Bloat is the exact descriptor for your suggestion and a medical profession along with improved injury management is a much looked-forward-to suggestion.  I would also like to see it available as a skill or two (the more the better, in my opinion) and have seen Toady mention better wound management a while back ... I think we were talking about Dwarves passing out from pain when missing a limb (or an eye) even after they completed their rest job.  Or in a thread about sparring injuries.  Alot of common ideas are buried in some other topic in some other section of the forum.

Meanwhile, there are some gameplay avenues available to you when a dwarf gets hurt.  Namely, filling the vacated position with the next best dwarf and trying to get back to work.  Yellow wounds will heal.  Can take between 1-2 years.  Internal injuries (a brown spine, or light grey brain) will never heal.  Never.  They will prevent an off duty Soldier from sparring but nothing else.  And they often occur during sparring.  Concussion has sidelined your favorite Macedwarf?  There is an honorable position in the Fort Guard for him.  Or maybe you need another Engraver to smooth your massive hallways.  And of course he will still fight enemies, and gain skill from any encounters, just won't spar.  Lastly, that red-wounded dwarf that hasn't got out of bed in over a year and likely never will?  Yet again, there is an honorary position in the Fort Guard for him also.  You can imagine he dispenses lectures and wisdom from his sickbed.  Or just curses and mutters incomprehensibly, whichever.

[Tamren]

http://www.bay12games.com/cgi-local/ultimatebb.cgi?ubb=get_topic&f=5&t=000997

this is the thread, its rather long and only mentions the doctors at the end.

Anyhow, assuming were not going to copy medieval conventions, being a doctor would require quite a bit of knowledge. Getting this knowledge would be a problem unless we someday have the inclusion of universities or thier equivalents.

For now i guess we could just assume such schools are part of the main dwarven empire.

Reason i thought of making him a noble was that he performs a job that cannot be done by other dwarves. You can learn to treat broken bones and the like without much trouble, but unless you have specific and detailed training about how the body works (ie cutting up stuff to look inside) you will not really be qualified for the more serious injuries.

Perhaps we could have some sort of "healer" or "wise old man" kind of dwarf, you could send dwarves off for training and have them come back as healers.

Not sure what we would call them though, i have read many names for this vocation, maesters, priest, adepts ect.

[Bricktop]

I'd prefer it if it was a normal skill. It's true that you could pick up the broken bones stuff quite easily whereas internal injuries would need more knowledge to deal with... but this could be sorted out with the skill levels.

If you could tell the doctor which dwarves to heal, then you could have in-experienced dwarves taking care of external injuries while a good doctor takes care of internal injuries. And as for the reason that players would have it like this... just make it so that the less experienced a doctor, the more chance of killing/injuring the patient.

This'd make a skilled doctor very valuable, and also add another way for dwarves to die if an experienced doctor isn't around. I mean, life for these dwarves is getting a bit easy... they need a bit more danger added to their lives   :p

[Keilden]

Mad doctors would be sweat. Those kind that love to test new stuff on their patient.

[Tamren]

Well that presents a problem.

Your average task nets you 30xp, making a crossbow, carving  out a table ect.

That means you have to accomplish around 600 tasks to reach legendary status, no easy feat.

So unless we start with a TRAINED doctor, we have a complete noob who needs to treat 600 injuries before he becomes the perfect doctor.

Well.... the problem is that a messup here could well mean a dead dwarf. Those 600 tasks could very well mean 600 mistakes! Not to mention that the dwarf would have no clue how to treat more serious injuries without trial and error.

So that means we need someone previously trained. One thing i mentioned in my noble thread, is that not all nobles are dead weight and have large demands like the king.

A doctor, like the other nobles, would require a bedroom and a tomb for him and his wife if he happened to get married.

Most nobles have no need of an office and will not ask for one, however the doctors office also doubles as the hospital for your entire fortress. Instead of just containing a table and chair like a normal office it would also require a bunch of other furniture including but probably not limited to:
1. Beds, lots of beds. In regular operation a dwarf might get wounded here and there, but if your military has a big scrap you will want a high capacity in order to keep all the wounded in one place.
2. Cabinets and chests, doctors have a lot of tools and presumably many medicines and other items.
3. Pantries or barrels to store food and drink, patients have to eat too!
4. Restraints, for keeping pets near thier owners, pets are good!
5. A well and a couple buckets, there are dangers involved, but that can be solved with traps, water close at hand is a must for recovering patients, those with torso wounds are probably not up to drinking booze.
6. Optional armour and weapon racks, not what you would expect in a hospital but remember that you have no time to take the armour off a wounded dwarf, the point is to get him to someone who knows how to stop the bleeding as soon as possible.

Once the armour comes off and the dwarf is happily resting in bed, the armour has to go somewhere, in order to save time twice, the armour can simply be stored on a stand beside the dwarfs bed. If the armour is particularily high quality it might even make the dwarf happier. Thus stored the armour does not need to be hauled away and will not litter the floor, also should a dwarf recover from a minor injury and be ready for duty immediatly his gear will be close at hand.

Pretty simple.

Now the harder part is determining what effect the doctor has on actual injuries. Light wounds heal pretty fast, moderate wounds might requre a years rest but dwarves can and do recover from them.

Red damage means a mangled limb, ordinarily this would render the dwarf a cripple, i have heard wounds of this severity can still heal over time but i have yet to see it.

Doctors would be able to speed the recovery of light and moderate wounds with clean bandages and a little medecine.

Mangled on the other hand represents harder stuff like broken bones and damaged organs. These would require some serious know-how to deal with.

One thing we havent brought up yet is medics. A medic on the battlefield in DF would not be a full fledged doctor, though perhaps that is where he will recieve his training.

A medic does not only need to save lives, he needs to keep everyone is optimal fighting shape. So he would have the knowledge to deal with sprains, broken and dislocated bones/joints and bleeding.

If an injury is minor enough, the medic can bandage it up and off you go, perhaps with some painkillers (herblore can be fun). If a dwarf is bleeding the medic can stop that too.

If a soldier or other dwarf happens to have critical injuries the medics job is not to treat them UNLESS there is no other dwarf needing his attention. Rather he must stabilize the patient so that they do not simple bleed out on the spot and get them to the doctor as soon as possible.

[Keilden]

Just give doctors increased xp?

[Toady One]

As far as searching the development pages, you can go here, the consolidated dev page and do text searches.  You'll find prosthetics there.  I haven't gotten a chance to read my history of surgery book yet though.

[Captain Mayday]

quote:Originally posted by Tamren:
<STRONG>Well that presents a problem.

Your average task nets you 30xp, making a crossbow, carving  out a table ect.

That means you have to accomplish around 600 tasks to reach legendary status, no easy feat.

So unless we start with a TRAINED doctor, we have a complete noob who needs to treat 600 injuries before he becomes the perfect doctor.

Well.... the problem is that a messup here could well mean a dead dwarf. Those 600 tasks could very well mean 600 mistakes! Not to mention that the dwarf would have no clue how to treat more serious injuries without trial and error.</STRONG>

Ah, but if you count each injured body part of a dwarf as a seperate task, you end up with fewer dwarves dead from malpractice.

[Behrooz Wolf]

I would imagine rebalancing XP is already part of the future dev plans, so that shouldn't be a critical objection to a non-noble doctor.  Plus, if you want to simplify things, bringing food/water to injured dwarves could give health care xp.  Maybe add another global order like "Only Farmers Harvest".

[Abyssal Squid]

quote:Originally posted by Behrooz Wolf:
<STRONG>I would imagine rebalancing XP is already part of the future dev plans, so that shouldn't be a critical objection to a non-noble doctor.  Plus, if you want to simplify things, bringing food/water to injured dwarves could give health care xp.  Maybe add another global order like "Only Farmers Harvest".</STRONG>

Add apprenticeship to that, so ideally you wouldn't have rank novices playing doctor except in the most dire circumstances.  There's the issue of getting your first skilled doctor, but that could be handled with a hybrid metalsmith/noble system, where you get a regular but trained dwarf after hitting some requirement.  Alternately, you could make doctors be nobles that can be trained from nothing, or something like that.

[Tamren]

Good points all. So what if we combined the two?

The original idea was to seperate the "unique jobs" not performed by workers away from the general workforce and give slightly increased status to the person who has to perform it. Stuff like book keeping cant be done by the average dwarf. So a truly qualified doctor would be a noble and afforded higher status.

The first doctor that shows up to your fortress is a noble, but he does work as detailed above, not just sits around and changes the price of boots. Once you have him though, you can start training other doctors. You cant start from scratch with this, you need a body of knowledge in order to undestand what you are doing.

A peasant trained to be a healer can be quite competent, they will learn how to heal cuts and broken bones and to stop bleeding. But really serious injuries such as damaged organs would need the doctors attention.

So how about this:
1. The doctor noble arrives as soon as you have a decent population, maybe 50+? Upon his arrival you set up a hospital, which also functions as his office. He will often demand that you furnish it with enough beds and cabinets so that the size of the hospital matches your fortress.

2. Upon arrival, the doctor will demand an assistant, this dwarf assistant will help the doctor with all his tasks and also learn from him. In time, he would become another doctor, with equal status. They would both share the office.

The new doctor will want an assistant of his own, and the old doctor will take one as well. So for every 40-50 or so dwarves in your fortress you will have 1 fully trained doctor, and his assistant. If your population rises above 80-100, the assistant will be promoted to the rank of doctor and the noble class upon reaching the required skill.

The assistant can handle all minor and somem oderate injuries, the doctor can do everything and at a quicker rate.

But even with 2 healers per 40-50 dwarves, this would not be enough in times of war, you would want to have medics.

3. To train a medic you pick a soldier or peasant and send them to the doctor. Any dwarf will work for this but because your medics will be seeing combat it is better to pick someone with proper training.

A medic in training will tag along with the doctor much like his assistant, once he gains a competent level of skill he earns the title of medic and goes on his way.

What a medic does is a bit different from a doctor. A doctor is a civilian, a medic is a trained soldier.

Unlike civilians medics have no problem with being in or near combat. If your soldiers start taking minor or crippling injuries, the medic will run to them and patch them up, this will not fully heal the injury but it will get the soldier back into the fight.

In the case of severe injury or bleeding them medic will instead drag the wounded soldier away from combat and attempt to stabilize them and stop the bleeding. If he is successful he will head back into combat to support the other soldiers. The wounded dwarf should be far enough away from combat for civilians to come in and take him to the hospital with all speed.

In the case of organ damage or severe bleeding the wounded dwarf will instead be rushed straight to the hospital. The medic can slow the bleeding but if it is too severe then it requires the doctors attention.

4. Stretcher bearers are any dwarf assigned to remove injured dwarves from combat. You need a team of 2 dwarves for this. This is a job you can toggle on and off. If a dwarf is wounded to the point where he needs evacuation the computer picks the nearest stretcher to the fight and the 2 closest stretcher bearers.

They will head for the fight and wait for the medic or another soldier to drag the wounded dwarf into the clear.

Once the medic has done all he can for a dwarf the stretcher team will load up and rush the wounded dwarf to the hospital. Dwarves in the corridors will attempt to get out of the way of the stretcher and may suspend tasks momentarily to accomplish this.

Once they have completed delivery they will head back to combat and remain on standby. Because quick response is essential you would have to put stretcher racks around your fortress just in case.

That handles regular healers, but what about other specialists? Too many would overcomplicate the situation. In fact we probably only need a physiotherapist to help the maimed and cripple dwarves using therapy and the aformentioned prostheses.