I was DMing for some first time players and following an encounter that left one of them very bloodied and at 1hp, another player said "Oh my god, we need to get you to a hospital!" to which I replied something along the lines of "you know from experience that almost any wound will close after a night's rest", which felt very strange to say despite being mechanically correct. How would you explain that "being badly burned, shot through the chest and gouged in the neck will be fine if you just sleep on it for a night" without making it sound ridiculous?

In a tangent thought: given that most things can be healed with a night's rest and that otherwise even 1st level characters can cast healing spells, do hospitals really exist outside of treatment for rare enduring conditions?

Hospitals can exist if you wish them to, i would say that part of being an adventurer is that you have a, call it an inner well, of innate magic this is what gives player characters the ability to do the feats of heroism they do compared to regular people. For fighters it strengthens their bodies, for wizards they can cast spells and so on. However every adventurer has a reserve of this inner well that is only accessed during a long period of sleep that heals all but the most grievous of injuries, for diseases and extremely grievous injuries they need a hospital still.

I just don't translate HP to wounds. It's more of heroic points. Not every time a monster hits a player I describe it as a wound.
"You dodge the ogre's club at the last moment and are out of breath (take 12 points of damage).
Only dropping to 0 hp counts as a wound.
"This time you were not fast enough as the ogre hit you squarely in the chest knocking the air out of your lungs and cracking your ribs, you drop to the floor losing consciousness"

When you do a long rest, I still encourage my players to roleplay their previous wounds, but they are refreshed enough to carry on despite those wounds.

Depends on the party I guess.

If you have a player that is proficient in medicine or has the healer feat you could just handwave that a long rest is them treating the party. Similarly, you could say that someone who has healing magic is doing a ritual style super long healing magic on the group.

Failing that, as a DM you have flexibility on the world. Maybe the healing rate is just much faster in this world (Particularly if NPCs also heal over a similar period of time) or it could be a quality of the unusual races of D&D if the players have gone for a non human party.

Alternatively, you could weave it into the narrative. If you have a Paladin or Cleric in the team, maybe their Deity is intervening to increase their recovery, maybe a Druid is drawing power from nature to heal their allies wounds, or a Warlocks patron is making sure their investment isn't wasted. Maybe some higher being has taken an interest in the party, because they are doing good, or they are simply amused by the parties actions and don't want their fun to end too soon. On a more mundane note, maybe a ranger has scavenged herbs from a favored terrain and brewed up some slow acting healing medicine (Or a proficient herbalist)

With the above in mind, you could say that hospitals exist for NPCs. Those without a higher being looking out for them, and lacking the magic or skills to heal themselves.

Alternatively, you could just do away with long rests if they feel ridiculous to you (depending the players opinions). Add hospitals and infirmaries to the world, maybe make healing scrolls/potions more common to compensate. Possibly reduce enemy damage a little or lower their attack bonuses?

This all sounds about right. Think of Indiana Jones on the trip in the ship in the first movie. It’s exhaustion and battering, but the hero always rallies. 

If you want something that carries over time or requires a "hospital", use some variation of lingering injuries. I use a somewhat ad-hoc trigger for this. As DM, I pretty much decide when to apply it (you could have more specific triggers if you run a crunchy table). Typically I rule it on epic critical hits, going to zero, falls or other injuries that are almost certain to be physical damage, etc. Whatever fits awesomely into the narrative.

For the “specifics,” I have a random table of general things that can be affected (d20 or choose):

1. Strength Bonus (usually -1)
2. Dexterity Bonus (usually  -1)
3. Constitution Bonus (usually  -1)
4. Intelligence Bonus (usually  -1)
5. Wisdom Bonus (usually  -1)
6. Charisma Bonus (usually  -1)
7. Strength Saves (usually  -1)
8. Dexterity Saves (usually  -1)
9. Constitution Saves (usually  -1)
10. Intelligence Saves (usually  -1)
11. Wisdom Saves (usually  -1)
12. Charisma Saves (usually  -1)
13. Sight
14. Smell
15. Hearing
16. Taste
17. Touch
18. Maximum HP or HD x 75%
19. Movement
20. Disfigurement

I then roll or choose the duration (d6)

1. Until next turn
2. Until end of combat
3. 24 hours
4. 2-3 days
5. 1 week
6. 1 month

A sight injury until next turn might mean the enemy threw sand in the characters eyes. For a month, might mean their eye was scratched. A modifier to wisdom saves might mean a concussion. and so and and so forth.

Simple. Fun. Narratively open-ended.

Quote from Greg >>

This all sounds about right. Think of Indiana Jones on the trip in the ship in the first movie. It’s exhaustion and battering, but the hero always rallies. 

If you want something that carries over time or requires a "hospital", use some variation of lingering injuries. I use a somewhat ad-hoc trigger for this. As DM, I pretty much decide when to apply it (you could have more specific triggers if you run a crunchy table). Typically I rule it on epic critical hits, going to zero, falls or other injuries that are almost certain to be physical damage, etc. Whatever fits awesomely into the narrative.

For the “specifics,” I have a random table of general things that can be affected (d20 or choose):

1. Strength Bonus (usually -1)
2. Dexterity Bonus (usually  -1)
3. Constitution Bonus (usually  -1)
4. Intelligence Bonus (usually  -1)
5. Wisdom Bonus (usually  -1)
6. Charisma Bonus (usually  -1)
7. Strength Saves (usually  -1)
8. Dexterity Saves (usually  -1)
9. Constitution Saves (usually  -1)
10. Intelligence Saves (usually  -1)
11. Wisdom Saves (usually  -1)
12. Charisma Saves (usually  -1)
13. Sight
14. Smell
15. Hearing
16. Taste
17. Touch
18. Maximum HP or HD x 75%
19. Movement
20. Disfigurement

I then roll or choose the duration (d6)

1. Until next turn
2. Until end of combat
3. 24 hours
4. 2-3 days
5. 1 week
6. 1 month

A sight injury until next turn might mean the enemy threw sand in the characters eyes. For a month, might mean their eye was scratched. A modifier to wisdom saves might mean a concussion. and so and and so forth.

Simple. Fun. Narratively open-ended.

and your decision as DM how magical healing affects these. I usually apply them pretty aggressively and allow any magical healing to clean it up.

I equate HP to skill and ability to take less damage from a blow than someone of lower level. Basically a sword swing that would kill a level one is the same as one against a level 20, but against the level 20 guy it was a glancing blow for 5% of his health whereas a lvl 1 just took the brunt of it and was killed. As far as healing over a long rest, I do carry over any physical weakness or damage into descriptors for the following day. "You wake up and feel better, although the burn to your torso is uncomfortable and the wound to your arm is healing nicely albeit a bit sore." Then when they miss an attack "as you swing your sword you feel a shooting pain in your injured arm and it causes you to lose focus and miss the target." I keep a short list of what is messed up on a particular character so to add a bit more realism to skill checks and attack rolls. If someone crits against that character I add in that they hit a fresh wound they had which causes more damage than before. I have had players say after a few play session that they are relieved that a particular wound is finally healed even though it didn't have any effect roll or rule wise on their play, I just used it as a reason for some things missing. 

It never seemed realistic that as you level up you can just take the same kind of damage that would kill a normal person and it just be a scratch. Going this route seemed like a more reasonable explanation of damage, at least to me. Then again, I could be a moron lol

Lingering Injuries variant rule is listed 272-273 pg of the Dungeon Masters Guide.

Damage normally leaves no lingering effects. This option introduces the potential for long-term injuries. It's up to you to decide when to check for a lingering injury. A creature might sustain a lingering injury under the following circumstances:

• When it takes a critical hit
• When it drops to 0 hit points but isn't killed outright
• When it fails a death saving throw by 5 or more.

Gritty Realism Rest rule variant is on 267pg of the Dungeon Master's Guide.

This variant uses a short rest of 8 hours and a long rest of 7 days. This puts the brakes on the campaign, requiring the players to carefully judge the benefits and drawbacks of combat. Characters can't afford to engage in too many battles in a row, and all adventuring requires careful planning.

This video by Dungeon Dudes talks rules that offer a grittier, more realistic feel to the game if you decide to use them. I think most if not all of these rules can be found in the Dungeon Master's Guide or other official sources.

Typically there are no "hospitals" in the official setting of D&D (Forgotten Realms), but you can have them exist if you decide to. Instead of hospitals, I encourage my players to get to a Temple. There are "All Faith" (non-denominational) shrines in towns, or temples to specific Gods where you can pay a priest for their healing services. You may rule that Inn's and Taverns are equivalent to hospitals since they are places of rest as well. 

Just make the healing with a long rest a thing that doesn't happen. If the party doesn't have any way of healing they better figure something out. Get to a town and get some healing. I understand when folks say HP isn't really wounds, but I don't believe that. To me it is not being out of breath ect. If you have bruises you got hit with a mace, or club. I think 5E has taken any of the game being hard on the players out and replaced it with just kill stuff and repeat. not my cup of tea. 

My explanation is, "It's a game thing."

There are no injuries or broken bones or lacerations or hospitals - just hit points. I mean, those things, as well as doctors and healers and hospitals, do exist in the game world but for our PCs we are just ignoring them for the sake of a faster, less icky game playing experience.

As others have said, don’t think of hit points as each point equals an injury. Think of them as an abstract way to represent how able a character is to roll with the punch. As they get to a higher level, they are better able to take a hit or twist out of the way, but even that has a limit before they start to get too tired and the little things add up. But after a good night’s rest, they’re back to feeling fine. 

And you’re the dm, if you say there’s hospitals, there’s hospitals. I’d imagine they would often be associated with a larger group, like a god worshipped by life clerics or something like the knights hospitaler (which I’m probably spelling wrong) where hospitals got their real world name. 

Hospitals would be for chronic and incurable conditions, mostly.  At least in my world. A hero with just the right healing spell might be more successful at saving the inmates than the less talented healers in charge.

I did have a little trouble with not wanting seriously wounded NPCs to be fresh as a daisy and ready to pitch in fighting the next day. The players were pretty okay with the explanation "She was shot through the chest, pinned to the mainmast, nearly drowned when the ship sunk, and has been teetering on the brink of death ever since.  She's going to need real time or high-level magic to recover. Her soul isn't sure yet that her body is really still viable."  Didn't want to pull that one too often, so I am making use of my NPC villain rogue wizard who is wanted for polymorphing people--now when I need to sideline an NPC so that the heroes can do their work for them, they recently had a run-in with the wizard and the curse had lingering effects that have not yet been successfully eradicated, like duck feet or hoof hands or something.

It sounds weird, but you have to remember 2 things about D&D:

1) HP =/= Health. HP is more of an abstraction of a characters heroic potential. 
2) Recovered HP =/= Healing. Recovering HP is more recharging heroic potential than physical healing. 

Someone above mentioned Indiana Jones recovering on the ship. That’s about accurate.
Another way to look at a short rest was when John McClane took a break to pull the glass out of his feet and then kept on going. In both cases the hero was still technically injured, but their heroic potential had been restored. 

For severely injured PCs I also impose exhaustion without magical healing. It takes a PC 1-3 Long Rests to fully get over it and makes things seem more realistic.

Quote from IamSposta >>

It sounds weird, but you have to remember 2 things about D&D:

1) HP =/= Health. HP is more of an abstraction of a characters heroic potential. 
2) Recovered HP =/= Healing. Recovering HP is more recharging heroic potential than physical healing. 

And yet... hit points are restored by spells named "Healing Word" and "Cure Wounds." Following the "heroic potential" logic, the cleric casting Cure Wounds isn't causing bloody gashes to seal up but is restoring the hero's... wounded pride? Wounded confidence? 

And when you get to 0 hp, there is a chance that you will... die from a lack of heroic potential?

The hp game mechanic may work in a game session but I wouldn't try to make any logical sense out of it, because there isn't any.

Quote from BioWizard >>

Quote from IamSposta >>

It sounds weird, but you have to remember 2 things about D&D:

1) HP =/= Health. HP is more of an abstraction of a characters heroic potential. 
2) Recovered HP =/= Healing. Recovering HP is more recharging heroic potential than physical healing. 

 

And yet... hit points are restored by spells named "Healing Word" and "Cure Wounds." Following the "heroic potential" logic, the cleric casting Cure Wounds isn't causing bloody gashes to seal up but is restoring the hero's... wounded pride? Wounded confidence? 

And when you get to 0 hp, there is a chance that you will... die from a lack of heroic potential?

The hp game mechanic may work in a game session but I wouldn't try to make any logical sense out of it, because there isn't any.

 

 Actual wounds would hurt a character’s heroic potential so for me it’s a little of column A and a little of column B.

Also, haven’t you ever heard of someone dying from shear exhaustion or simply from pain or shock with hardly a scratch on them? 

Just remember, D&D rules are meant to quantify abstract concepts, not granular specifics.