# Medical Design [Rane, Approved]

## Introduction

### Medical status quo in multiplayer role-playing sim games

SS13, modded ARMA, Barotrauma, and others have a shared set of considerations that lead to pretty similar designs in how medicine works.

1. The game is some level of a simulation. Simply using a magic heal beam or shoving a medical tool in the face is considered too video gamey.
2. The game also has to function as a real-time multiplayer game with other things going on. It's one part of a larger whole, so things need to get expedited quite a lot compared to a true sim.
3. The game needs to give people a lot of ways to distinguish their skills through knowledge, without requiring them to literally be a doctor in real life.
4. There still needs to be a decent bit of abstraction. The games usually choose a simplified model and stick to it, leaving out nuances that might exist in real life. This is both easier to create and maintain, and it makes the experience less frustrating.
5. These are social games. You're healing another person, often talking with them at the same time.

Taking these into consideration, most of these have arrived at something quite alright. Most of the implementations address most of these concerns well, failing one or two. We want to try and nail all five.

### Common considerations
There are 3 common gameplay considerations we need to balance between.
1. Resource Management. Do I have enough medicine, enough space, enough of everything I need that is somehow limited? Is there any adjacent labor I need to do like replacing bandages or moving bodies?
2. Diagnosis. What's wrong with this guy? What do I need to do to fix whatever issues he has?
3. Treatment. What specifically do I need to do to treat him?

All of these will exist to some degree, even in a simple implementation. The question is, how much focus do we place on each of these 3. Should they be equal? Should one be way more important than the others?

To solve that, let's ask what the strength of a multiplayer role-playing sim game (MRPSG) is.

Multiplayer means that we are playing with other people. That has little consequences on the weighting, although treatment should probably respect people's time comparible to a similar degree other game mechanics do.

Role-playing means this is a social game. We, and the other players, have social interactions in-character. We assume roles. In this context, one of us is the doctor, one of these is the patient. We should both play out those roles, and "bedside manner" can be as important to the game as pressing the right buttons.

Sim here does not necessarily mean this approximates every aspect of real life, but that it is aiming for an internally consistent milleu. Players should be able to latch onto the logic being used very fast, and use their real life layman knowledge to predict what will happen. 99.9% of players are not doctors, but most will have been through a few biology or health classes in their time. We can expect them to understand things like overdoses, tourniquettes and vaccines.

So, we want something that involves socializing with other people, and involves internally consistent logical deduction.

## Failures
### SS13 Med
SS13 med is way too focused on wordless interactions. Health analyzers are the main cause of this. They discentivize roleplay because you can just instantly see what's wrong with someone. People act annoyed if you have the gall to ask how they are feeling instead of just wordlessly scanning and shoving a pill in their mouth.

Chem is literally just pressing buttons in the right order alone in a room. I think we all know it sucks.

Overall, massive failure of the social aspects.

### Milsims
I don't want to spend 2 hours unconscious and wake up just in time for the game to end. Don't force people into this state, just kill them.

Fidelity in outcome with simpler mechanics is always perferable to more intensive simulations that achieve exactly the same result. There's basically no reason to distinguish states that have the same actual impact on the player.

## Solutions
Going back to how we should weight resource management, diagnosis, and treatment, I would propose this:
60% diagnosis
20% resource management
20% treatment

Diagnosis is the only thing that works well with all of our considerations. It forces us to talk to people, it forces us to make logical deductions, it forces us to immerse ourselves in what's going on and try to use our actual brains rather than mindlessly clicking muscle memory buttons. SS13 has the benefit of a wide, unpredictable variety of injures besides gunshot wounds, and each of these can be a unique, emergent puzzle.

Tools should be able to give us a piece of the puzzle, rather than instantly solving it for us. Visual examination, stethoscopes, blood samples, etc are all very good. Skillful patients can bypass these by accurately describing what happened to them, and skillful doctors can connect the dots much quicker than worse ones.

Resource management and treatment add a lot of tension and things to go wrong. Their mechanics can remain simple while contributing a lot to the actual situation. Simply choosing who gets to use a stasis bed can be an extremely difficult decision sometimes. Treatments with different balances of time, chance to work, side effects, and rarity introduce more decisions to make for what's ultimately the same result.

The Doctor Gameplay Loop:TM: then is this, and it's pretty similar to what you'd expect from a hospital milleu:
1. A patient shows up.
2. Are they obviously dying right now or can I afford to make them wait a bit to attend to worse cases?
3. If they are dying, take non-specific, obvious measures to try to stabilize them. Gauze, stasis bed, emergency medipens, etc.
4. If they are stable and able to talk, try to get information out of them. What happened? Did they eat anything? Were they in a fight with someone?
5. Use information gained in 4 (if any) to decide where to look for problems. Take any relevant low-risk precautionary measures (ipecac / activated charcoal if they did ingest something, etc.) Choose the diagnostic tools based on the most likely thing wrong with them.
6. After identifying the problem, use the treatment most appropriate for the situation. Weigh the current time pressure, the severity of the patient's condition, the current stocks of medicine or free machinery. Observe the effects on the patient.
7. Decide when to discharge the patient, or return to step 4.
8. Clean up. Put tools back in their place, sterilize everything, return bodies to the morgue, etc.

Treatments should go from low risk, low efficacy, broad medications to highly specialized ones. This is roughly how real drugs work when trying to treat someone with an unknown condition, and it's a simple concept to wrap your head around.