That’s awesome, and very much like the leveling mechanic in The Black Hack. You have to carouse and share one or more stories about your PC’s past to hit that new level.
This topic was a weird one for me, because it seems pretty dialed in on just the D&D experience. I like all sorts of damage / healing systems, depending on what game I’m playing and what fiction or genre I’m trying to emulate. (Magic healing is frankly one of the things that drove me away from D&D, decades ago. I’m a low fantasy grunt at heart.)
Anyway, some of my favorites:
Barbarians of Lemuria has an excellent, fairly gritty system that models the hit points abstraction that D&D goes for in a more sensible way, IMHO:
- Characters have a Lifeblood score of 10 + Str (0-3)
- Weapons deal, on average, 1d6 damage. Armor reduces damage.
- After a combat, participants can take a knee and recover up to half of the Lifeblood that they lost.
- Each night of good rest, get back 1 Lifeblood
- Death is at -5 Lifeblood, and if you’re below 0, you’re losing 1 per round. You’re dying, and this can only be prevented by your friends helping, the Gods intervening, or spending a Hero Point.
Into the Odd and it’s offspring (Electric Bastionland, Mausritter, etc.) have very cool mechanics where characters have relatively few HP… and where the “HP” actually means “Hit Protection” in the latest incarnations of those games. Once those are gone, damage goes straight to your STR attribute and you have to make a save to avoid a critical injury every time you take a hit. HPs return right after the battle, but it takes a long time to heal attribute damage. (A week, if memory serves.) So you have a buffer, then is gets serious, fast.
In general, I don’t think any system can touch Fate for realism, since ‘Consequences’ can model any kind of injury – mental, physical, social or spiritual, and it can take a long time to recover from these, depending of if they are Mild, Moderate, or Severe. Mild clears after one scene, Moderate after one session, Severe only after a milestone, which might mean “the whole adventure.” I also highly recommend the optional Extreme Consequences, which forever change the character (and one of their aspects). Basically, “you live, but…”
If you limit the conversation to D&D-styled play, I agree with Warden and a few others upthread – ask how do you want the game to feel? Dangerous but heoric fantasy vs. gritty OSR play vs. epic heroes bristling with healing magic who never need to worry about injuries. Very different styles, even within the same overall game.