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D&D 5e's Skills (Part 1): What's the DC for Open Heart Surgery?

Hello, Helpful NPC Thom here, and I'm going to talk about how to make 5e's skill system work for you, but first let's talk about the DC for open heart surgery. Honestly, there isn't one. But if there were, it would be DC 15, and I'll explain why.

The Criticism

5e is designed around bounded accuracy ("flat math"), and this translates to level 1 characters who are fairly competent with their skills. They remain fairly competent and don't improve all that much as they level. A starting character in D&D 5e who is "reasonably good" at a skill will have a +4 or +5 bonus in his skill. Without magical enhancement, he'll have a +11 or thereabouts at level 20. Some parts of the game bend this, like the rogue's expertise, but for the most part, characters won't improve that much as they level. (By that same token, a character who's not very good at a particular skill at low levels will stay not very good at high levels, and if he decides to "git gud," he'll end with a reasonable bonus.)

This angers some people because they believe that there's not enough room for a character to advance, and that high-level characters, fighting dragons, demons, and deities, ought to be significantly better than their lower-level counterparts. Then again, it seems unjust that the character who spends his resources becoming especially skilled in one regard still might be bested by his lesser.

In this case, let's talk open heart surgery. What's the DC? Is it DC 20? That's surely too low! An untrained, unskilled, average intelligent individual has a 1-in-20 chance of performing open heart surgery successfully. What about DC 30? Wait, that's too high! If it's DC 30, then only a high-level character can perform open heart surgery, and I don't know about you, but a 10 HD surgeon seems a bit wonky to me.

Some might puzzle this out, justifying that a surgeon would have a high Intelligence, skill training, skill expertise, a surgical team offering him the Help action, so that DC 25 or 30 open heart surgery was possible even for a surgeon who wasn't a level 20 rogue.

These logical contortions are unnecessary.

John Q. Adventurer's Skill List and the Game's Scope

Look at the skill list in D&D 5e. Athletics. Arcana. Perception. Insight. Persuasion. Survival. These are all things that anyone can do. I, a lowly human nerd, climb a tree (Athletics), cast a line with a worm on it (Survival), and recall that Dracula doesn't like crucifixes and garlic (Religion). In a world of magic and adventure, all of the 5e skills are things that can be done by the everyman.

John Q. Adventurer can use Medicine to know that bleeding gums are a symptom of scurvy and that an orange will set him right. John Q. Adventurer can't perform open heart surgery. Ever. Even though open heart surgery is a DC 15 Medicine check.

Why? Open heart surgery is not part of the standard Medicine skill. D&D is not designed to handle a character performing open heart surgery, so trying to utilize the skill system in this regard is a fool's errand.

The full scope of D&D 5e is a monster fighting game that includes light mechanics that facilitate "adventuring"--the other parts of the game that don't involve defined combat mechanics. It's a broad system that exists to provide a framework for GMs to adjudicate actions outside of attack rolls, saving throws, hit points, and spell effects.

Open heart surgery is so far out of scope that it's preposterous to suggest that it could be part of the game, yet I maintain that if it were part of the game, it would be a DC 15 Medicine check.

Numbers So Small

A meager DC 15 Medicine check to perform open heart surgery? Yes. Because if you're in the position where you can perform open heart surgery, you have years of training that has gone into it. Alongside vast knowledge of the human circulatory system, you have observed open heart surgery. You have studied it in-depth. You are a specialist working with a team of specialists. For you, open heart surgery is routine. It's complicated, it's difficult, it's stressful, and it's something you're prepared for. It's DC 15. The level 17 cleric rocking 22 Wisdom and skill expertise in Medicine can't perform open heart surgery, but the CR 1/2 cardiologist can.

How does that work? Tune into this series of blog posts where I Thomsplain 5e's skill system.


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