I'm slowly gearing up to run a one-shot of Dread, but I'm finding myself a little wary of the elective pull rules. They feel a little "cheap" to me, and I'm not quite sure how often I should be bringing them up.
Here's the example given in the book:
A trained surgeon [...] may not know that the patient has a rare allergy to the anesthetic being used. In these cases, asking for another pull will most likely alert the player that there is something wrong. [...] In this case, the host may opt not to offer the pull. [...] If the player does ask to make an elective pull, the host can assume the character is investigating for further complications.
The adventure I'm planning on running has one elective pull spelled out. But the question I have is how often should I be adding elective pulls to the complications I create?
Is this something I should be trying to add in as often as possible, to help train the players to make the pulls (and give value to the pulls themselves)?
Or is it something that I should do fairly rarely, to help add impact when something does go horribly wrong?
Clarification: How often should I penalize the players for not taking/not thinking to take an elective pull? I.e. how often should situations like the one quoted above come up?