Best Practices for Surgical Roleplay by Neeve Barbosa

This is based in the Gorean world, which is based on the books by John Norman. 

Several of the speakers at the recent Fair do not wish their talks to be used by others as group training/lessons. If you wish to do so, please contact the speakers direct.



A Practical Guide to Realism, Fairness, and Engaging Medical RP

Medical roleplay can be some of the most immersive and rewarding RP in-world—when it’s done thoughtfully. This guide outlines best practices for surgical roleplay, focusing on realism, clarity, fairness, and opportunities for meaningful interaction.

These are guidelines, not rigid rules. They are meant to support believable roleplay while allowing flexibility based on player preference and story needs.

Understanding the Limits of Roleplay Medicine

One of the key challenges physicians face in roleplay is the lack of visual assessment. We cannot truly see internal damage or subtle physical indicators unless they are explicitly emoted.

Because of this, clarification before treatment is not only acceptable—it is recommended.

What We Often Cannot Reliably Assess Without Clarification

  • Internal injuries

  • Severity of trauma

  • Exact location of damage

  • Underlying causes

Visual descriptions can suggest problems, but they rarely provide enough detail for accurate treatment without communication.

Clarifying Injuries: Best Practice

Roleplayers often under-emote injuries, making diagnosis difficult. To maintain both realism and fairness, clarification protects everyone involved.

Recommended Steps

  • IM the patient to confirm:

    • What caused the injury

    • What body part was affected

    • How severe the injury is

  • When possible, ask for a short notecard describing the injury

GM Meter vs Roleplayed Injuries

  • GM-only injuries:
    The patient may reasonably choose the type, location, and severity.

  • Roleplayed injuries:
    Incorrect treatment may result in valid invalidation.

Always discuss what is happening and what will happen next during treatment.

General Order of Treatment

A logical and consistent treatment flow helps maintain immersion:

  1. Control bleeding

  2. Clean the wound

  3. Close the wound (if necessary)

  4. Apply salves or treatments

  5. Bandage

  6. Provide follow-up care

Bleeding Control: A Unified Approach

Common Methods

  • Direct pressure (primary method)

  • Elevation

  • Pressure points (short-term use only)

  • Tourniquet (last resort)

⚠ Tourniquet Warning
Tourniquets are dangerous and may result in limb loss. They should only be used in life-threatening situations where no other option exists.

Wound Cleaning

Proper cleaning is essential to prevent infection.

Acceptable Roleplay Methods

  • Cleansing solutions (herbal or unnamed if unsure)

  • Thorough irrigation for puncture wounds

  • Honey or spider webs for emergency field treatment

If you’re unsure about herbs, it’s perfectly fine to emote simply:

“The wound is carefully cleaned.”

Suturing & Wound Closure

Thread Use

  • Gut thread: internal sutures

  • Silk thread: external sutures

Best Practices

  • Do not overtighten sutures

  • Interrupted sutures are preferred for most wounds

⚠ Cauterization Warning
Cauterization destroys tissue and should only be used when no other option exists, typically in extreme field conditions.

Roleplayed Suturing Techniques

For added realism, consider emote detail when suturing:

  1. Simple Interrupted Sutures

    • Individual knots

    • Adjustable tension

    • Minimizes scarring

  2. Continuous (Running) Sutures

    • Faster

    • Requires careful tension control

  3. Mattress Sutures (Vertical or Horizontal)

    • Strong wound edge support

    • Useful for wounds under tension

Detailed RP here helps patients understand the severity and durability of their treatment and reduces confusion later.

Scarring can absolutely be roleplayed intentionally—especially if the patient wants it.

Bandaging & Follow-Up Care

  • Keep wounds clean and slightly moist

  • Remove stitches when appropriate

  • Monitor carefully for signs of infection

Infection Notes

Infection is unlikely if wounds are properly cared for and bandages are changed, but it can still happen. Encourage patients to return for follow-up checks 1–2 days after closure.

Bonus: follow-up visits = more RP opportunities.

Healing Time Guidelines (Flexible)

These are guidelines, not hard rules. Healing times should always be discussed with the patient.

  • Bruises: less than 1 day

  • Minor wounds: ~1 day

  • Stitched wounds: 2–4 days

  • Broken bones: 3 days to 2 hands (depending on severity)

  • Major internal injuries: 2–3 hands

Treatments, Salves, and Substances

A wide range of antiseptics, salves, pain relievers, sedatives, and herbal treatments may be used in roleplay. Not all physicians use all substances, and restraint is encouraged for realism.

Healing Salves

  • Often rare and valuable

  • Not used casually for every injury

  • May be applied sparingly

  • Some roleplay distinguishes between divine-grade and common variants

Stabilization Serums

  • Effects vary by individual

  • May not work for everyone

  • Changes may be subtle or dramatic depending on age and player preference

  • Long-term effects are best explored collaboratively in RP

Final Thoughts

Medical and surgical roleplay works best when:

  • Communication comes first

  • Realism supports the story rather than stifling it

  • Physicians and patients collaborate

  • Flexibility and consent guide outcomes

Above all, good medical RP should enhance immersion, not shut it down.

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