jawsurgeryforums.com
Surgeon Information => Surgeon Reviews and Leads => Topic started by: ghiggson90 on August 08, 2019, 05:57:52 AM
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See the attached images. I have seen several surgeons engage in this ethically questionable practice (Antipov is another). It's problematic for at least three reasons:
(1) Conflict of interest: Employees are compensated by their employer and thus rely on their employer's economic success for their livelihoods. Consequently, they have economic incentives, albeit somewhat more attenuated than their employer's, to leave positive reviews. The impartiality of employee or employee/patient reviews is thus suspect.
(2) Undue influence: An employee or employee/patient might face adverse consequences for leaving negative reviews or not leaving a review at all for their employer. For this reason, the impartiality of an employee or employee/patient review must be questioned.
(3) Patient experience: If indeed the employee is a patient, the patient/employee has the benefit of day-to-day monitoring from the surgeon and if the employee's status as a patient is public, the employee becomes a visible exponent of the surgeon's work. For this reason, the employee/patient is likely to receive post-operative attention and care that might be different from that of the standard patient.
At a minimum, a patient reviewer who is an employee of a surgeon should disclose such relationship.
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Gunson is extremely overrated as is without possibly misrepresentative reviews ;D
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hey hold the f**k up. Jenae the receptionist actually had surgery with Gunson. She was 8 weeks post op when I went to see him for my consult, and she looked fantastic. She documents her entire process on her Instagram too, and wrote a congruent review of her experience. Yes shes lucky she works in his office but she took 2 weeks off just like anybody else and had her follow ups just like anyone else.
I also did notice another google review from someone who works at A&G but I dont know the full story there. I think you're right in that they should disclose theyre employees, but I dont think theyre obliged to, granted the review and experience with the office is authentic, which as far as I can tell, it seems to be.
PS. When i noticed the few familiar names (people I knew worked at A&G) on the reviews I decided to dive into the reviews on google and yelp and found that most of them seem legit as far as I can tell. The office only has so many employees after all.
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hey hold the f**k up. Jenae the receptionist actually had surgery with Gunson. She was 8 weeks post op when I went to see him for my consult, and she looked fantastic. She documents her entire process on her Instagram too, and wrote a congruent review of her experience. Yes shes lucky she works in his office but she took 2 weeks off just like anybody else and had her follow ups just like anyone else.
I also did notice another google review from someone who works at A&G but I dont know the full story there. I think you're right in that they should disclose theyre employees, but I dont think theyre obliged to, granted the review and experience with the office is authentic, which as far as I can tell, it seems to be.
PS. When i noticed the few familiar names (people I knew worked at A&G) on the reviews I decided to dive into the reviews on google and yelp and found that most of them seem legit as far as I can tell. The office only has so many employees after all.
The employees should still disclose their relationship to the employer when posting a review. It's definitely ethically questionable not to.
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See the attached images. I have seen several surgeons engage in this ethically questionable practice (Antipov is another). It's problematic for at least three reasons:
(1) Conflict of interest: Employees are compensated by their employer and thus rely on their employer's economic success for their livelihoods. Consequently, they have economic incentives, albeit somewhat more attenuated than their employer's, to leave positive reviews. The impartiality of employee or employee/patient reviews is thus suspect.
(2) Undue influence: An employee or employee/patient might face adverse consequences for leaving negative reviews or not leaving a review at all for their employer. For this reason, the impartiality of an employee or employee/patient review must be questioned.
(3) Patient experience: If indeed the employee is a patient, the patient/employee has the benefit of day-to-day monitoring from the surgeon and if the employee's status as a patient is public, the employee becomes a visible exponent of the surgeon's work. For this reason, the employee/patient is likely to receive post-operative attention and care that might be different from that of the standard patient.
At a minimum, a patient reviewer who is an employee of a surgeon should disclose such relationship.
You make some good points. But I would ask if the fact that she gave her real name in the review was a 'minimum' in disclosing her relationship to the doctor given the easy cross reference.
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You make some good points. But I would ask if the fact that she gave her real name in the review was a 'minimum' in disclosing her relationship to the doctor given the easy cross reference.
Would the average prospective patient identify such relationship when considering whether to have an initial consultation? No. Is it reasonable to expect an average prospective patient to conduct diligence to determine whether any reviewers have financial ties to the surgeon? No. Should the headline rating of a surgeon include the reviews left by patient-employees? Debatable. Is the burden on the reviewer to disclose far lower than the burden on prospective patients to conduct conflicts diligence? Yes.
She or Gunson should disclose, as is standard practice in other contexts.
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Gunson is extremely overrated as is without possibly misrepresentative reviews ;D
Who in the US would you say is better?
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Who in the US would you say is better?
"Better" is pretty subjective. Depends on what criteria.
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Would the average prospective patient identify such relationship when considering whether to have an initial consultation? No. Is it reasonable to expect an average prospective patient to conduct diligence to determine whether any reviewers have financial ties to the surgeon? No. Should the headline rating of a surgeon include the reviews left by patient-employees? Debatable. Is the burden on the reviewer to disclose far lower than the burden on prospective patients to conduct conflicts diligence? Yes.
She or Gunson should disclose, as is standard practice in other contexts.
I see she's on Yelp but didn't post the review there:
https://www.yelp.com/user_details?userid=mBB5GS-xqZ1bUbqiWHE2JQ
However, I also saw on yelp she voted for the positive reviews of other people.
Where did you find this review and is it STILL up?
Although I agree she should have disclosed her relationship but I would not hold Gunson's feet to the fire for her not doing so. She 'should have' known better. But maybe she didn't know any better. Have you established whether Gunson KNOWS of this. Litmus test would be to drop him a line telling him of it and see if he gets her to take it down assuming it's still up--is it still up?
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I see she's on Yelp but didn't post the review there:
https://www.yelp.com/user_details?userid=mBB5GS-xqZ1bUbqiWHE2JQ
However, I also saw on yelp she voted for the positive reviews of other people.
Where did you find this review and is it STILL up?
Although I agree she should have disclosed her relationship but I would not hold Gunson's feet to the fire for her not doing so. She 'should have' known better. But maybe she didn't know any better. Have you established whether Gunson KNOWS of this. Litmus test would be to drop him a line telling him of it and see if he gets her to take it down assuming it's still up--is it still up?
It’s still up. From the business page in Google search. Probably against Google’s review conflict of interest policy too.
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It’s still up. From the business page in Google search. Probably against Google’s review conflict of interest policy too.
OK. Just saw it up there. Best to tell him though in the event he might not know it's there because the only surefire way to know that he wants her to have it up there is to tell him it's there and then see if he gets her to remove it.
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Who in the US would you say is better?
Gunson has crippled me and was dishonest with me about how he screwed up my mandible. I would say Steve Sullivan has twice the amount of experience as gunson and is a much better surgeon. Reza Movahed is also top notch. Relle in CA.
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See the attached images. I have seen several surgeons engage in this ethically questionable practice (Antipov is another). It's problematic for at least three reasons:
(1) Conflict of interest: Employees are compensated by their employer and thus rely on their employer's economic success for their livelihoods. Consequently, they have economic incentives, albeit somewhat more attenuated than their employer's, to leave positive reviews. The impartiality of employee or employee/patient reviews is thus suspect.
(2) Undue influence: An employee or employee/patient might face adverse consequences for leaving negative reviews or not leaving a review at all for their employer. For this reason, the impartiality of an employee or employee/patient review must be questioned.
(3) Patient experience: If indeed the employee is a patient, the patient/employee has the benefit of day-to-day monitoring from the surgeon and if the employee's status as a patient is public, the employee becomes a visible exponent of the surgeon's work. For this reason, the employee/patient is likely to receive post-operative attention and care that might be different from that of the standard patient.
At a minimum, a patient reviewer who is an employee of a surgeon should disclose such relationship.
I have looked into this. Under the law, this is misleading advertising, both on the state and Federal Level. The Federal Trade Commission internet endorsement rules CLEARLY and unequivocally target this practice as unethical and misleading. It’s not just employees that have posted reviews for Gunson without identifying the business or personal relationship, he has his own daughter and her husband posting positive reviews on Google. Jenae has placed reviews on every major sites, as if she were assigned to do some social media marketing because she is an internet influencer with 20,000 followers. Also posted are a number of reviews from other staff, and from a number of orthodontists with him he works. ALL of it is misleading, unethical and improper—and its revealing that he is engaging in such tactics.
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OK. Just saw it up there. Best to tell him though in the event he might not know it's there because the only surefire way to know that he wants her to have it up there is to tell him it's there and then see if he gets her to remove it.
I have already told them about this and that they post reviews by orthodontists with whom they work and post reviews from his own daughter and her husband and other staff, when they took no action i posted on google stating that people should llook at the reviews carefully because they include staff, business associates and family members—would not be surprised if some of the other positive reviews were not legit. You can see these for yourself. I cant find my google review I think they got it taken down.
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You make some good points. But I would ask if the fact that she gave her real name in the review was a 'minimum' in disclosing her relationship to the doctor given the easy cross reference.
It actually has nothing to do with the fact that her real name is used. The nature of the advertising is that the relationship, business or personal must be disclosed. Also when people see the reviews they, dont know who she is, they also dont know that Hanna McComb is Gunson’s daughter or that Jenae works for him, its just wrong and its intentional.
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I've visited a lot of surgeons and still think Gunson has been the most technical/informative/helpful by far. My experiences with him line up with what the reviews say, but I haven't had surgery so my opinion isn't as important.
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I've visited a lot of surgeons and still think Gunson has been the most technical/informative/helpful by far. My experiences with him line up with what the reviews say, but I haven't had surgery so my opinion isn't as important.
I think he's simply operating at the limit of his ability. It's one thing to be able to draw up fancy plans, and another to execute them.
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I think he's simply operating at the limit of his ability. It's one thing to be able to draw up fancy plans, and another to execute them.
Would you do surgery with him?
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Would you do surgery with him?
No. Although the others may be even worse. Jaw surgery is just a risky business.
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Assuming (big if) Gunson is aware of this or even involved, I think what makes this all the more disappointing is that he is, at a minimum, an above-average surgeon, with many happy patients, has no shortage of business and makes millions a year. He doesn't need to do this. Of course, he makes thousands off a single surgery, and to the extent a single bad review turns away a single surgery, one can see the enormous incentives to suppress bad reviews or put up positive ones.
I'd agree he is overrated compared to say, a Wolford, who has pioneered multiple surgical techniques, like the step osteotomy, the modified BSSO cut, the use of porous HA for grafts, mentalis resuspension technique, etc., and is revered by other OMFS. Gunson is barely cited in the literature, but probably produces good results frequently. The reviewer in question has, I think, a good result, which makes her disclosing the relationship all the more costless. "Yes, I work for him, but my face speaks for itself, and my Instagram shows that he actually did do a surgery on me and that it was successful."
I suspect Google is in bed with the businesses on its pages. It has watered down its review COI policies over the years, for example, employee reviews used to explicitly be prohibited, now it just says reviews should be "honest and unbiased." We are sorely lacking a citizens watchdog group to police unethical medical advertising. Nobody is really policing this with any degree of effectiveness. The use of other OMFS's patients photos, conflicted reviews, fake reviews, unverified or ambiguous claims about the volume of publications or surgeries, stock photos, claims like "top surgeon", the absence of disclaimers, etc. The unethical practices are rampant. Medical advertising should inform, not manipulate. Frankly, this site is probably what comes closest to a watchdog, though it's also highly imperfect.
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It actually has nothing to do with the fact that her real name is used. The nature of the advertising is that the relationship, business or personal must be disclosed. Also when people see the reviews they, dont know who she is, they also dont know that Hanna McComb is Gunson’s daughter or that Jenae works for him, its just wrong and its intentional.
Well, personally, it's hard for me to establish willful intent on his part from this Jenae not knowing any better and possibility of his not realizing that was done. However if those with legal degrees want to establish willful intent on his part (or even hers), I have no objection to that discussion.
I'll try to put this 'diplomatically' but I DID check out her social media stuff and she just strikes me as a 'Me so Pretty...look at me.' type as in someone hired for LOOKS as opposed to 'smarts', in particular in reference to the ins and outs of guidelines for employee disclosure. I totally agree it was not a smart thing for her to do and a more knowledgeable employee would have known better at least IMO. But she did not strike me as the type who would have known better, particularly with reference to specific FTC guidelines of direct disclosure of association. However, by her using her real name that could be found in direct association as employee of Gunson, I don't know if I'd say she was willfully hiding any association either.
In general, my advice--or at least guideline I use--is to take reviews WITH A GRAIN OF SALT, in particular when it comes to venues where one is 'ONE AND DONE' with the review which is often the case with Google, YELP, rateMDS, VITALS and those types of places. Even applies to Real Self with the one and done reviews. Feedback on doctors is better garnered when discussion of such can be ongoing. For example a message/discussion board such as this.
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I have a theory that the recent influx of positive reviews has been in response to Kates very vocal expression of her disappointing experience with her surgery with Gunson. I say this because Nancy Christensen (who has been with A&G for like 35 years), Gunsons daughter and son in law, and Jenae all posted positive reviews in the past few months, as well as a few ortho and dental professionals as well. A disproportionate number of possitive reviews over the past 3 months vs a practice that has been around for decades.
What still strikes me as odd, is the negativity bias that is common in online reviews. Often 100 happy patients yields one happy review, but 100 unhappy patients yield 200 unhappy reviews. This is especially true for an oral surgeon, since a bad result can really ruin someones QOL.
If Gunson does 3-5 jaw surgeries/week, and has for his 17 year practice, where are all the unhappy reviews at?
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I have looked into this. Under the law, this is misleading advertising, both on the state and Federal Level. The Federal Trade Commission internet endorsement rules CLEARLY and unequivocally target this practice as unethical and misleading. It’s not just employees that have posted reviews for Gunson without identifying the business or personal relationship, he has his own daughter and her husband posting positive reviews on Google. Jenae has placed reviews on every major sites, as if she were assigned to do some social media marketing because she is an internet influencer with 20,000 followers. Also posted are a number of reviews from other staff, and from a number of orthodontists with him he works. ALL of it is misleading, unethical and improper—and its revealing that he is engaging in such tactics.
Here's the FTC site where they go over example of the GUIDELINES.
https://www.ftc.gov/tips-advice/business-center/guidance/ftcs-endorsement-guides-what-people-are-asking#onlinereviewprograms
They don't list the specific laws. But they say they don't monitor this stuff themselves but give option to file a complaint and imply they will evaluate case by case.
Here's one that seems to apply to this situation but with EXCEPTION that we don't know (or do we know for sure?) IF Gunson has a policy precluding employees from making reviews and not disclosing relationship.
Q: "Our company’s policy says that employees shouldn’t post positive reviews online about our products without clearly disclosing their relationship to the company. All of our employees agree to abide by this policy when they are hired. But we have several thousand people working here and we can’t monitor what they all do on their own computers and other devices when they aren’t at work. Are we liable if an employee posts a review of one of our products, either on our company website or on a social media site and doesn’t disclose that relationship?"
A: "It wouldn’t be reasonable to expect you to monitor every social media posting by all of your employees. However, you should establish a formal program to remind employees periodically of your policy, especially if the company encourages employees to share their opinions about your products. Also, if you learn that an employee has posted a review on the company’s website or a social media site without adequately disclosing his or her relationship to the company, you should remind them of your company policy and ask them to remove that review or adequately disclose that they’re an employee."
Also from the site:
"The Guides, at their core, reflect the basic truth-in-advertising principle that endorsements must be honest and not misleading. An endorsement must reflect the honest opinion of the endorser and can’t be used to make a claim that the product’s marketer couldn’t legally make."
IDK. Clearly, one could make an argument for non-disclosure. But I don't know where that goes with the FTC when it's not that clear cut that she's being dishonest, getting 'paid' (in some way) by him to put it up there or what's she saying doesn't reflect her honest opinion. It just looks like this was her honest opinion BUT she should have disclosed the relationship. But perhaps didn't know any better to do that. However, it does call into question whether or not Gunson has a POLICY aimed at PRECLUDING reviews of him by family, friends and employees. Now the answer to that could be 'NO, he doesn't'. (I don't know if he does or doesn't). But maybe he will get wind of this thread and clarify his policy of employees leaving reviews in absence of disclosing the relationship.
A really CLEAR CUT case, years back, was with 'LifeStyle Lift' where they had TONS of complaints about them. The Attorney General most definitely found non disclosure documents which were evidence that employees 'job' was to get on internet and post glowing reviews and counter patients complaining about their outcomes. Webmasters would also sent IP info that the glowing reviews were coming from the LSL office. So, I guess it would depend on the volume of complaints, webmasters themselves having enough of the problem coming from the office of the company where volume of complaints dovetail on FTC and AG looking more into it. In their case they were BLATANTLY DECEPTIVE, workers were required to give fake reviews and PRETEND to be happy patients and FIRED or threatened with legal action if they gave their honest opinion about the company.
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I have a theory that the recent influx of positive reviews has been in response to Kates very vocal expression of her disappointing experience with her surgery with Gunson. I say this because Nancy Christensen (who has been with A&G for like 35 years), Gunsons daughter and son in law, and Jenae all posted positive reviews in the past few months, as well as a few ortho and dental professionals as well. A disproportionate number of possitive reviews over the past 3 months vs a practice that has been around for decades.
What still strikes me as odd, is the negativity bias that is common in online reviews. Often 100 happy patients yields one happy review, but 100 unhappy patients yield 200 unhappy reviews. This is especially true for an oral surgeon, since a bad result can really ruin someones QOL.
If Gunson does 3-5 jaw surgeries/week, and has for his 17 year practice, where are all the unhappy reviews at?
Well ya. There has been an uptick of positive reviews subsequently where they resolve to associates in some way or the other. It's like people close to him could feel impelled to do so (share their positive but honest opinions) and could/would do so in absence of his 'putting them up to it'.
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I have a theory that the recent influx of positive reviews has been in response to Kates very vocal expression of her disappointing experience with her surgery with Gunson. I say this because Nancy Christensen (who has been with A&G for like 35 years), Gunsons daughter and son in law, and Jenae all posted positive reviews in the past few months, as well as a few ortho and dental professionals as well. A disproportionate number of possitive reviews over the past 3 months vs a practice that has been around for decades.
What still strikes me as odd, is the negativity bias that is common in online reviews. Often 100 happy patients yields one happy review, but 100 unhappy patients yield 200 unhappy reviews. This is especially true for an oral surgeon, since a bad result can really ruin someones QOL.
If Gunson does 3-5 jaw surgeries/week, and has for his 17 year practice, where are all the unhappy reviews at?
He hasn't done that many jaw surgeries. More than most surgeons his age, but not that many.
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Here's the FTC site where they go over example of the GUIDELINES.
https://www.ftc.gov/tips-advice/business-center/guidance/ftcs-endorsement-guides-what-people-are-asking#onlinereviewprograms
They don't list the specific laws. But they say they don't monitor this stuff themselves but give option to file a complaint and imply they will evaluate case by case.
Here's one that seems to apply to this situation but with EXCEPTION that we don't know (or do we know for sure?) IF Gunson has a policy precluding employees from making reviews and not disclosing relationship.
Q: "Our company’s policy says that employees shouldn’t post positive reviews online about our products without clearly disclosing their relationship to the company. All of our employees agree to abide by this policy when they are hired. But we have several thousand people working here and we can’t monitor what they all do on their own computers and other devices when they aren’t at work. Are we liable if an employee posts a review of one of our products, either on our company website or on a social media site and doesn’t disclose that relationship?"
A: "It wouldn’t be reasonable to expect you to monitor every social media posting by all of your employees. However, you should establish a formal program to remind employees periodically of your policy, especially if the company encourages employees to share their opinions about your products. Also, if you learn that an employee has posted a review on the company’s website or a social media site without adequately disclosing his or her relationship to the company, you should remind them of your company policy and ask them to remove that review or adequately disclose that they’re an employee."
Also from the site:
"The Guides, at their core, reflect the basic truth-in-advertising principle that endorsements must be honest and not misleading. An endorsement must reflect the honest opinion of the endorser and can’t be used to make a claim that the product’s marketer couldn’t legally make."
IDK. Clearly, one could make an argument for non-disclosure. But I don't know where that goes with the FTC when it's not that clear cut that she's being dishonest, getting 'paid' (in some way) by him to put it up there or what's she saying doesn't reflect her honest opinion. It just looks like this was her honest opinion BUT she should have disclosed the relationship. But perhaps didn't know any better to do that. However, it does call into question whether or not Gunson has a POLICY aimed at PRECLUDING reviews of him by family, friends and employees. Now the answer to that could be 'NO, he doesn't'. (I don't know if he does or doesn't). But maybe he will get wind of this thread and clarify his policy of employees leaving reviews in absence of disclosing the relationship.
A really CLEAR CUT case, years back, was with 'LifeStyle Lift' where they had TONS of complaints about them. The Attorney General most definitely found non disclosure documents which were evidence that employees 'job' was to get on internet and post glowing reviews and counter patients complaining about their outcomes. Webmasters would also sent IP info that the glowing reviews were coming from the LSL office. So, I guess it would depend on the volume of complaints, webmasters themselves having enough of the problem coming from the office of the company where volume of complaints dovetail on FTC and AG looking more into it. In their case they were BLATANTLY DECEPTIVE, workers were required to give fake reviews and PRETEND to be happy patients and FIRED or threatened with legal action if they gave their honest opinion about the company.
I was on a panel with a senior FTC enforcement officer and authored the comments to certain FTC Green guides. I can tell you these reviews go against the guidelines. Whether the FTC will get busy with a very small medical practice that is located way outside any metropolitan area is a different question. It WRONG, plain and simple and does not turn on the intent of the jenae. Also IMO, they engage in a number of misleading marketing practices. First they take before pictures with a big chunk of wax bite in the mouth that makes the improvement post-op look better. Also the California Dental Board prohibits use of the name of a legacy dentist who no longer is active in the practice after one year. (teaching alone is not active). Arnett has been inactive for several years. The website is misleading as it makes it looks like Arnett is still an active surgeon seeing patients. It lists Dr. Arnett has having privileges at cottage hospital, when cottage has told me he is retired. If you take the Arnett out of Arnett Gunson, the picture looks totally different. Dr. Gunson was a literature major and is not an innovator, and does not publish in peer review/prestigious academic publications. He is not a researcher and has published almost nothing as a lead author. His lectures are mostly to orthos regarding lips. I think he had a good mentor and fell into an incredible opportunity but now lacks a surgical partner. I am betting things will reveal themselves in time. There is a lot of smoke and mirrors going on here folks. If you believe for one minute gunson does not know that Jenae is posting these reviews, think again. He reviews, likes and dislikes his own yelp reviews. And he personally returns the favor of posting a positive review of the orthodontists that support him. He is in the social media game himself.
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Well ya. There has been an uptick of positive reviews subsequently where they resolve to associates in some way or the other. It's like people close to him could feel impelled to do so (share their positive but honest opinions) and could/would do so in absence of his 'putting them up to it'.
Trust me, he puts them up to it. I have personal knowledge of this.
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I was on a panel with a senior FTC enforcement officer and authored the comments to certain FTC Green guides. I can tell you these reviews go against the guidelines. Whether the FTC will get busy with a very small medical practice that is located way outside any metropolitan area is a different question. It WRONG, plain and simple and does not turn on the intent of the jenae. Also IMO, they engage in a number of misleading marketing practices. First they take before pictures with a big chunk of wax bite in the mouth that makes the improvement post-op look better. Also the California Dental Board prohibits use of the name of a legacy dentist who no longer is active in the practice after one year. (teaching alone is not active). Arnett has been inactive for several years. The website is misleading as it makes it looks like Arnett is still an active surgeon seeing patients. It lists Dr. Arnett has having privileges at cottage hospital, when cottage has told me he is retired. If you take the Arnett out of Arnett Gunson, the picture looks totally different. Dr. Gunson was a literature major and is not an innovator, and does not publish in academic publications. He is not a researcher and has published almost nothing as a lead author. His lectures are mostly to orthos regarding lips. I think he had a good mentor and fell into an incredible opportunity but now lacks a surgical partner. I am betting things will reveal themselves in time. There is a lot of smoke and mirrors going on here folks. If you believe for one minute gunson does not know that Jenae is posting these reviews, think again. He reviews, likes and dislikes his own yelp reviews. And he personally returns the favor of posting a positive review of the orthodontists that support him. He is in the social media game himself.
Well, as I said in my post and link to FTC guidelines, they give OPTION to FILE a COMPLAINT. You have one, are knowledgeable legally to buttress one, have information on him that counters general 'uncertainty' as to whether or not he puts his staff up to posting reviews. It very much sounds you are in capacity to lodge a complaint with the FTC.
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sorry to hear that, i checked out wolford and he has negative reviews
Surgeons are humans. Wolford is one of the best in the world. A true innovator in TMJ dysfunction management and pathology. But he is human, and as the best in the world, hes dealing with some of the most difficult cases. Human biodiversity is vast as f**k and any surgery has a certain level of uncertainty.
I was reading a paper the other day about a girl who was in for routine tooth extraction but had some artery structure running under the tooth. After extraction, she started bleeding like a gunshot wound and spent 2 weeks in the ICU. I bet she wrote a negative review.
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That's how it works with every business. Also, most surgeons let their assistant do the surgery and only supervise. They have too much demand to do the surgery themselves.
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That's how it works with every business. Also, most surgeons let their assistant do the surgery and only supervise. They have too much demand to do the surgery themselves.
Pretty sure that's how I copped all my nerve damage.
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Pretty sure that's how I copped all my nerve damage.
Sorry to hear.
How do you know that was caused by an assistant instead of the surgeon?
By the way, I wouldn't trust reviews online. I think these are more important 'cues':
- how may clients visit the surgeon? If the place is packed with clients, chances are there has been alot of good word of mouth. Still, there are exceptions when for example there is multiple surgeons working at the place. You won't know who came for who.
- how perfectionist is the surgeon? If he takes alot of time to look at your face and design the plan it's better than doing it fast. It often really really is a matter of millimeters.
- in office results of previous procedures
- experience with the specific procedure. The more mistakes the surgeon made, the better, cause we learn from mistakes.
All other things like: is the surgeon nice, does he have social skills, does the office looks good, are the assistants polite, does the surgeon react fast, etc. It doesn't say anything about the quality of the work.
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- how perfectionist is the surgeon? If he takes alot of time to look at your face and design the plan it's better than doing it fast. It often really really is a matter of millimeters.
This is something I should’ve paid more attention to. I don’t know what sort of software Posnick uses, but during my ‘surgical planning appointment’ he was just eyeballing it.
He had me wear some head appliance and also put something between my teeth to see if I had a cant. He just sort of looked at it and then asked his fellow if he saw anything. He did this for a few different measures.
He also gave me a range of 8-12mm and asked me on the spot how far I wanted to be advanced. 8mm according to the clinical photos and 12mm according to the software. I just said 10mm because I didn’t know any better.
I don’t know how other surgeons do their planning, but in retrospect this seems a little off the cuff to me. Not necessarily wrong I guess, just haphazard from the patient perspective.
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This is something I should’ve paid more attention to. I don’t know what sort of software Posnick uses, but during my ‘surgical planning appointment’ he was just eyeballing it.
He had me wear some head appliance and also put something between my teeth to see if I had a cant. He just sort of looked at it and then asked his fellow if he saw anything. He did this for a few different measures.
He also gave me a range of 8-12mm and asked me on the spot how far I wanted to be advanced. 8mm according to the clinical photos and 12mm according to the software. I just said 10mm because I didn’t know any better.
I don’t know how other surgeons do their planning, but in retrospect this seems a little off the cuff to me. Not necessarily wrong I guess, just haphazard from the patient perspective.
Most of them just eye ball things. Yet we have to wear it. Mine did not use "computers".
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This is something I should’ve paid more attention to. I don’t know what sort of software Posnick uses, but during my ‘surgical planning appointment’ he was just eyeballing it.
He had me wear some head appliance and also put something between my teeth to see if I had a cant. He just sort of looked at it and then asked his fellow if he saw anything. He did this for a few different measures.
He also gave me a range of 8-12mm and asked me on the spot how far I wanted to be advanced. 8mm according to the clinical photos and 12mm according to the software. I just said 10mm because I didn’t know any better.
I don’t know how other surgeons do their planning, but in retrospect this seems a little off the cuff to me. Not necessarily wrong I guess, just haphazard from the patient perspective.
I don't know what kind of software Posnick uses these days other than to say I know he used to do it the classic or 'old fashion' way which before the advent of VSP was a good way such as hand tracing of the cephs, hand drawn proposals and doing the surgery on model blocks. In fact a lot of articles by him on line show the plaster cast model blocks of the teeth.
I know (or have very good reason to believe) Gunson uses something called 'NemoFAB'. The FAB part stands for Face Airway and Bite. It is software designed with and in accordance to the Arnett analysis. They are out of Madrid, Spain. Nemo software even had a symposium named after Arnett. https://nemouniversity.nemotec.com/en/first-european-arnett-orthognathic-surgery-forum-symposium/
I think a good number of other Spanish and/or Euro docs use this software too.
Their 'Nemo' site used to have a video of Arnett explaining sleep apnea cases and how to maximize the aesthetics along with airway opening. But I can't find that on there anymore.
Doctors who use a high tech software program for planning will usually give you a ceph read out along with a 2D displacement diagram or sometimes a 3D VSP. It might not be the 'final' plan (because final plan is contingent on the braces getting you into the position they want). But it shows they are using very modern software for planning (as opposed to eyeballing or winging it on table).
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I don't know what kind of software Posnick uses these days other than to say I know he used to do it the classic or 'old fashion' way which before the advent of VSP was a good way such as hand tracing of the cephs, hand drawn proposals and doing the surgery on model blocks. In fact a lot of articles by him on line show the plaster cast model blocks of the teeth.
I know (or have very good reason to believe) Gunson uses something called 'NemoFAB'. The FAB part stands for Face Airway and Bite. It is software designed with and in accordance to the Arnett analysis. They are out of Madrid, Spain. Nemo software even had a symposium named after Arnett. https://nemouniversity.nemotec.com/en/first-european-arnett-orthognathic-surgery-forum-symposium/
I think a good number of other Spanish and/or Euro docs use this software too.
Their 'Nemo' site used to have a video of Arnett explaining sleep apnea cases and how to maximize the aesthetics along with airway opening. But I can't find that on there anymore.
Doctors who use a high tech software program for planning will usually give you a ceph read out along with a 2D displacement diagram or sometimes a 3D VSP. It might not be the 'final' plan (because final plan is contingent on the braces getting you into the position they want). But it shows they are using very modern software for planning (as opposed to eyeballing or winging it on table).
Can confirm about the plaster models- he took moulds of my teeth pre-op
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Can confirm about the plaster models- he took moulds of my teeth pre-op
This is normal. All surgeons do (or at least should) a practice surgery with models. At the end of the day it's all about the bite. If the bite splint fits, then "Grate Success!".
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All surgeons are guided by a bite splint during surgery, they need to be. But the splint is representative of the plan. So the difference between a good and bad surgeon is in the design of that splint (i.e the plan) - good surgeons will make sure that bite fits in the most ideal position in the face, while bad surgeons don't give a f**k about your face. So for example, a splint for a 'linear DJS plan' and a splint for a 'CCW DJS plan' will both guide the bite to fit together, but the splints will be shaped differently.
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- how perfectionist is the surgeon? If he takes alot of time to look at your face and design the plan it's better than doing it fast. It often really really is a matter of millimeters
I wish all surgeons were perfectionists with analysis/planning. Like you shouldn't even be allowed to operate on someone's face unless you're meticulous.
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I wish all surgeons were perfectionists with analysis/planning. Like you shouldn't even be allowed to operate on someone's face unless you're meticulous.
Perfectionism = more costs. For example, alot of surgeons work with assistants. When you deal with a business, you can choose to hire a mediocre but cheap assistant or a high level but expensive assistant. Sometimes a surgeon lets his assistant do the surgery under his supervision. You can complain about this, but it's just how the business works. If an assistant never does the real work, he will never learn how to do it. Other problems are: if an assistant is really good, he will want to go set up his own office. How do you keep loyalty?
If a surgeon is very perfectionistic, he will hire a great assistant and supervise him tightly. Sometimes, assistants do have more skills than the supervisor. And I mean, with skills: natural talent/artistic eye. They still lack the experience of the supervisor, but a good assistant learns fast.
These things are way more important than: this surgeon is a nice guy and listens blabla. The fact that a surgeon is a nice guy or socially adept is of no importance when it comes to quality.
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Perfectionism = more costs. For example, alot of surgeons work with assistants. When you deal with a business, you can choose to hire a mediocre but cheap assistant or a high level but expensive assistant. Sometimes a surgeon lets his assistant do the surgery under his supervision. You can complain about this, but it's just how the business works. If an assistant never does the real work, he will never learn how to do it. Other problems are: if an assistant is really good, he will want to go set up his own office. How do you keep loyalty?
If a surgeon is very perfectionistic, he will hire a great assistant and supervise him tightly. Sometimes, assistants do have more skills than the supervisor. And I mean, with skills: natural talent/artistic eye. They still lack the experience of the supervisor, but a good assistant learns fast.
These things are way more important than: this surgeon is a nice guy and listens blabla. The fact that a surgeon is a nice guy or socially adept is of no importance when it comes to quality.
Do you realize Gunson’s assistant is not a surgeon, she has no real surgical training and is pretty meek, never gives input, she works part time and has a background in aesthetic fillers. He used to have a surgical partner. I am also not sure of the software used since arnett retired.
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Do you realize Gunson’s assistant is not a surgeon, she has no real surgical training and is pretty meek, never gives input, she works part time and has a background in aesthetic fillers. He used to have a surgical partner. I am also not sure of the software used since arnett retired.
OK, Thats simply not true. She has been a PA and Surgical Assistant since 1999 in orthopedic surgery, emergency care and dermatological surgery.
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Do you realize Gunson’s assistant is not a surgeon, she has no real surgical training and is pretty meek, never gives input, she works part time and has a background in aesthetic fillers. He used to have a surgical partner. I am also not sure of the software used since arnett retired.
OK, Thats simply not true. She has been a PA and Surgical Assistant since 1999 in orthopedic surgery, emergency care and dermatological surgery.
Physician assistants, although not surgeons themselves, have a type of training where they can assist in surgeries, and other aspects of med care.
Ref= https://www.learnhowtobecome.org/physician-assistant/
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Surgical PAs are highly qualified. PA school is essentially an abbreviated MD program and requires at least 2k hours of practical experience to graduate. I believe they also require continuing education to maintain their certifications, similar to CPAs (my profession). My girlfriend is looking at PA programs right now and it's highly competitive.
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Surgical PAs are highly qualified. PA school is essentially an abbreviated MD program and requires at least 2k hours of practical experience to graduate. I believe they also require continuing education to maintain their certifications, similar to CPAs (my profession). My girlfriend is looking at PA programs right now and it's highly competitive.
I must be missing someone, I called the California medical board and she is a PA, a member of the AAPA, not the AASPA—there is indeed a difference in training for a straight PA and a surgical PA. I had probably more than 30 visits and had no diagnostic input on any occasion—Even on her own linkedin, she does not tout any real surgical experience. https://www.linkedin.com/in/lori-heinze-78642876/?locale=de_DE. She works part time and teaches barre class at Barre3 in Santa Barbara, so its very different than a surgical partner. Is my information wrong?
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I must be missing someone, I called the California medical board and she is a PA, a member of the AAPA, not the AASPA—there is indeed a difference in training for a straight PA and a surgical PA. I had probably more than 30 visits and had no diagnostic input on any occasion—Even on her own linkedin, she does not tout any real surgical experience. https://www.linkedin.com/in/lori-heinze-78642876/?locale=de_DE. She works part time and teaches barre class at Barre3 in Santa Barbara, so its very different than a surgical partner. Is my information wrong?
I don’t know about her specifically, I just assumed she was a surgical PA
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I must be missing someone, I called the California medical board and she is a PA, a member of the AAPA, not the AASPA—there is indeed a difference in training for a straight PA and a surgical PA. I had probably more than 30 visits and had no diagnostic input on any occasion—Even on her own linkedin, she does not tout any real surgical experience. https://www.linkedin.com/in/lori-heinze-78642876/?locale=de_DE. She works part time and teaches barre class at Barre3 in Santa Barbara, so its very different than a surgical partner. Is my information wrong?
As to membership in AAPA vs AASPA:
It would depend on whether or not being a member of one but not the other precluded any assistance during surgery. That is to say, is it contingent she be a member of AASPA to provide any assistance during a surgery?
A cross reference with AAPA.org as to such dependencies yielded the following info:
According to: AAPA.org https://www.aapa.org/what-is-a-pa/
Scrolling down to the question: 'What do PAs do?', one of the answers is:
'Assist in surgery'
Further cross reference with AASPA.com https://www.aaspa.com/about-surgical-pas
Scrolling down to Duties & Responsibilities, 2 of the answers are:
'Performs First Assist duties in surgery'
'Performs minor surgical procedures'
Given the first bone of contention of her not being a surgeon herself was addressed, (PAs are not surgeons themselves but are qualified to assist in surgeries), what's 'MISSING' here is WHAT your specific complaint actually is.. as it would relate to any impropriety
of Gunson having this PA 'assist in surgery' ?
a: Does teaching a barre class or only working part time as PA and not actually being his surgical 'PARTNER'*, disqualify her from what PA training qualifies her to do; TO ASSIST IN SURGERY?
* The term 'surgical PARTNER', for all intents and purposes would refer to another SURGEON. eg. Gunson was Arnett's surgical partner
b: Do you have any details as to how the extent of her surgical assistance EXCEEDED her capacities. For example, did she PLAN the surgery or perform a significant part of it?
* If the problem was that you got no specific diagostic imput directly from her, that would be consistent with her NOT exceeding her capacities whereas as AASPAs do interpret diagnostic studies.
c: Is this something where you feel; IF not for her existence, at all, as his PA, your results would have been better?
d: Is there a preponderance of circumstances where patients who have had surgery with Gunson, when THIS particular PA was in his employment, have had poor outcomes?
So.....WHAT is your specific complaint about his having her as his PA where specifics of such would DIRECTLY relate to any IMPROPRIETY on his part for having her in his employ?
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I am not answering these questions in the public form. You misunderstood many of my comments. I will say though that the truth will come out about this practice.
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That's OK. We can leave them as rhetorical ones.
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She does.
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She does.
Who wouldn't?
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Well I have surgery coming up with him, so fingers crossed...still full of buyers remorse just thinking about all the other options and possible outcomes.
I will say despite reading this and being very worried and scared, his staff has been nothing but great when it comes to my questions or concerns.
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I will say despite reading this and being very worried and scared, his staff has been nothing but great when it comes to my questions or concerns.
I agree. I've only had a digital consult, but they've been helpful and attentive in answering my questions. Lori especially.
I've not had the same level of attentiveness from any other maxfac offices I've consulted with.
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Supporting team and website don't say anything about the quality of the surgeon. How nice they are or how quick they respond to your questions: nothing of that is of any importance when it comes to the outcome of the surgery. Qualified assistant that has a very good eye for aestethics: yes, very important. All other things, for example how nice the surgeon is, or how beautiful the building is, may seem very important for patients, but it's a pitfall.
Other things that aren't really important or have almost no value:
- Online reviews (zero importance; many fake reviews; one bad review might kill the reputation of a surgeon while having done many other succesfull procedures).
- Many online articles (that's theory, only practice counts)
- A surgeon talking about his knowledge (everyone can do the talk. You can be a very good talker but a bad surgeon. Technical skills in practice = only thing that counts)
- Online results (surgeons post their best results)
Only hard proof might give clues:
- in office results (ask as many as possible)
- other patients' experience and results
- experience. How much experience does a surgeon have with that specific procedure?
- perfectionism (very difficult to know if a surgeon is a perfectionist, but there are 'certain clues'
- how many patients? Too much patients = less time for you. Too little patients: there might be something wrong?
- how good is his assistant? (We don't know) Does this assistant has to prove himself?
Honesty might sometimes be a factor that's correlated with quality as well.
There are also alot of factors that unfortunately have to do with luck:
- Technical unexpected difficulties during the surgery that hinder the surgeon achieving the 'ideal' result
- A surgeon having a bad day
- Encountering a surgeon during a certain period of his life when he lost his passion
And many other factors of luck.
You might get better results when something is 'at stake' for the surgeon, if he has to prove himself for somekind of reason. The more time someone spends on you, the better the results (usually). That goes for every service. Time = quality for you, time = costs for the surgeon. Are you a special client or just a number?
Money doesn't do the trick. You could offer a surgeon more money, you won't get better results. Money never does the trick. Offering more money is a sign of weakness.
The problem with consumers in general is that they look at all the wrong signs when choosing a service: online reviews (highly manipulated), how nice employees are ('she's treating me nice, it must be a good business'. Really?), the website (superficial stuff, it's very cheap to build a fancy website), the building (there's no correlation between how nice a building looks and the surgeon's skill). All these kind of stupid, superficial stuff.
That being said, there's never any guarantee you get the results you want, even if all signs are good.
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When you start to look behind the gloss, you see a lot of unimpressive stuff and borderline if not actual fraud. In California, you are not supposed to use the name of dentist that has retired from active practice for more than a year after departure, its been several years and the website (which was actually recently updated) talks about Arnett like he is still operating and available to patients. The website even says he has privileges at Cottage when Arnett does not. Also Jenae posted a review on yelp today. No disclosure.
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Supporting team and website don't say anything about the quality of the surgeon. How nice they are or how quick they respond to your questions: nothing of that is of any importance when it comes to the outcome of the surgery. Qualified assistant that has a very good eye for aestethics: yes, very important. All other things, for example how nice the surgeon is, or how beautiful the building is, may seem very important for patients, but it's a pitfall.
Other things that aren't really important or have almost no value:
- Online reviews (zero importance; many fake reviews; one bad review might kill the reputation of a surgeon while having done many other succesfull procedures).
- Many online articles (that's theory, only practice counts)
- A surgeon talking about his knowledge (everyone can do the talk. You can be a very good talker but a bad surgeon. Technical skills in practice = only thing that counts)
- Online results (surgeons post their best results)
Only hard proof might give clues:
- in office results (ask as many as possible)
- other patients' experience and results
- experience. How much experience does a surgeon have with that specific procedure?
- perfectionism (very difficult to know if a surgeon is a perfectionist, but there are 'certain clues'
- how many patients? Too much patients = less time for you. Too little patients: there might be something wrong?
- how good is his assistant? (We don't know) Does this assistant has to prove himself?
Honesty might sometimes be a factor that's correlated with quality as well.
There are also alot of factors that unfortunately have to do with luck:
- Technical unexpected difficulties during the surgery that hinder the surgeon achieving the 'ideal' result
- A surgeon having a bad day
- Encountering a surgeon during a certain period of his life when he lost his passion
And many other factors of luck.
You might get better results when something is 'at stake' for the surgeon, if he has to prove himself for somekind of reason. The more time someone spends on you, the better the results (usually). That goes for every service. Time = quality for you, time = costs for the surgeon. Are you a special client or just a number?
Money doesn't do the trick. You could offer a surgeon more money, you won't get better results. Money never does the trick. Offering more money is a sign of weakness.
The problem with consumers in general is that they look at all the wrong signs when choosing a service: online reviews (highly manipulated), how nice employees are ('she's treating me nice, it must be a good business'. Really?), the website (superficial stuff, it's very cheap to build a fancy website), the building (there's no correlation between how nice a building looks and the surgeon's skill). All these kind of stupid, superficial stuff.
That being said, there's never any guarantee you get the results you want, even if all signs are good.
While in the abstract, what you say makes sense. However if someone who is supposed to me one of the best surgeons in the world engages in misleading and or careless claims in glossy marketing, you can be sure that the practice of misleading patients does not stop at the marketing. I am biased of course because i was horribly mislead in addition to having my mandible destroyed by gunson. I am collecting everything and it will all be for public view. (Covers up mistakes and blames outcomes on made up diagnostics—-has an answer for everything, bald face lies to patients) I think it was Dan Rather who once said that Truth is like sharp stick in the eye.
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I don't think it's specific to her or a reflection of the practice. Having lived in California for over a decade, I can say that's simply the culture and personality. Californians can't seem to get close to one another and be "real" and everything is kept superficial and at arms length. It's weird.
I am from the east coast originally and IMO, the practice is culturally a bit beyond the usual California culture (which i agree with, btw). I met a patient who flew in from Europe for surgery and cancelled her surgery—remarked that the office was like Stepford (for anyone below 40, you probably need to google that) Another patient recently said something similar. I actually had a good working relationship with Gunson, and a lot of trust and faith through what i thought was simply a difficult recovery. Ironically, I even helped him out—-to address a negative yelp review. I had this expertise because I had performed legal work for yelp years ago and knew the founder Jeremy Stoppelman and I lectured on the topic in the real estate development industry. Also, i think that it will turn out that he has a serious memory problem and mixes patients up—too much on the plate.
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Lori dosnt do any bone cutting. Shes mainly just acting as steady hands for holding tools, and most importantly, an aesthetic eye.
My experience with Jenae has been the opposite, she was a few months post op when I met her and she has always been friendly and helpful.
As to Gunson not being in this position without arnett, sure thats probably true. I wouldent be an engineer if it wasnt for my 11th grade physics teacher. As clinical practices like engineering or surgery progress, the skills get passed down and improved on. I do wish Arnett was still assisting surgeries though.
My Experience with the office for the most part is positive. They helped me find an ortho, helped me interpret my sleep study results (public healthcare docs are useless) and always answer my questions as best they can.
I will say that all this has scared me from booking surgery. Luckily im not in braces so I have time to research and let things unfold.
Here is he question you need to ask yourself, if you paying 60-80k for surgery and what showed up on my bill as an assistant surgeon, in the event that something goes wrong, would you not not expect a trained (even if young surgeon or star fellow) experienced second set of eyes and hands right there along side Gunson as opposed to someone who can steady a tool and look at the aesthetics of things at surgery? Also, it would have been nice to have a surgical partner to review my case and give guidance or at least input with all the post op complications. I even asked if we could meet with Arnett to review my case....that was right before he terminated me as a patient.
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To me, from where i sit now, the whole practice is like a Hollywood movie set. When you start to look behind the gloss, you see a lot of unimpressive stuff and borderline if not actual fraud. In California, you are not supposed to use the name of dentist that has retired from active practice for more than a year after departure, its been several years and the website (which was actually recently updated) talks about Arnett like he is still operating and available to patients. The website even says he has privileges at Cottage when Arnett does not. Also Jenae posted a review on yelp today. No disclosure. I reported it.
This is how the world works these days. Everyone have Instagram accounts and Facebook pages where everything looks so easy and 100% perfect results. We have this technology, look at this result etc. Same as when you look at anyone's Instagram account, no ones life corresponds to how they portray it in social media.
If you start reading up on all of this and understand what these procedures really are and what it means to be a surgeon, you also realise it's really not that glamorous. Firstly, it's not that a surgeon is a superman and that no one else could learn or understand what they do. Like Kavan use to say, it all mostly resolves to basic geometry. It surely takes practise and experience to become an expert, but so does a lot of professions. I'd say with the level of interest and knowledge of some people on this board, they could pick up the practical parts pretty fast and become good surgeons or orthodontists. Interest makes better professionals than education.
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Like Kavan use to say, it all mostly resolves to basic geometry.
DOES say, with regularity.
If you can wrap your head around the basic movements and rotations, you’re better off than 90% of patients. Basic trig will get you far when it comes to JS.
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DOES say, with regularity.
If you can wrap your head around the basic movements and rotations, you’re better off than 90% of patients. Basic trig will get you far when it comes to JS.
Sometimes I don't know if it's better to not know. What it does to me is that I want to involve my self in the planning and ask way too many questions, which is a big no no for many surgeons.
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Sometimes I don't know if it's better to not know. What it does to me is that I want to involve my self in the planning and ask way too many questions, which is a big no no for many surgeons.
Those are probably not surgeons you want to deal with then. At the very least, this knowledge gives you the tools to evaluate any plan you are presented with on a basic level.
I did ‘some’ research before my own surgery, but did not find this forum until I researched the side effects I was unhappy with. Pre-0p I basically succumbed to the “ante face = good” meme and thought the only other concern might be tooth show. I didn’t even understand what the occlusal plane was; much less rotational movements. I had no idea any of that existed or was important. I think we on this forum forget how ‘arcane’ this might seem to someone just getting into JS.
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Those are probably not surgeons you want to deal with then. At the very least, this knowledge gives you the tools to evaluate any plan you are presented with on a basic level.
I did ‘some’ research before my own surgery, but did not find this forum until I researched the side effects I was unhappy with. Pre-0p I basically succumbed to the “ante face = good” meme and thought the only other concern might be tooth show. I didn’t even understand what the occlusal plane was; much less rotational movements. I had no idea any of that existed or was important. I think we on this forum forget how ‘arcane’ this might seem to someone just getting into JS.
I only had an inkling that I have a steepish occlusal plane. I thought that all this OP plane talk here was for "difficult LFS" cases and CCW boiled down to anterior impaction. It was more than a year after my surgery and more than 2.5 years after I registered here that I learned that the OP could be manipulated with posterior downgrafting as well.
I got the same verbal "plan" from almost every surgeon. The only exception being one surgeon, who suggested setback of the lower as well. I thought my case was easy. Little did I know that Australia is an absolute bush league when it comes to jaw surgery. Some borderline developing countries have more progressive surgeons.