Arly: first of all... i think that you have struck a very important note re: causallity of pain.... re the md... do you normally write med reports to attending physicians? if so then he gets a letter indicating what you did, what you found, discussion with ped andwith mother.... in the final analysis it is the mother who must make this decision... you can only inform her.... if you do not normally write to the attending's it is up in the air... if you write to him, what is your goal? if you can write very objectively adn not feel that you ahve bettered him, although you have, go ahead.... but think carefully about not creating an enemy ..... Patricia