I stand by what I said about pyloric stenosis. In my opinion, the approach we see today just is poor medicine. It means that every spitting up baby is getting ultrasounds. Instead of doing a history and physical examination, the doctor gets an ultrasound. Then to justify what he's done, the doctor has to do something more. So, he says "Well, luckily, the baby does not have a pyloric stenosis, but he must have reflux, so we'll put him on cisapride, or take him off the breast and give him rice and ABM". But I'm not saying never do an ultrasound, for crying out loud. I'm just saying that history and physical examination is a lost art. If physicians remembered about it, we would save the health system a bundle. And I do not practice according to the way the lawyers want me to. Believe me, if you spend your time discussing the issues with the parents, you will not get sued. Defensive medicine is dangerous for the patient. Jack Newman, MD, FRCPC