A frequent occurrence in front line medicine as practice by family physicians, internists and emergency room physicians is the patient’s demands for laboratory proof of almost any diagnosis, whether it’s peptic disease or a fractured rib. Or even a sprained ankle. Articles have been written on the examination of the ankle, taking into account the type of injury and whether an x-ray will prove helpful. ER physicians who are experts in this diagnosis are not allowed to make clinical diagnosis by the patients who demand an x-ray. It the physician spends time explaining the reason for no further tests, the patient will listen politely and still demand an x-ray. A physician can spend the equivalent of two appointment times ($250) explaining why further testing is not necessary, the patient will always win having the unnecessary expense expended by either returning to the ER when the next doctor arrives and state his ankle is still painful. Frequently he may not have even taken the prescribed analgesics. That’s why as an intern, I always carried a bottle of extra-strength Tylenol and would give out two pills with a cup of water in the triage room and continue my triage rounds. Sometimes before I returned to the same place in the triage ward, perhaps 45 to 60 minutes later in the busy county hospital, the ankle pain would be resolved. When asked, what were the two marvelous pills you gave my wife, I would only state they were extra strength PAIN pills. I found out rapidly in my internship, if I stated they were Tylenol, they would be back very soon with the same pain. By not mentioning Tylenol the pain would generally be resolved–sometimes permanently.