In my limited experience in gaming, we were reminded to periodically ask about game mechanics: "But does this make the game more fun?"
Simulating realism is cool, but reality is full of boring or unpleasant stuff. Why suffer that extra? "Oh no, it seems you cut your finger while making dinner. Now you have an infection! And since you didn't eat dinner, you are now faint and must lie down. You need a doctor! Oh no, you _were_ the doctor!"