My Ninja Spy is in a static group that always has 1-2 healers, so she doesn't have to worry about self-healing much. And Earth Stance IV and Shadow Fade mitigate a lot of damage, and Vampiric Stonedust Handwraps (easy enough to get if you run the Lordsmarch chain a few times) do some automatic healing as you fight. OTOH, my Quad H is a soloist who does PUGs sometimes. That's what the build seems to be optimized for. I didn't have any problem soloing the pure monk either, but had to run with pocket clerics a lot.