Doctors without Patch?

Can anyone tell me how they work the Doctor skill at their table if they don’t have “Patch”? Does it mostly just help with Recovery during downtime? Does it have any function at the table, aside from non-mechanical Fiction or identifying science-y stuff in labs or strange substances? AFAIK there’s no way to interact with Harm penalties other than abilities, Recovery actions, and items?

You could Doctor a sample of alien tissue to better understand its xenophysiology (increased effect when administering drugs to the species). You could Doctor a planet’s poisonous vegetation and modify the crew’s air scrubbers to filter out the worst toxins. You could Doctor a plague victim and try to calm them down by explaining what’s happening to their body—and, hopefully, by explaining how you’re going to fix them!

The “Crafting” section breaks down “Assembly” into Rig (for hardware) and Hack (for software), but I think it’d make good sense to use Doctor if a PC was assembling a chemical compound from a “schematic”/formula/recipe.

Does it have any function at the table, aside from non-mechanical Fiction or identifying science-y stuff in labs or strange substances?

The fiction informs the mechanics in Scum and Villainy, so I’d caution against looking at Doctor as being mostly “fluff” outside of Harm treatment. Like most Actions, it’s relatively focused while still overlapping with other ratings, such as Study or Consort. What’ll be most important in play is the goal the player states when they choose to roll their Doctor rating, and how the player’s narration influences the GM setting position and effect.

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Thanks for the thoughtful answer, Sean!

What’ll be most important in play is the goal the player states when they choose to roll their Doctor rating, and how the player’s narration influences the GM setting position and effect.

Yeah, totally! I guess, my question is, Fictionally, the first reflex of anyone new to the system with the Doctor skill is going to be to want to try to help their team mates who are hurt. What do you do when they do that?

Ex: During a daring rooftop escape, Alice was pushed off a high roof and has a compound fracture in her leg (harm 2). Doctor Bob comes along and says he wants to reset the bone, clean the wound, splint the leg, and fashion a crutch for Alice to get around with.

My understanding of FitD is that one of three things should happen:
a) We just say that Doctor Bob has done all that, there’s no roll because there’s no consequences here. Also, nothing changes except for the Fiction. (Not trying to say changing the Fiction isn’t important, just also trying to be clear that the Harm isn’t changed.)
b) Bob is using Doctor as a set-up action for the later healing clock test when Alice tries to Recover in Downtime. Consequences could just be that the door is closed to further treatment now, a complication (oops, the leg is now freely bleeding, time for emergency surgery!), etc.
c) ???

I guess I’m wondering what happens at most tables. a)? b)? Is there even a c) without Patch?

Ah, gotcha. I like your “B” option for sure—the PC can do some “meatball surgery” now, and we could use that as set-up for a future healing clock. (Though I’d probably be pretty harsh with setting position/effect there—Doctoring during an escape would be tough, and Harm reduction takes the sort of time that the scoundrels just won’t have available on a job.)

I think you could also rule that Doctor would be useful if a PC “Needs Help” with Level 3 Harm. Maybe Doctor Bob shoots his patient full of painkillers, and that lets them take a few actions even though their leg is absolutely shattered.

Ultimately, though, this is a matter of setting expectations. The Stitch isn’t really an “action healer” in the D&D sense (outside that “Patch” move), and it’s generally not possible to heal significant amounts of Harm during a job. If a Stitch player wants to be a more capable medic on jobs, they should take “Patch.” (Or, they should engage the crafting rules between jobs! Ask the Stitch if they want to start a Long-Term Project to design and build a “medigun” that could do a quick heal say… once a job.)

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Patch allows you to treat a wound so well that wound penalties are removed for an entire job. It seems reasonable that you could do something similar but more short-lived without it. For instance, if a crewmate was going to make an action at reduced effect due to a level 1 harm penalty, I’d allow someone to roll a setup action with Doctor to cancel that out with increased effect for the duration of one task.

Honestly even when people aren’t injured you might be able to inject them with drugs as a setup to improve their effect at all kinds of things.

Don’t forget the Stitch’s core ability: I’M A DOCTOR, NOT A…

“You can push yourself to roll your doctor rating while performing
a different action. Say which patient, research, or posting taught
you this trick”

This may be the single most powerful core ability in the book! If you’re playing a Stitch, you will put three dots in Doctor. So you’ll always get three dice on a push even if you have one or zero dots in that action.

It’s not actually OP because it’s limited by the amount of Stress available. Still, it makes the Stitch the ultimate clutch player – when you really need to pile dice on an action, there’s always one guy who can step up if need be.

If you like to lean on this a lot, I highly recommend picking up Purpose as a Veteran ability (from speaker). It gives you a permanent +1 to resolve resists, and lets you use your special armor box for a free push any time you’re outclassed by opposition or affected by wounds. That’s probably the most open-ended free push you could find.