Thanks Mark. I had mistakenly thought this affected the monitor refresh rate.
Well, it tries to. Here's the basic idea:
1) Set display mode with requested refresh rate.
2) Check refresh rate is actually in effect, as not all refresh rates are supported on all cards and, even more fun, my ATI driver LIES!
3) If so, simply use vsync for game timing - all is nice and smooth.
4) If not, disable vsync and use custom timing - all is still fairly smooth.