Risks of medicine!

[Puciek]

Right now the problem is that almost anyone can be a physician. And while such knowledge out of physicians may be frowned upon, there is pretty little that can be done to enforce it short of some lengthy and pretty risky and with small chances of success lines of RP to try to find the back-alley rings. Why people do, it is not a discussion I won't be getting in to.

And the problem with that is that it takes away RP from the physicians, and provides, in reality, a very little risk of carrying on, especially when used inside a very close ring of people. So I would suggest as follows:

1. Any treat used outside of the Madison rooms does have a risk for infection, from just mild ones to deadly ones; depending on how good the medics skills level, severity of the wound and type of room. Ie suturing an 80% wound in swamps would almost guarantee one for even most well-trained physicians, tending a bruised knee in a clean part of the streets would be virtually without risk for an even pretty new physician.
2. Those deadly infections have 100% chance of curing when treated and tended to in the Madison. make your choice, trust the back alley doctors to keep trying to keep you alive, or risk being exposed but alive. Or maybe seek mages to help, as sometimes neither of the above is a good option (they should get some spells around that if they don't have already).
3. Alert the Reeves/doctors when treat is used in Madison by a non-physician.
4. Ability to obtain IC rooms that are medical rooms, with varying quality, that adds a factor to a lower chance of infection. Creating those rooms should be done via plots, be paid for with high to exuberant amount of silver and leave traces of such room is organised. How many traces, what type, that would depend on rolls inside of the plot. Those places also require resupplying every X time, also done via a plot that has a chance to leave trails.

This would require careful balancing of course, but this should balance out the need for back alley physicians (starting from the high-risk cheap doctors, ending up with possibly Brotherhood ran hospital) with the need that normal players should only go and see an actual doctor when hurt. If they got something to hide, they could go back alley, but there is always a chance of contracting a potentially deadly infection.

Maybe even untended wounds, that do require tending, could have a chance of infecting too? Something for the pain-immune types .

[Voxumo]

This seems like a great suggestion, and would certainly be in support of it. Can't really say more on it than what you've already said.

[Famine]

Just some perspective from a non-physician.

I look at things like this like eating food. We all have to eat. We also may all have to cook and prep what we eat. Does that make us a chef? Just because we eat food every day, does that make you a chef right?

The issue is that, what's to stop your mother, who has cooked for years for you and your family, from becoming a chef? Not much really, except maybe formal training or in the case of medical in our real world, certification. Thus, would it make sense to limit her simply because she does not become or claim herself as a professional chef? She may still cook better than 80% of the so-called professional chefs simply for the fact she has been cooking for her family longer.

That being said, the tools used by professionals and the methodologies they practice may be different -- good or bad. I would imagine a facility that is built specifically for treating and healing would have a higher chance of preventing infections than say, your mothers living room. That does make sense. But, I wouldn't say we walk the line trying to make those who do home treatments or whatever simply because you feel less valued. That's like trying to limit people from using Uber because the Taxi cab drivers are upset they are losing business as opposed to adapting.

[Voxumo]

It's more than certification that makes a doctor a doctor or a chef a chef. These people typically go through specialized training beyond what the common bloke would. Just because you've been doing some for years on a low-level doesn't make you a specialist on it.

Would you want someone whose only ever done basic stitching and cpr to do your open heart surgery?

[Puciek]

Am, I don't think I see what point you are trying to make. Especially as the only difference in what I proposed between guided and unguided physicians is that the ones outside of the guild will be reported by orderlies when treating people at Madison. Because medicine is not something, random people in lithmore will/should know, and be able to perform. Anyone doing so is automatically suspicious, because where did they learn it? This isn't like cooking where you can get by on just trial and error, as learning of the humours requires proper training from some source.

[Starstarfish]

Anyone doing so is automatically suspicious

It's been stated before that "anyone doing X is automatically suspicious" in a lot of cases is sort of meta and frowned on as a RP thread.

[Puciek]

Anyone doing so is automatically suspicious

It's been stated before that "anyone doing X is automatically suspicious" in a lot of cases is sort of meta and frowned on as a RP thread.

Pretty sure the auto-reporting tools we have contraindicated with that. Someone attacking someone is suspicious of crime - hence Reeves get a message of it (when done in rooms that report), same when people cast spells on reporting roads, those also get reported to order by code. What players will do with such reports is up to them. Similarily a random person coming to Madison and suddenly treating people is suspicious to the orderlies that wander there.

[Famine]

Am, I don't think I see what point you are trying to make. Especially as the only difference in what I proposed between guided and unguided physicians is that the ones outside of the guild will be reported by orderlies when treating people at Madison. Because medicine is not something, random people in lithmore will/should know, and be able to perform. Anyone doing so is automatically suspicious, because where did they learn it? This isn't like cooking where you can get by on just trial and error, as learning of the humours requires proper training from some source.

I think I'm trying to say that in this time period, sickness and getting hurt is extremely common. So common, people likely know how to treat it using home remedies and methodologies than say, professional training. I mean, you have to realize that something like bounding a wound, cleaning it with water and even stitching it is likely not something only professional doctors would know. At least not in my opinion. The real skill comes in diagnosis and being able to perform surgery where it minimizes risk and so forth. You know, the difference between a crooked stitch and a straight stitch, but they both still stitch. Or the difference to understanding a set of symptoms versus just someone saying you ate something bad.

I would imagine things like binding a wound to how to treat headaches would be common knowledge and likely have home remedies that are pretty affective. The reasons they happen, not so much. The same goes for major surgery. Likely not something anyone can perform outside of a trained professional who has cut off limbs, opened up a chest, etc.

[Puciek]

@Famine: helpfiles come handy:

Helpfile for Medicine

Urth does not have knowledge of modern medicine. The typical man or
woman in the street would have no idea of anatomy or treatment, and many
things we take for granted today, such as germ theory, are simply unheard
of.

The three primary methods to deal with a medical complaint are the
following:

A) Visit a physician to balance the ill humours.
B) Visit a priest to expel the evil spirits.
C) Simple herbal remedies from an apothecary or herbalist.

The physician's treatment would be based on the theory that the body
consists of four humours which must be kept in balance to ensure good
health. These four humours are blood, phlegm, black bile and yellow bile,
balanced by a combination of bloodletting, diet, emetics, purgatives and
surgery. While perhaps horrifying today, these would be considered
commonplace on Urth to the extent that the rich and/or noble might insist on
regular bleeding from a personal physician as a matter of course, and one of
the privileges of money.

OOCly, while being treated by a doctor, their treatment can only be carried
out with sufficient RP on both sides. Please do not go AFK and expect to be
healed by the time you get back. Not only will the code prevent it, this is
some of the only RP that a doctor might get. Please have the courtesy to
reciprocate.

In addition, pain is also a very real part of treatment, especially in this
time period. While we all want to play the hero who can withstand great
suffering, please allow for a modicum of realism. Superhuman feats of pain
resistance are just that: superhuman. Don't be surprised if your unnaturally
stoic character is suspected of witchcraft.

If this helpfile has been assisted to you, please consider the
degree to which you are treating your character's injuries in a
realistic manner. You are free to RP how you wish, but be especially
aware of possible repercussions mentioned in the previous paragraph.

For the minor binding etc. there is a separate command, not even a skill, explained under help bind (or used to be, didn't use that in ages). That is what everyone knows, and all it does it block bleeding. Actual treat requires understanding how the humours work, how to balance them, and is a very much expert knowledge that you won't figure from getting bruised. Similarly, herbalism is now aside from medicine, so option 3 is well open for everyone to RP, previous that avenue was very limited. That is if you want to rely on concoctions alone.

[Rabek]

Lithmore is a city with near 100% literacy rate, and there is a library full of manuals on healing and herbs. It makes no sense to restrict the knowledge on a code-based level.

Guilds should reinforce their role through IC methods, whether or not you assume those methods are "unlikely to work."

As the help file says, germ theory is not part of Urth's knowledge base. A hospital isn't going to be all that much better for healing than staying at home (and indeed, house calls weren't exactly an uncommon thing throughout history). Sometimes they're worse, due to bad sanitary practice. Giving weird coded benefits to guilds is not the direction I think TI should continue to go (they already have some, of course). That's how those weak "RP-encouraged" games run things, with classes disguised as "guilds" as if that makes it more IC.

Reporting non-physicians using the Madison would make perfect sense, though. That's a reasonable protection they would use to defend what is actually theirs.