this is followoing on from the Laser Shark thread...

also references This RPG.net thread, which references a discussion on the Herow Wars mailing list, and a huge amount of fantastic stuff by Roderick Robertson, Bruce Ferrie and TIm Ellis, amongst others.

Okay, checked out the old thread on mundane gaming, and just trying to deal with the main issues raised there...

The games I'm thinking about would simulate the reality of a medical or legal or cop show as well as D&D simulates combat oriented fantasy.

Everyone who's played in a game with a martial artist or weapons expert will know that they either nitpick the combat system, pile on the house rules, bite their tongues for the enjoyment of the group, or otherwise turn off their expertise for the duration of the game.

The game I'm thinking of would do the same for the medical, legal or procedural process. Accurate modelling of correct procedure isn't necessary, but verisimilitude is, to enhance the drama of the situation.

For example, I have some medical training (2 years radiography). My partner is a trained nurse with five years experience. we both watch British and American Medical dramas (though please god, not any heartwarming ones set in the dales, the sixties, or the dales in the sixties). Both of us have an unwritten rule that we kibbitz on medical matters only in bad episodes.

(We also play the "guess the victim and tragedy" game beloved of all regular Casualty viewers, but I digress)

That's the kind of attitude I want to see supported in the game: when watching ER, most viewers know enough that a sucking chest wound is bad news. They don't know why or how, but it sounds bad, and everyone's panicking. That's the level of information you need... if a player has more expertise, that's great, but in an emeregncy room you only need to have a couple of bits of information about a condition, and you can pretty much wing it.

And those couple of bits of information are, essentially, contained in the monster manual for the game, each "monster" being a medical condition, with presenting symptoms, likely treatments with their chances of succes, probable complications, etc.

Plus additional complications familiar to any viewer of medical drama "You used to be the best damn neurosurgeon in Topeka!" "Till you served your decree nisi, Margaret, I was! Now lok at me!"

We still have a conflict, not procedural, system, but the conflict is between the PC and the condition.

The important thing isn't getting the medical knowledge right, but drama, verisimilitude and conviction.

If the players get too worried about doing it right... well, they don't tend to worry about doing combat "right", just right enough. Most times, cool is better than right in dramtic combat games. Why not in dramatic medical games?

pete_darby wrote: The important thing isn't getting the medical knowledge right, but drama, verisimilitude and conviction.

Agreed!

In law, cop, and medical shows, it's not really the actual skills that are being showcased, so much as various characters' personal qualities, while exercising those skills. Integrity, courage, pettiness, cunning, whatever ... all the technical expertise is Color.

And then of course, you have all the secondary distractions like romance, family hassles, or what-have-you, for which the question is, "Will this help or hinder the real tasks at hand?" So you have one relationship which provides strength and grounding for protagonist A to deal bravely with a difficult operation, whereas there's this other relationship which makes the protagonist nervous and jumpy, so he over-estimates his ability to handle a professional crisis ... and so on.

Best,
Ron

pete_darby wrote: That's the kind of attitude I want to see supported in the game: when watching ER, most viewers know enough that a sucking chest wound is bad news. They don't know why or how, but it sounds bad, and everyone's panicking. That's the level of information you need... if a player has more expertise, that's great, but in an emeregncy room you only need to have a couple of bits of information about a condition, and you can pretty much wing it.

And those couple of bits of information are, essentially, contained in the monster manual for the game, each "monster" being a medical condition, with presenting symptoms, likely treatments with their chances of succes, probable complications, etc.

This is a very intiguing premise. I'd be intrigued with the peripheral concerns of the Dramatic Doctor besides the actual medical task at hand. Frequently the drama on ER (last time I watched) were unusual non-medical circumstances with which the Staff (PC group?) had to deal.

- Irrational family members barging in the emergency room
- Malpractice lawsuits
- Breaking the news of a failed medical task to loved ones
- Losing or trying to gain residency at a hospital
- Having to be the one that demotes or promotes other staff members
- Stress-related psychological problems
- And always, always frenetic flashing of lights and beeping of medical equipment.

A friend of mine just suggested irregularly scheduled players be re-occuring patients at the hospital who come in for the same problems over and over but who are tolerated because of their entertainment value... and that Hippocratic thingy.

I think...that an interesting way to do that would be to build off of this idea:

Suppose the GM of a detail-heavy martial arts game told the players up front: "I have 4 carefully mapped out locations for fights: an abandoned mine shaft, a foundry full of molten metal, a gangster's mansion, and the wing of a biplane used by a stunt pilot. Also, someone will have to seduce a femme fatale. I'm gonna start you at the Dragon Boat races in Hong Kong harbour, where you are trying to prevent the assasination of a politician friend of yours. The challenge is this: I want you guys to incorporate all of these locales, and the seduction scene, into a convincing sequence. If you stick to your characters, and you maintian at least a John Woo level of plausibility, I will give you 1 [insert combat-assisting token] for every scene you incorporate.

Irrational family members barging in the emergency room
- Malpractice lawsuits
- Breaking the news of a failed medical task to loved ones
- Losing or trying to gain residency at a hospital
- Having to be the one that demotes or promotes other staff members
- Stress-related psychological problems

My computer just froze, so I lost an almost complete post.

I like John's ideas for the drama. I'll add triage to the list: does this patient need to be seen now, or can he wait while we deal with that patient? If you fail in triage, patients in your waiting room are getting worse.

Recurring patients for sporadic players is a good idea. They call these frequent flyers in most hospitals I've seen. There are a lot of good reasons they're there, and a few bad ones. Nursing home residents and severely ill people on home care often are brought in when they have severe problems and returned when they are stabilized. Indigent people sometimes lack the ability to provide adequate medical care for themselves and so are brought in when they are serious. People in hazardous occupations (that includes, for example, professional athletes) come in for job-related injuries. There are, of course, those who use the ER as a clinic, coming in for ordinary medical care in the off hours.

There are a lot of other ways to handle such players, though. Specialists are called in when needed. I know the best osteopath in the county is in the operating room doing open reductions six to ten hours a day two or three days a week, and still goes in for emergencies at other times. Cardiologists and surgeons are also frequently consulted from the ER.

It also occurs to me that my hospital ER is staffed around the clock all week, and I probably have met most of the doctors and nurses who work there at one time or another, but they aren't all there at once. There's no reason why in this kind of game player characters whose players are at the table can't be the ones on duty, and other player characters can't be off today, or on vacation this week. Even, if it's a very rural area, it might be that the doctors are not emergency medicine specialists but doctors pulling time in the ER for extra money. A lot of young doctors used to do that in the county only a couple decades ago, before they brought in an emergency practice to take it over. Thus you could have family physicians and osteopaths and radiologists who also work in the ER. Their absence on any particular day or stretch is because they're pursuing their regular practice at that time. That's less common now, but I'd bet it's still found in rural locations.

Also, generally interns and residents are only found in teaching hospitals; that means they're students, and have school requirements in addition to hospital shifts. They have grueling schedules, and a lot of them burn out.

--M. J. Young

M. J. Young wrote: They have grueling schedules, and a lot of them burn out.

gobi wrote:

M. J. Young wrote: They have grueling schedules, and a lot of them burn out.

Perhaps I'm thinking too mechanically, but it'd be interesting if these little incidents would have stress ratings similar to the hazard ratings in octaNe. More people assisting in an incident could reduce the stress on an individual participant. Frequent and prolonged exposure to stress would have cumulative effects like irritability and whatnot. Could be fun to role-play.

M.J. wrote

There's no reason why in this kind of game player characters whose players are at the table can't be the ones on duty, and other player characters can't be off today, or on vacation this week.

contracycle wrote: Things like career progression and actual expertise might also work on that long a time frame, developed over sessions and affected by action.

Stress and burnout ratings are a very good idea indeed. Ideally, "doing your job well" should increase the burnout rating, putting in an incentive for PC staff to be slack. However, the idealistic rookie who works like mad will eventually wind up taking those burnout penalties to his skills, which means one day he'll walk out of the ER and someone'll say "where's the scalpel?" and he'll say "shit! still in the patient!" and be disgraced. Meanwhile, old Doctor Bumfuzzle who takes it easy is just plugging along, loathed by the rookie who just doesn't understand him.

I really like the "shift" idea, too. It makes a lot of sense.

You could get away with a fairly low level of medical knowledge as long as you were willing to sound like you knew what you were talking about. What's the cliche? "I need 20 ccs of medicine, STAT!"

James Holloway wrote: You could get away with a fairly low level of medical knowledge as long as you were willing to sound like you knew what you were talking about. What's the cliche? "I need 20 ccs of medicine, STAT!"

gobi wrote:

contracycle wrote: Things like career progression and actual expertise might also work on that long a time frame, developed over sessions and affected by action.

I'm imagining something like Madness Meters in Unknown Armies. Stress checks of lower rank than traits like Career Progression or Expertise will incur no penalties to maintaining composure during the procedure. Taking relaxants or other types of drugs can give temporary resilience to the stresses that you'd normally be unable to handle calmly on your own.

Somne thoughts on the shift structure. This could be used as very overt staging and scene framing. Now its a long time since I watched ER or any opf the procedurals, but we could set up a "locker room" scene at the bginning, cut to the on-shift action onece that scene is done, do Lunch as a scene if available, a second on shift, then packing up and getting out.

The point is that this frames some of the action such that the characters go back to their private lives and interact personally, rather than in a goal-oriented manner during the on shift stretches. Secondly, the start phase would hopefully serve as a "getting into the groove" moment and the packing up as a "debriefing" stage, sort of, or a "winding down" opportunity.

There should be mechanical actions specific to each phase. So maybe, at lunch, you can do a save vs. stress or something similar to shrug off the mornings nastiness - IF you get lunch. Maybe theres a similar save during packing up, and they accumulate if you didn't or couldn't save at lunch break. This could be used to provoke directly inter-active behaviour amongst characters - Sharing A Joke at lunch gives bonuses to a stress save, having a squash partner with whom you depart at Packing Up gives bonuses there.

An office romance gives both bonuses and penalties, I reckon. Maybe external romances and family relationships can be used as devices manipulating stress levels, allowing possibly individual "outside cameos", sorta thing.

It's interesting to wonder whether or not this all drives directly at both the party approach and overt cooperation. Sure, they're all working toward the same goal but they, the characters, need not necessarily be cooperative all the time. Maybe stabbing a fellow player in the back gives you better opportunities for a promotion (which I would think at least temporarily off-sets stress) but gives the character you stabbed stress. Maybe sharing a whinge about a colleague offloads stress, as does dumping your work on others.

Alternatively, there might be room for a sort of gambling system, in which the players select which topics or problems in which to commit their characters sense of satisfaction and wellbeing. If there is a good (mostly medical) outcome, you get paid bennies, but if it all goes horribly wrong the character is devestated and acquires further problems/guilt/stress.

contracycle wrote: Maybe stabbing a fellow player in the back gives you better opportunities for a promotion (which I would think at least temporarily off-sets stress) but gives the character you stabbed stress. Maybe sharing a whinge about a colleague offloads stress, as does dumping your work on others.

contracycle wrote: Somne thoughts on the shift structure. This could be used as very overt staging and scene framing. Now its a long time since I watched ER or any opf the procedurals, but we could set up a "locker room" scene at the bginning, cut to the on-shift action onece that scene is done, do Lunch as a scene if available, a second on shift, then packing up and getting out.

gobi wrote:
A chapter devoted to a rundown of "Dramatic Medical Lingo" would be cool. I think the Buffy RPG did a similar treatment with Buffyspeak.

gobi wrote:
Part of the fun of the game would be doing a "character creation" for the hospital itself. What kind of funding does it get? Average staff burnout rate? Most common medical cases? Is the hospital respected? If so, among whom? Is there rivalry between departments?

gobi wrote:

EDIT:

I just thought of a name for this game, slap me if it's too cheesy:

STAT!
The Game of Medical Drama

gobi wrote:
EDIT2:

And a name for its sister rpg:

Objection!
The Game of Legal Drama

The focus on one shift tends only to happen in ER (for example) when they're doing the shift from hell episode. Usually, the action covers a couple of shifts, allowing them to do more out of work development.

One problem with using "reduce stress" as a main mechanic is that it eliminates the stock character "the machine" who thrives on stress.

Unless.... every character gets to define "stressors" and "relievers."

In fact, this is getting better than my idea for "ambition" as a motivator, so my horrible name for these games can be consigned to the dustbin of design.

Report (or Handover, as it's called over here) can be played out or abstracted in mechanics so that, whenever knowledge from Report is needed, the GM can supply it (or not, if the character fails his recall rolls).

I can't remember ever seeing report "on screen," if only because a realistic portrayal of handover would cause outrage and questions in parliament ("old girl in bed 2, PFO, wait for her to sober up and send her on her way.")

PFO is a phrase you'll never see on TV... "Pissed, fell over." It won't be in the lexicon.

I'm getting a terrible feeling of Deja Vu....

That just says there's gold in them hills.

Points noted but this is Stat!, not Sim-ER. So I'm thinking we should exploit those devices rather than reproduce them faithfully.

I watched ER last night, I note tight timing of action. Both the crises occurred simultaneously to the point of cutting between surgery scenes. Also there was the cliff-hanger linking the next episode. I like the latter but am not so sure about the former, seems to me players would conspire to avoid that like the plague.

The report stuff I think would work best as a discrete phase, because it permits explicit communication. The methodological distinction between nurses, doctors and others should be played out, I think. Perhaps the Hill Street Blues briefing section is a better example of the kind of device I'm thinking of, a ritual that starts play built into the mechanics (this idea was tentaivley broached a while back but I forget by whom).

Also, end of shift Report/Handover could be used to bring explicit closure to play, and you do it in character so you can go Bang! with the Cliff-hanger afterwards or during. This also allows characters from other shifts to make cameos appearances as NPC's, and possibly as replacement characters should the change be needed. These sorts of dramas include a sort of rolling cast, and so this could do with a stock of NPC's hanging about and in contact with the action as per the stable discussed in the T&T game threads. I reckon an audience of players familiar with the TV conventions might welcome that sort of thing being in place.

I watched ER last night, I note tight timing of action. Both the crises occurred simultaneously to the point of cutting between surgery scenes. Also there was the cliff-hanger linking the next episode. I like the latter but am not so sure about the former, seems to me players would conspire to avoid that like the plague.

pete_darby wrote: Unless.... every character gets to define "stressors" and "relievers."