A cheap asset that grants a static boost to three (!) skills is an insane value. While it doesn’t help with , all the other stats help keep you alive against various treacheries and also for evasion. And it occupies the body slot, which is rarely contested by better options.

But the sanity hit is a concern, especially in a campaign which is famous for being brutal with dishing out horror.

There are some cards that make taking this an easy proposition. First are assets that can heal a horror each turn like Peter Sylvestre, Precious Memento, or Girish Kadakia. Having one of these lets you pretty much ignore the first point of horror that you suffer each turn. If it’s not your first trip down the Path to Carcosa you likely have considered these cards already.

Alternately, anyone running a soak-heavy build with allies or Cherished Keepsake, such as certain builds for William Yorick, Leo Anderson, or Tommy Muldoon. Your constant stream of disposables lets you shrug off horror onto assets.

Otherwise you take this card at your peril…

I know people are aware of how powerful Dr Milan is. I've now tried a few decks where i deliberately didn't take him. I can honestly say, this man is so incredibly powerful, that not taking him, is a deliberate, and non-power-gamey choice. If you want to win, and you are using book, and you have access to this man, there is no reason not to take him. Other allies can do other things, but this man helps you win the game, and gives you more money for doing so to help you play more things. He just combines 2 things you need in one card. I played a Trish deck most recently, that was still focused on using book. And I felt his absence. The lack of the boost to a baseline 5, and the lack of drip feed of economy was so painful it made me question my life choices. This is in a context where I consider Magnifying Glass just Forbidden for being too good. On the math, Mag glass is better than Milan since you never spent the 3 or 4 resources for him, saved an action, and you still get the boost. Milan at least means you have to consider the slot.

This man is too damn powerful, and, yes, you can win without him. But the difference between having him and not is so apparent each time. This card is S tier. If you think the game is too easy, just play without the good Dr. No need to go to Hard or Insane difficulty. Just adjust the player cards and remove the S tier options, and feel the difficulty rise.

As far as I am concerned, the worst part about this card by far is that Carolyn Fern has no way to take Miss Doyle. It would definitely not be a good deck, but collecting all the kitties would be fun.

As nckjnsn notes in his comment below, one of the great things about this card is it does no damage to allies on a miss. This is fantastic in multiplayer as it totally takes the sting out of swinging and hitting your buddies 2, and saves a lot of "let's Taunt, just to be safe" actions.

Brutally punishing location for Return to Carcosa. It pulls two copies of Visions in Your Mind straight into your hand. It’s likely that you won’t be able to meet the condition on one or both of these, leading to 2 direct damage and 2 direct horror.

Being direct means that soak isn’t possible, so packing along some sort of healing is appealing for this Return To!