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Spiritual Guidance: Triage

Dawn Moore

Every Sunday, Spiritual Guidance shares all the insight on wielding the light as a discipline or holy priest. Priestess Dawn Moore does her best to guide innocent priests away from the shadowy influences of Fox Van Allen, propagator of gateway specs. She stands vigilantly, fighting to ensure that priests do not get lost in the dark world of demon pacts and mage hate. Remember: mages are our friends.

Last week, I began my weekly column by annoying you all with information about my GearScore. This week I will be repeating this needlessly pretentious practice by telling you my other GearScore. My other GearScore, you ask? Why yes, dear readers, surely you know that elite players such as myself have multiple gear sets for all of our PvE whims. So without further ado:

I have a 3390 GearScore.


Dawn is seen pecking away a laptop keyboard. An over-the-shoulder shot shows her computer screen just as she finishes highlighting the text "My other GearScore ..." We then see the cursor mouse over to a font styles menu where the following options are listed: Bold, Italic and Sarcasm. Dawn selects the last option.

Film school flashbacks aside, this week we are going to talk about triage. If you didn't already know, triage is the act of making a priority list for who to help first in a situation where several individuals require medical attention. Triage was referenced earlier this month in a forum post where Ghostcrawler answered some scrutiny to Blizzard's suggested healing philosophy for Cataclysm. Let's look at that post and talk about what it will mean for priests. I will also explain where I was going in my GearScore sequel from above.

The original poster in said forum thread suggests that the current model of damage and healing (where healers have infinite mana and players who fail to perform a key action in a fight will die faster than healers can respond) is superior to the model he observed in Burning Crusade, where good healers and tanks could carry other players through content simply by healing and tanking through it. The poster seems to imply that by making mana a commodity there is a risk that healers will be punished (by going OOM) instead of proper punishment being directed to irresponsible members in the raid who carelessly take damage. Ghostcrawler responded with:

I have found this philosophy to be a tough one to communicate. Painted broadly, we have some players who chose healing because they like to be challenged and we have some players who chose healing because they like to be the hero. In LK, raid healing can definitely be stressful at times, but we're not actually convinced the challenge is there. After a tough fight, whether it was succesful or not, ask yourself what you should have done differently. Did you use the wrong heal in the wrong situation? I'd suspect not since most healers have pretty stringent rotations these days where you use your strongest heals on cooldown and fill in the time left with your next strongest heals and so on. Did you heal the wrong person at the wrong time? Probably not because anyone you failed to heal was probably about to die. You probably overhealed a lot because there is little consequence for overhealing.

Go back and look at a few videos of BC raid encounters. A couple of points may be strking. One, several characters may be at various stages of injury -- the healers could not keep them all topped off. Second, the healers may be at various stages of mana -- in other words, it's not just a matter of having more GCDs before everyone is fine again. It's a matter of triage.

Triage is one of the things missing from today's healing game (even though you likely learned First Aid through a triage quest). Loosely defined, triage is deciding who needs immediate attention (vs. who is stable vs. who is a lost cause). We want healers to be able to make decisions like "The tank is wounded, but she is unlikely to die in the next few hits, and hots are ticking on her, so she's probably okay for a moment and I can heal this Ret paladin over here," vs. "The rogue is wounded, but my big heal would overheal for a ton and I need the mana, so I can use a small heal." We want the dps to likewise be thinking about ways to minimize damage on themselves, not because they'll die in a global (i.e. before they could respond anyway) but because the healers are going to risk running out of mana.

Today, in LK, healing risks feeling even more like whack-a-mole. Injury? Heal. Injury? Heal. You're testing your reflexes more than your decision-making ability. Whack-a-mole can be challenging, but it doesn't have much depth. It's easy to add depth though. Let's start with the notion that there are two hammers. The little hammer can dispatch most of those moles, but sometimes you can use your big hammer too. The big hammer has limited charges or whatever. Now let's have some of the moles pop out a little slower so that you have time to consider which hammer to use. See where I'm going with this?

Running out of mana doesn't have to be, and won't be, the only reason you fail an encounter. But it is a point of failure that we don't have today. Adding it back in will make the encounters feel more distinct from each other and will actually, we believe, make healing more interesting and ultimately more fun. I agree it's going to be a tough sell though. In one of our playtests recently, the healer came back frazzled. "I couldn't keep everyone topped off," she said. "It took me half the dungeon to realize that I didn't have to." Once that clicked, she said she started having fun. Hopefully it will click with other players quickly too.

Ghostcrawler later followed up in the thread with the following:


Punishment should be doled out primarily because I didn't diagnose or treat the patient properly, not because I ran out of bandages.

I see what you're saying, but that's part of triage too. You can't order surgery for every patient, which is kind of the equivalent of using your largest or fastest heal for every patient, regardless of injury.

The other part of that is if you use your efficient Heal for every single problem, then you'll have tons of mana, but you'll lose people. (In other words, sometimes expensive surgery is exactly the right thing to do.) Mana isn't the entire healing game. It's just one consideration.

As a healer who has played since vanilla, I have to say this whole thread got me quite excited. I remember I once tried to explain to an arena partner how it was that I healed in PvP, and referred to something I called a "mental queue." I said that one thing I do when I enter the arena against a team comp I've never faced before (or alternatively, a new raid I've never played before) is observe the way incoming damage is displayed on a healing bar, and compare it to what is happening in the game world itself. The longer I observe this, the more versed I become in understanding what the upward and downward movement on a player health bar means in a given fight. After a while, I start to know exactly what kind of damage needs to be healed as soon as possible and what can be put off for a second more. My "mental queue" is then derived from that: who needs my attention first, and what kind of attention do they need? This conversation was all an elaborate way of saying "stop calling out for heals" because it risked disrupting my queue by trying to "butt in line." Such an interjection would often undermine everything my experience and intuition was telling me to do, which would lead to confusion and deaths. What I described to my partner then was basically the triage that Ghostcrawler described in this forum thread.

Now obviously, arena is a very stressful environment where one poor choice (like trying to use a Flash Heal for a Penance) can cost an entire game. The majority of raid content isn't like this and shouldn't be like this, simply because the numbers don't call for it. If your 25-man raid wiped every time a single player made one mistake (such as healing with the wrong spell), then it probably wouldn't be fun to the majority of players. (It has the opposite effect on me, personally, as I love when the costs of my mistakes in PvE are on par with arena; but that is another post in itself.) The problem is raid content is a bit unsatisfying on a personal level right now, especially for healers. By introducing the idea of mana management as a more prominent factor, healers will get a taste of punishment and reward without having to endure the masochistic conditions that progression raiders or PvPers put themselves through. A single mistake might not equate to wiping, but as you make continued poor decisions over the span of an entire fight, those mistakes would steadily add up until finally you receive your individual punishment: you're OOM.

This will make the game a little harder, sure, but believe me when I say the rewards are sweeter when you work for it. Have you ever listened to the audio on a world-first boss kill? The sound of those players always puts a smile on my face. It's what makes me raid in the first place, and this is probably something you've already experienced on your own, regardless of what level you raid at. Triumphing over challenges is rewarding, but look at what we do to raid. Last week, I lamented for the majority of my post about how bubble spam is largely unsatisfying. So, when I look at this new philosophy Blizzard is discussing, I'm pleased that they want to make healing in PvE just as satisfying on a personal level as it is on a group level.

Just think: no more of that trivial whack-a-mole at your local Chuck E. Cheese's; instead, we could be seeing intense, whack-a-mole for adults. I don't even mean that jokingly; I think it's a fun game, especially when it's composed of using the right hammer, on the right mole, at the right time.

So what does this have to do with priests specifically? Well, as your healing guide, I feel like I need to prepare you for triage in the upcoming expansion. Thus I present to you:

Step 1: Go to the auction house.
Step 2: Buy 150-175 item level gear.
Step 3: Queue for random dungeons.
Step 4: Learn how to heal again. (Alternatively: pull out your hair.)

Okay, so that had nothing to do with priests, but the advice is still sound. I would encourage all healers to equip a full set of awful gear (like my 3,390 GearScore set -- something with worse stats than the quest rewards you'd be wearing by the time you hit 80), and go into a random dungeon and get in touch with how difficult healing with no gear is. Your mana regen will be awful, your cast times will be slow, your heals will be weak, and your global cooldown will clock in at a full 1.5 seconds. If you do this, I can guarantee that you will struggle with healing your group in some way shape or form. The goal in all this is to eliminate as many of those struggles as possible NOT by getting better gear, but by making better decisions in what and when you cast.

It may be a little cruel and unusual for the people you queue up with, but everyone could stand to actually earn that "the Patient" title, don't you think? That aside, I'll be honest and tell you right now that this is a very difficult task I'm assigning to you. It will be frustrating and take time to perfect. What I will promise you though, is if you do this, no matter what level of healing you currently play at, it will make you a stronger healer. (If you're going to spend your time doing something, why not do it as best as you possibly can, right?)

So now comes the priest thing. I've said it before, but here it is again: You have more healing abilities than any other class in the game. Each one of those heals is designed to respond to a different kind of damage that your allies will take. Start looking outside your top three spells and try to utilize everything available to you. Think of your heals as keys that unlock specific doors. Let's look at our tool box, or in this case, our keyring:
  • Flash Heal Until we get Heal back in Cataclysm, this is arguably the closest we get to a basic heal. We currently use this when one player requires a small or medium amount of healing and can afford the time to wait for a cast. In the future, this spell will cost more mana to make up for its speed.
  • Binding Heal If you can spare the time to cast a Flash Heal, but also need to heal yourself up in the process, Binding Heal is your best bet. It costs twice as much as a Flash Heal, but that's due to the fact that you are doing twice the healing. Not a bad deal with all the time you save.
  • Greater Heal Use this if your target is missing a large portion of health and won't die without an immediate heal. When dealing with fast-paced damage, this spell is used sparingly.
  • Prayer of Mending This spell can be used preemptively on a target you know is going to take damage. The amount healed is low, and so is the mana cost, but it will buy you some extra time to get your next heal to that target. Use it on a tank whenever, or on a target you know will be taking damage in the next few seconds.
  • Penance A discipline priest can use Penance in place of Flash Heal or Greater Heal as a large but quick, instant-like heal.
  • Circle of Healing When multiple members of your raid need quick attention, a holy priest can use Circle of Healing to deliver a quick burst of healing to those targets. The heal is smaller than a cast Prayer of Healing, but the instant nature of it will buy you more time to get your allies to full.
  • Prayer of Healing This long-cast heal will deliver a huge burst of healing to a group. The spell heals for a lot and thus has a long cast time and mana cost. Think of it as a multi-target Greater Heal or Flash Heal. Use it when players low on health are clustered in the same group. If only two players in a group are low, two Flash Heals are sometimes more effective since it will allow you time to move between the two casts.
  • Renew Use this spell to grant a target additional healing on top of all your cast spells. This spell works while you're doing other things and can help to stabilize damage which sometimes allows you the freedom to switch targets. If you're a holy priest with Empowered Renew, this becomes a great instant heal for keeping someone (maybe even yourself) alive long enough to cast a heal.
  • Power Word: Shield This is an even more powerful form of preemptive healing. A shield can be placed on one or many targets to protect against incoming damage.
  • Holy Nova This instant-cast heal is area-based and specific to your party. This makes situations for its maximized use very uncommon. However, if you are stacked up and need a small burst of healing for your group this is perfect. Alternatively, if you're a disc priest who just needs to heal yourself, you can use this spell as filler when you don't have time to cast a spell on yourself and aren't able to use Power Word: Shield yet.
  • Divine Hymn Use this spell when many members of your party or raid require fast healing. This spell will automatically heal players of the lowest health for a large amount, so naturally this spell costs a great deal of mana.
Most of that should have been obvious, but let it serve as a reminder of what spells are designed to do versus how we use them. Right now, for example, we use Circle of Healing all the time, but the spell is actually overkill for most situations. We can get away with it now due to mana, but in the future we may not be able to. If we start preparing ourselves for future changes, we'll be able to hit the ground running when Cataclysm hits.

One last thing before I leave you to boggle at this week's Spiritual Guidance. Last week I wrote about gems, and Penance Priest conveniently published a great post about improving your performance as a healer through casting more. I thought it was an excellent follow-up read to my gem post, which is why I'm plugging it now. The mentality the article offers may seem to conflict with my anti-meter mentality at first glance, but consider it from the angle of today's article. You should be able to always cast, provided you are casting the right spells. You're already making an effort to maximize the quality of your actions, so the next step is to do it at a pace that lets you maximize every moment you spend in combat.

Want to find more great tips for carrying out your priestly duties? Spiritual Guidance has you covered with all there is to know. Check out Holy 101 or Disc 101 for an introduction to healing as a priest, or assess yourself for advice on how to improve yourself as a healer and raider.

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