Imagine that you have chest pain, and you call me for a suggestion. If the symptoms are mild — consistent with a pulled rib muscle, for example — I might recommend that you rest and take a mild anti-inflammatory drug. The risk is low, and the solution is both inexpensive and likely to solve your problem.
Now suppose that the next week you call to say that you have new chest symptoms, which are more significant, but still consistent with a mild problem, like esophageal reflux (heartburn). I might suggest an over-the-counter antacid, like Maalox, alone or in combination with an over-the-counter H2-receptor antagonist like famotidine (trade name Pepcid AC). The risk is still fairly low, the solution a little more expensive.
The next day, however, you tell me that you're having severe chest pain, which radiates down your arm, along with difficulty breathing. Before I even speak, you absolutely refuse to go to the hospital. What should I recommend?