Whatever Happened To Triage Healing?

14 Feb

The other day, I was listening to a podcast that I did with Kurn which was released slightly before opening night of Cataclysm.  It was fun to compare the changes that we were predicting would happen and the ones that actually took place and have stuck.  I would like to think we were pretty spot on about most things, but one change that we and most healers felt pretty strongly about never seemed to take hold.  That change was the advent of a new way of thinking and healing called “triage healing.”

The concept of triage healing was pretty simple.  Players would need to get used to the idea that not everyone would need to be topped off at all times and we would have to get comfortable seeing ourselves sitting at 75% health or even 50% health at any given time.  This would lead to healers not having to feel like healing was such a reflexive action or like “Whack a Mole,” as some have described and it would lead to DPS having to play smarter, knowing they wouldn’t be allowed to continue making stupid mistakes and expecting their healer to heal them through it.  These changes were made to not only change how healing is done, but also because there were sizeable changes being made to how mana works in the game and how healers would need to start managing their resources again.

Cut to today and it feels like that idea is all but gone, except for 5 man Heroics.  Healers are still racing to be the first to top off that errant ret paladin’s health or that entire group they have been assigned.  I know triage healing was a controversial idea and not every healer reacted positively to it, but I assumed we would still see some evidence of it being practiced.  Where did it go?  Why did the idea not take off, the way some of us had hoped? 

Let’s go over some of the reasons why triage healing didn’t seem to last too long, with the help of some friends and fellow bloggers that I posed these questions to.

Reason #1:  Gear

Borsk was the first one to respond, stating he felt that Tier 11 gear was causing raiders to possibly outgear current content already.  This is a valid argument, one that was supported by the “Every little bit helps” mindset that motivated people to take the time to better themselves in smaller ways to prepare themselves for 5 man Heroics and beyond.  I know when I started Heroics, I had the attitude of “It’s just a bracer enchant.  What does it matter?”  Slapping that extra spirit on my bracers made my mana regen better, so I could make it through healing those initial Heroic boss fights much better. 

People were finding that even the most basic upgrades were setting themselves worlds apart from the competition.  Compare your mana and health that you have now from what it was when you first hit 85 and were running regular dungeons.  You will find that you and your stats have come a long way.  You can probably afford to go all out a little more and even more so with a full spread of raid buffs.  This could be one reason that players are healing more, because higher stats on gear have given them the means to do so.

Reason #2:  Boss fight mechanics

Lissanna suggested that one reason triage healing may have lost some allure was because of the burst AOE damage that goes out on a lot of boss fights in beginning raid content.  This is true, beginning with what are considered entry level bosses, such as Magmaw or Halfus Wyrmbreaker.  Granted, there is damage on both fights that can be avoided, but there is also a lot of damage that everyone will just have to eat and that will need to be healed through.  Much of this damage could easily kill someone, if they’re not healed up to full or close to it.  Cooldowns like healthstones, health pots or Lightwell charges can only do so much.  They are still going to need heals from you and probably more than the triage style of healing would normally allow or suggest.

Reason #3:  More healers

It’s a pretty common reaction when someone is taking damage to want to heal them.  If the other healers in your raid are anything like you, they will probably have that same reaction.  So that person sitting at 35% is probably going to attract the attention of other healers and your carefully thought out heal could end up being just one of a slew of heals suddenly thrown at them.  It’s not that you weren’t practicing the triage style of healing, but that everyone else was, too and you all reacted at the same time.  I wouldn’t say this is a bad thing, but having more heals to go around will almost certainly lead to nobody staying below a certain threshold of health, unless your healers are asked to keep it that way or you’re on a particularly taxing encounter.

These are just some of the reasons why triage healing may not have grown in popularity as an acceptable style of healing.  What do you think?  Do you still practice triage healing?  If you don’t, why did you stop?


18 Responses to “Whatever Happened To Triage Healing?”

  1. Amyranth February 14, 2011 at 9:35 am #

    I like the idea of triage healing, but as long as there are healing meters, it’s not going to happen in raids.

    There just isn’t any easy way to accurately measure a specific healer’s general effectiveness, so raid leaders don’t have much else to go on, even when they know that healing meters are not a good measure of quality.

    • Oestrus February 14, 2011 at 9:45 am #

      Hey there, Amy!

      It is possible, if your GM or healing lead really takes the time to look at the logs and go through them. Obviously, not everyone has the time to do such things. But for those who do, there are many indicators that can show how a specific healer is doing. Believe me, Kurn leaves no stone unturned and I’m really grateful that I have a GM who refuses to allow us to judge ourselves just based on the numbers and who doesn’t buy into that herself. It isn’t an easy way, but it is a way and can be done.

      We as healers have been long overdue for something to snap us out of that notion of numbers being everything and triage healing could have really helped with that. It’s kind of sad to see how we have fallen back into that mindset. And I’m guilty of it, too! I freely admit that!


      • Kurn February 15, 2011 at 3:07 pm #

        It takes forever, not going to lie. 😛 But it’s why I frown on people publicly being all “zomg, I win, I topped meters!!!”. Meters don’t matter and if you have a healing lead who takes a few hours a month to go over your stuff, meters won’t matter to them either.

        Healing leads who go off the meters are likely meter whores themselves. 😉

        My two cents! 😉

  2. Zinn February 14, 2011 at 9:51 am #

    I’ve made the same “discovery”. The healers who were best at triage healing at the beginning of Cata – holy priests and paladins – were also the best healers. Now that we are starting to outgear the content (yes it is true, I’ve had -horrid- tries on bosses that worked only because we had the gear for it), we find that the good old sniper-heal classes from Cata make a return – Disc priests and resto druids. Disc just recently got a huge buff too, which matters of course. But most importantly we are seeing people being topped alot more often, making it difficult for the slow but big healers (shamans, holy priests) to winkle in their heals. The tougher content (heroics, end bosses) don’t require triage healing either, they require burst healing (also returning to Wrath style). I definitely intend to write more about this subject, as it saddens me actually. I liked triage healing. But maybe it is inevitable that it turns out this way.

    • Oestrus February 14, 2011 at 10:01 am #

      Hi Zinn,

      Holy priests could be lumped into the sniper-heal classes you described, since CoH now outshines PoH in many situations and it’s been suggested on EJ that it should be used off cooldown, when raid healing. I tried this last night and my numbers blew up. I hadn’t seen CoH be my top used heal since ICC. It felt nice, but also felt a little strange, too. I certainly wasn’t using it just to use it, people were taking damage. But I couldn’t help but feel like I had maybe taken a step backward and not forward.

      I’m glad to see you stopped by and I look forward to reading your post about this very subject!

  3. adgamorix February 14, 2011 at 2:33 pm #

    I know in our raids, triage healing still happens. It may be more of an assignment situation, but here’s a current example.

    Working on our first Nef kill, we have our rogue kiting the adds in P1. This is the only fight we 3 heal, with a Disc Priest, Holy Priest, and me (H Paladin). My job is to keep the Ony tank alive, and to help raid heal after a Crackle. The Disc Priest is on the Nef tank (same secondary role) and the HPriest is on the rogue (same secondary role). We had a lot of issues where the rogue would get stomped, so I tried sniping heals on him – to the point where I’d lose the Ony tank.

    Same goes after a Crackle. I can’t afford to bring the whole raid up, I just hit HR and LoD – and keep healing the Ony tank.

    I’m guessing that triage healing is dead in raids that bring too many healers – that’s where I’d be looking to make a change.

    • Oestrus February 14, 2011 at 2:39 pm #

      Hey there Adgamorix,

      I think it also depends on your raid makeup. It sounds like from the brief description you gave of the Nef encounter that you may belong to a 10 man guild. If you are in a 25 man guild and I read that wrong, I apologize in advance.

      You’re right about too many healers, if that’s the case. From what I recall in my days of doing 10 mans and 10 man hard modes (which I did strictly for a brief period), there wasn’t much overhealing going on. Just about every heal counted and made a difference. So I can see how triage would be seen more in that format than anything else.

      Thanks for stopping by!

  4. Jen February 15, 2011 at 4:11 am #

    There is SO much AoE damage in the fights we’re doing that all I can do is flail, WG and Rejuv the fuck out of everyone, and hope. We don’t outgear the content (I only have one piece of T11 and no raid drops) and we’re not very progressed (4/12, 10 man guild), but at this moment I can’t see myself doing triage more than in Wrath. I will heal a good DPS before a bad DPS, but that’s about it.

    I blame the AoE first, but I think you’ve got a point with the “other healers theory” too. I know that if I see someone low on health, I will throw a Rejuv, so even if the priest was trying to triage that guy… well oops. I’ve seen too many people 1-shot by 50 or 70k hits and I’d rather not risk people being too low. As long as my mana can handle it, I’ll go for topped off.

    • Oestrus February 15, 2011 at 8:19 am #

      Hi Jen,

      I had heard that druids were having a tough time with AOE healing up until recently and boy did it make me glad I rolled a priest! Just kidding. You do have a point about the AOE burst healing congrats on the 4/12. Progression is progression!

      I like what you said about having the mana and if you do, you will top someone off. I think that was one of the variables behind triage healing was that we weren’t supposed to have the mana to go around to be able to heal people that much and now that we do, we are free to heal more. I wonder if we will stay that ahead of the curve in further levels of content or whether we may get knocked back to being thrifty with mana again after each tier.

      • Jen February 16, 2011 at 2:17 am #

        I guess it all depends on raid composition too. I was running OOM pretty bad a week or two ago… not anymore. My gear hasn’t changed though. What changed are two things:
        – the team – we replaced a couple of people who weren’t experienced enough or had bad connections (having tanks who CAN taunt helps!)
        – the healing team in particular – our enh shammy has been helping out and damn, Mana Tide really is OP on that short timer.

        I only run OOM now if I need to top someone off really fast and I spam some Regrowth. If I time my Innervates right (and the other healers use their Hymn and totem) then everything goes smooth. (And we’re 5/12 now \o/)

        In short, the only time I do triage now is when I’m OOM, which only happens if I fuck up.

        • Oestrus February 16, 2011 at 9:58 am #

          Taunting tanks? Who needs those?!

          Mana Tide is incredibly OP and I’m fortunate enough to run with two resto shamans who time the dropping of their totems beautifully. I love them for it!

          Congrats on the 5/12, by the way!

  5. Gaia February 15, 2011 at 9:46 am #

    I think you largely overlooked the huge change to incoming tank damage, which usually accounts for ~50%+ of the damage taken in eve a heavy AoE raid encounter, and its associated healing requirements

    As a tank it has been REALLY noticeable that my health pretty regularly hovers around the ~70-80% mark for extended periods of time. Whereas in WoTLK that would have meant I was about to die without a cooldown of some sort, nowadays it likely means that the healers are just busy dealing with someone’s mistake or trying to conserve their mana.

    • Oestrus February 15, 2011 at 10:01 am #

      Hello Gaia,

      I understand what you’re saying, but I think that largely depends on how your group handles healing. In my raid, we have healing assignments and we have dedicated tank healers. As far as I know, our tank healers do not stray from our tanks. We have a generous amount of raid healing that goes out and there is very little need for them to leave their tanks alone to handle that.

      Personally, I always viewed triage healing to affect DPS and healers more than tanks. I still don’t like having my tank get to 75 or 80% health, if I can help it. I know that tank damage can be spiky and I would rather not risk an unlucky blow taking them too far down. It could be that your healers are practicing triage healing and conserving mana by leaving you at that threshold of HP or they are in fact handling mistakes by others, which could probably be handled by others who aren’t focused on tanks.

      Just my two cents!

      • Gaia February 16, 2011 at 1:10 pm #

        Just to clarify, I wasn’t really trying to disagree. I was just trying to point out that I think that the changes with tank healing/health are a much easier place to see the differences in healing requirements pre and post Cataclysm. Throughout most of wrath, there were mechanics in most encounters that would 1-shot anyone in the raid who wasn’t topped off, especially tanks. In Cata, similar situations are few and far between and are generally constrained to very short periods of time. Which means that regardless of whether you are actually managing to keep your tanks and healers topped off 100% of the time, for the most part it isn’t actually required at the moment in order to beat an encounter.

        My blanket recommendation for people/raids/guilds who are seeing their raid/tanks sitting at full health most of the time to start thinking about scaling back on the number of healers used.

        As far as healing meters go, once your group starts moving in heroic modes, I would actually recommend going back to the practice of evaluating overheal numbers long before you start looking at either total healing done or HPS numbers. HPS and Total Heal numbers are more contingent on healing assignment, class, and whose assignment screws up more often than the “skill” of the healer. If you wanted to top the meters at this point as a healer you should just bribe your healing assignment to stand in the fire more often (at least until you start running out of mana) since WoL doesn’t actually count overheal in its “normal” healing numbers.

        • Oestrus February 16, 2011 at 3:28 pm #

          Oh no, I didn’t take it that way at all!

          I agree with everything you said in your reply just now and I’m pretty sure Kurn is already thinking of new and interesting ways to read the logs, come Heroic modes.


  6. Imakulata February 17, 2011 at 11:47 am #

    I think that idea of “being able to keep people at 50% but not being able to keep them topped” is wrong. If I have enough mana to keep someone at 50%, I can keep them at 100% – ~5k (unless I’m resto shaman), after all the DTPS is the same, isn’t it? So there are only two options for it: either people are dying slowly during the encounter and healers can only slow it down or the healers can save mana for a short while until people get to e. g. 50% and then top them again.
    Gear is to blame too. Triage only works when healers’ regen is low. If it isn’t, the only options will be to either make it easy or make the twitch important again. The burst is just a way to challenge healers with high mana regen.

    • Oestrus February 17, 2011 at 12:04 pm #

      Hey there Imakulata,

      I agree with you about triage being more prevalent when the mana regen isn’t there. You couldn’t keep people (tanks excluded) topped off all the time with your stats being the way that they were when you first hit 85 and even leveling up to that point. It just wasn’t there. Now that we do have higher stats, we could afford to top people off if we needed to. But that’s the thing. We don’t need to on every fight. I think there’s still glimpses of people slipping back into that “Damage? ZOMGYOUAREAT99PERCENTANDTHATISUNACCEPTABLE!” Just because we can do something doesn’t mean we always need to.


  7. Kuri March 1, 2011 at 8:08 pm #

    Triage healing is pretty much dead in raids. If you look at nearly any Heroic boss fight, the concept of triage is pretty much laughable.

    Atramedes: 50k+ sound blasts, 50k searing flames
    Cho’gall: 60k Shadow’s Orders
    Sinestra: 60k damage every 20 seconds in P1, 100k damage every 20 seconds in P3, not to mention Wrack etc.

    These are just 3 of the many fights with massive dip-your-raid-to-sub-50%HP abilities bosses have this raid tier. It seems Blizzard’s still convinced the only way you can challenge a healer is to make them spam-heal up targets after taking massive damage. I can assure you if there’s any pause for thought, it’s “Will I let the guy with the 10% AP buff or McStandsinfire Shaman die?”

    It’s unfortunate, since once healers got the hang of Heroics healing, most I’ve spoken to did tend to like it if their group was communicative and competent.

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