For the most part, when I looked at the rules to D&D I made pretty good guesses about how the various rules would work in practice and how effective each maneuver would be. But it is interesting to keep track of things that don’t turn out how I expect. I’m discovering that the ability to spend a healing surge, by means other than the standard Healing/Inspiring Word, is far less useful than I thought. Say you are a 6th level party with a Warlord. You have a healing surge of 14 points. Say you have a power that lets you spend a healing surge when you hit the target. Originally, I thought this was really useful because it makes you 14 points harder to defeat in combat, a huge increase in your defenses. But I hadn’t noticed on first reading the rules that the Warlord can spend an unlimited number of Inspiring Words between combats. This means that when you heal noncombat, you heal an average of 21 points per healing surge. In addition, although 4th edition D&D is designed to make each individual fight scarier than in 3rd edition, it is still the case that D&D encourages multiple fights over the course of a day, each of which drains your resources, but all of which the players win. This means that in most fights the players are not in serious danger of losing, and the main measure of success is to spend as few resources as possible (that way you have less need to rest and can rescue the princess sooner, before she is eaten by the dragon). Each healing surge “represents” 21 hit points of damage that you can take over the course of a day.
If you spend a healing surge yourself, you get 14 hit points right away but lose 21 hit points that you could have gained later in the day. So you are basically causing yourself 7 points of damage by spending the healing surge. Of course, using the surge may prevent you from falling to negative hit points. But as long as the fight is not too hard and your healer has healing left, that is not necessarily all that bad. It is actually more efficient to let someone go negative before healing them, since all of the “negative” hit points are healed for free.
So a power that lets you spend a healing surge is really only useful when the party is under a lot of pressure in a really tough fight, or when you are personally in a tough spot where falling unconscious would be highly undesirable. There is a significant chance that such an event would not happen during the course of the day. This makes a daily healing surge power, like Comeback Strike, less often useful than a power which just does more damage, like Brutal Strike, since you're always certain to want to cause more damage at some point during the day. This isn't necessarily a bad thing from a game balance perspective, since otherwise those healing surge powers were looking pretty good.
The really significant effect this has is that encounter powers which give you healing surges aren't actually much better than daily powers, since in most encounters you won't want to use them at all. In particular, the dwarf power to use a second wind as a minor action looked quite impressive when I first read it, but now I think it is weak compared to something like Second Chance. In general, it seems that a non-dwarf character will almost never want to spend a second wind while still conscious, since you are basically spending an attack action to damage yourself. A dwarf ‘s second wind is more useful, he may find his resilience power very handy in the dramatic combat of the adventure. But a halfling’s power is generally much more practical, since he can use his power in practically every fight.
In comparison, the powers that give you temporary hit points, or that just heal you flat out, really shine in comparison.