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Medical Forum / General / Dentistry / May 2006

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How reliable are peer referrals?

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abc - 21 Mar 2006 00:57 GMT
I am new to the town (Seattle) and have some challenging and expensive
dental work to be (re)done. Don't know how to even approach finding a
good dentist. So here are some options:

* Peer referrals (from a pediatric dentist in my case). Pros: doctors
know each other well. Cons: do they trade favors & refer patients not
to the dentists they believe are the best, but to those who refer most
patients to them?

* Doctoroogle.com: Cons: not enough data; some big fan of a particular
dentist could easily post 10 positive reviews.

* Patient referrals: have not had good luck with those in the past.

Help!
Mark & Steven Bornfeld - 21 Mar 2006 01:55 GMT
> I am new to the town (Seattle) and have some challenging and expensive
> dental work to be (re)done. Don't know how to even approach finding a
[quoted text clipped - 11 lines]
>
> Help!

    I can't speak for other dentists.  I know I wouldn't steer a patient of
mine to a bum.  And I can't think of a reason nearly good enough to
steer a patient to a bum.  I don't care how expensive the Christmas
presents are.  Referring a patient to a bum will only come back to bite
you in the a.s.  Therefore---I'd never refer to a bum.
    I would take a strong patient referral way ahead of Dr. Oogle too, esp.
if you know and trust the patient.

Steve

Signature

Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

abc - 21 Mar 2006 02:36 GMT
Thanks Steve,

To a bum, sure, but how do you find the best doc in town? I do have a
very complicated case, thanks to one fresh out of school dentist who
nearly ruined my front teeth years ago. I am tired of having to redo my
teeth over and over and would hand out any sum of money to just get it
done and forget about it.

I came across one dentist who is widely known to be (one of) the best
in town, teaches in a good university, is a Ph.D. among other things
and all; however, he was not all that good cosmetically for some
reason. And now, like I've said, I am in a new town; and, just like
he's warned me, the root has finally cracked. So, where are the local
best doctors to be found?

Seattle Magazine has just published its "100 best dentists" directory,
based on peer reviews  - is it a way to go? I thought so; then, I found
someone who's made it to 100 best, but is not booked at all, so the
patients apparently disagree... hmm. The more I think about it, the
more lost I am.

Sorry if I sound paranoid or something. Choosing a new dentist is like
blind date, really, only worse, as you have, arguably, less control
over the consequences.
Mark A - 21 Mar 2006 03:19 GMT
> Thanks Steve,
>
[quoted text clipped - 3 lines]
> patients apparently disagree... hmm. The more I think about it, the
> more lost I am.

There is a magazine in Denver that published the same information. But when
I called the "best cosmetic dentist in Denver" they informed me that the
original dentist is not accepting any new patients and his practice was
taken over by another dentist, but that the original dentist would not have
done that unless the new dentist was very, very good.

The new dentist was a quack who loosened a crown during a routine exam.  So
people will do anything for money, especially if they are retiring. Beware.
Mark & Steven Bornfeld - 21 Mar 2006 15:58 GMT
> Thanks Steve,
>
[quoted text clipped - 20 lines]
> blind date, really, only worse, as you have, arguably, less control
> over the consequences.

    There is no one best doc in town.  The best one for you is the one who
is caring, empathetic, spends time determining what is best for what
your particular needs are, considering your clinical picture, special
requests, time and money issues.  He/she knows what they can do, and
(maybe more important) what they cannot do well, and when to refer.
    First off, they have to be able to sit down with you and determine if
what you are looking for is realistic, and where is the best place for
you to get as close to the best result you can--keeping in mind your
past history, current condition, general health, capacity to spend the
required time in the chair, ability to prioritize treatment.
    I have had patients that I discover (better sooner, but unfortunately
sometimes later) would be better served going to another dentist, and I
refer them.  There is no magic here, and the fact that you apparently
have a complicated situation increases the chances that there is no one
magic dentist who is going to solve all your dental problems.
    But if you have a competend, caring individual who is truly committed
to getting you what you want (within the limits of what is good clinical
dentistry), they will do their best to get you from here to there.

Steve

Signature

Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

Bill - 21 Mar 2006 17:37 GMT
> Thanks Steve,

Steve has given good advice here -- be sure to read both of his
replies.

> To a bum, sure, but how do you find the best doc in town? I do have a
> very complicated case, thanks to one fresh out of school dentist who
> nearly ruined my front teeth years ago. I am tired of having to redo my
> teeth over and over and would hand out any sum of money to just get it
> done and forget about it.

One idea would be to check with a good prosthodontist. But again, the
problem is choosing WHICH prosthodontist. So it might be wise to simply
get evaluations and treatment plans from a couple of different
prosthodontists, as well as some general dentists too.

Multiple exams and treatment plans should start to form a pattern of
what is possible for your treatment, and what the best choices might
be.

> I came across one dentist who is widely known to be (one of) the best
> in town, teaches in a good university, is a Ph.D. among other things
[quoted text clipped - 5 lines]
> Seattle Magazine has just published its "100 best dentists" directory,
> based on peer reviews  - is it a way to go?

Who is in charge of the "peer reviews?" It's quite possible that the
results are skewed according to who was invited to make the reviews.

I thought so; then, I found
> someone who's made it to 100 best, but is not booked at all, so the
> patients apparently disagree... hmm.

Some of the very best dentists in my city are NOT booked months in
advance. They do not advertise loudly, they prefer to keep their
practices low-key and concentrate on the patient's treatment, not on
marketing.

And some of the worst dentists are fully booked, as they spend all
their time with buying advertising and exposure -- instead of investing
their time in their patients.

Many of the busiest dental offices in this region are busy because they
are cheap, sloppy, and have huge insurance contracts. The insurance
companies love them because they can ram a large volume of patients
through the mill in record time.

In my opinion it is better to avoid the offices that are busy-busy, and
aim for a dentist who has time to devote to you.

The more I think about it, the
> more lost I am.

You have a lot of company. Finding a good dentist can be complex.

> Sorry if I sound paranoid or something. Choosing a new dentist is like
> blind date, really, only worse, as you have, arguably, less control
> over the consequences.

You're not paranoid. Yet, you do have control over the consequences as
you have the freedom in this country to visit as many dentists as you
want before you make your selections. Many countries with state-run
health plans prohibit that, and you would be stuck with whatever the
local authorities want for you.

With a complex dental case, my advice is to obtain as many second
opinions as you are able, and to follow the advice of Steve regarding
the type of dentist that would be best for your health in the long run.

Best regards,
- dentaldoc
Mark & Steven Bornfeld - 21 Mar 2006 18:04 GMT
>>Thanks Steve,
>
[quoted text clipped - 11 lines]
> get evaluations and treatment plans from a couple of different
> prosthodontists, as well as some general dentists too.

   
Bill--

    I've heard the suggestion as well to check with dental labs.  It's an
intriguing concept--labs will see a facet of dental care that even
colleagues will not be aware of.
    But it's only one factor.  A good lab tech will have some evidence of
the level of skill and care, but it tells you nothing about diagnostic
skills and little about appropriateness of care.
    The "best doctors" lists would be amusing, if people didn't take them
so seriously.  They really do appear to be more like popularity contests
than anything else.
    When we picked our daughter's pediatrician, he had a framed copy of
"the best doctors in New York" on his wall, with his name circled.  We
used him anyway.  ;-)
    The next year he wasn't included again.  We were going to ask him if we
should therefore switch doctors, but we didn't.

Steve

> Multiple exams and treatment plans should start to form a pattern of
> what is possible for your treatment, and what the best choices might
[quoted text clipped - 57 lines]
> Best regards,
> - dentaldoc

Signature

Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

Bill - 22 Mar 2006 08:01 GMT
> Bill--
>
[quoted text clipped - 14 lines]
>
> Steve

Steve,

There is a dentist in my town who frequently runs a newspaper ad which
touts him as "Voted the Best Dentist in San Diego." The county does
have over 2000 dentists, but only about 60 here in the town that I
share with him. I've been here over 30 years and I had never heard of
him until he started to run the ad. Most of my colleagues have never
met him either.

It seems that the vote was taken by a newspaper that has a telephone
system set up to record votes that are dialed in. Anybody can dial the
"vote" number as many times as they want in that kind of system.

Now if only we could vote that way for city council, I'd be the mayor
tomorrow!

Best regards,
Bill
Steven Bornfeld - 22 Mar 2006 14:50 GMT
> Steve,
>
[quoted text clipped - 14 lines]
> Best regards,
> Bill

    They do that in Chicago, right?
(just kiddin'!!)

Steve
Bill - 21 Mar 2006 18:29 GMT
> Thanks Steve,

Steve has given good advice here -- be sure to read both of his
replies.

> To a bum, sure, but how do you find the best doc in town? I do have a
> very complicated case, thanks to one fresh out of school dentist who
> nearly ruined my front teeth years ago. I am tired of having to redo my
> teeth over and over and would hand out any sum of money to just get it
> done and forget about it.

One idea would be to check with a good prosthodontist. But again, the
problem is choosing WHICH prosthodontist. So it might be wise to simply
get evaluations and treatment plans from a couple of different
prosthodontists, as well as some general dentists too.

Multiple exams and treatment plans should start to form a pattern of
what is possible for your treatment, and what the best choices might
be.

> I came across one dentist who is widely known to be (one of) the best
> in town, teaches in a good university, is a Ph.D. among other things
[quoted text clipped - 5 lines]
> Seattle Magazine has just published its "100 best dentists" directory,
> based on peer reviews  - is it a way to go?

Who is in charge of the "peer reviews?" It's quite possible that the
results are skewed according to who was invited to make the reviews.

I thought so; then, I found
> someone who's made it to 100 best, but is not booked at all, so the
> patients apparently disagree... hmm.

Some of the very best dentists in my city are NOT booked months in
advance. They do not advertise loudly, they prefer to keep their
practices low-key and concentrate on the patient's treatment, not on
marketing.

And some of the worst dentists are fully booked, as they spend all
their time with buying advertising and exposure -- instead of investing
their time in their patients.

Many of the busiest dental offices in this region are busy because they
are cheap, sloppy, and have huge insurance contracts. The insurance
companies love them because they can ram a large volume of patients
through the mill in record time.

In my opinion it is better to avoid the offices that are busy-busy, and
aim for a dentist who has time to devote to you.

The more I think about it, the
> more lost I am.

You have a lot of company. Finding a good dentist can be complex.

> Sorry if I sound paranoid or something. Choosing a new dentist is like
> blind date, really, only worse, as you have, arguably, less control
> over the consequences.

You're not paranoid. Yet, you do have control over the consequences as
you have the freedom in this country to visit as many dentists as you
want before you make your selections. Many countries with state-run
health plans prohibit that, and you would be stuck with whatever the
local authorities want for you.

With a complex dental case, my advice is to obtain as many second
opinions as you are able, and to follow the advice of Steve regarding
the type of dentist that would be best for your health in the long run.

Best regards,
- dentaldoc
Bill - 21 Mar 2006 18:30 GMT
> Thanks Steve,

Steve has given good advice here -- be sure to read both of his
replies.

> To a bum, sure, but how do you find the best doc in town? I do have a
> very complicated case, thanks to one fresh out of school dentist who
> nearly ruined my front teeth years ago. I am tired of having to redo my
> teeth over and over and would hand out any sum of money to just get it
> done and forget about it.

One idea would be to check with a good prosthodontist. But again, the
problem is choosing WHICH prosthodontist. So it might be wise to simply
get evaluations and treatment plans from a couple of different
prosthodontists, as well as some general dentists too.

Multiple exams and treatment plans should start to form a pattern of
what is possible for your treatment, and what the best choices might
be.

> I came across one dentist who is widely known to be (one of) the best
> in town, teaches in a good university, is a Ph.D. among other things
[quoted text clipped - 5 lines]
> Seattle Magazine has just published its "100 best dentists" directory,
> based on peer reviews  - is it a way to go?

Who is in charge of the "peer reviews?" It's quite possible that the
results are skewed according to who was invited to make the reviews.

I thought so; then, I found
> someone who's made it to 100 best, but is not booked at all, so the
> patients apparently disagree... hmm.

Some of the very best dentists in my city are NOT booked months in
advance. They do not advertise loudly, they prefer to keep their
practices low-key and concentrate on the patient's treatment, not on
marketing.

And some of the worst dentists are fully booked, as they spend all
their time with buying advertising and exposure -- instead of investing
their time in their patients.

Many of the busiest dental offices in this region are busy because they
are cheap, sloppy, and have huge insurance contracts. The insurance
companies love them because they can ram a large volume of patients
through the mill in record time.

In my opinion it is better to avoid the offices that are busy-busy, and
aim for a dentist who has time to devote to you.

The more I think about it, the
> more lost I am.

You have a lot of company. Finding a good dentist can be complex.

> Sorry if I sound paranoid or something. Choosing a new dentist is like
> blind date, really, only worse, as you have, arguably, less control
> over the consequences.

You're not paranoid. Yet, you do have control over the consequences as
you have the freedom in this country to visit as many dentists as you
want before you make your selections. Many countries with state-run
health plans prohibit that, and you would be stuck with whatever the
local authorities want for you.

With a complex dental case, my advice is to obtain as many second
opinions as you are able, and to follow the advice of Steve regarding
the type of dentist that would be best for your health in the long run.

Best regards,
- dentaldoc
abc - 21 Mar 2006 18:44 GMT
Wow. Lots of excellent advice, thanks!

Maybe I should stick to prosthodonstists then? The Is there a lot of
differences between general dentists and prostho?
abc - 21 Mar 2006 19:53 GMT
Does this doctor's before and after cases look too good to be true?
(there are 4 cases with photos)

http://seattle.doctoroogle.com/reviews/viewdentist.cfm/pageID/6/dentistID/90716
Mark & Steven Bornfeld - 21 Mar 2006 20:47 GMT
> Does this doctor's before and after cases look too good to be true?
> (there are 4 cases with photos)
>
> http://seattle.doctoroogle.com/reviews/viewdentist.cfm/pageID/6/dentistID/90716

    No, not too good to be true.  Pretty labwork.
    But I want to see case #5. ;-)

Steve

Signature

Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

abc - 21 Mar 2006 21:53 GMT
Steve,

So, if I am reading you right, you know his lab is good, which is
important, but would not be able to comment about the dentist based on
the photos.

>But I want to see case #5. ;-)
What do you mean?

FWIW, he is the 2nd most recommended dentist in town according to Dr.
Oogle, which I understand does not tell me much anyway. 20 patient
reviews - is it possible, or a potential red flag? Unless his customers
are somehow way more internet-savy than the rest of the population, I
am not sure there is a legitimate way for one dentist to get 10 times
the average amount of reviews, good or bad.
carabelli - 21 Mar 2006 22:02 GMT
This sounds pretty worthless to me

Pay to be listed??  give me a break

http://www.doctoroogle.com/dentist/index.cfm/pageID/7

carabelli
letsconnect - 21 Mar 2006 22:34 GMT
> This sounds pretty worthless to me
>
> Pay to be listed??  give me a break
>
> http://www.doctoroogle.com/dentist/index.cfm/pageID/7

By and large, I find doctoroogle to be a useful resource, but there are
some fakes in there as well. Being listed, on its own, is not so much a
red flag as being listed and having tons of rave reviews. Makes me
wonder if the dentist in question didn't just ask some select patients
to post a review there. There are also some dentists listed (in San
Francisco) who have direct ties with doctoroogle (and started up with
lots of rave reviews when doctoroogle was still in its infancy). But
overall, especially if you go for the paid option which allows you to
read reviews for all dentists, it can be pretty good.
abc - 21 Mar 2006 23:25 GMT
> Pay to be listed??  give me a break
> http://www.doctoroogle.com/dentist/index.cfm/pageID/7

Oops, I missed that part, thanks!

OTOH, of the 5 dentists I've known in real life, 4 are listed on Dr.
Oogle, so being listed can't be such a red flag after all. The red
flag, to me is 1) anonymity of the posters, 2) from all the wording on
the site, I would not be surprised if it deletes the negative
responses.

I wrote:

"Unless his customers
are somehow way more internet-savy than the rest of the population, I
am not sure there is a legitimate way for one dentist to get 10 times
the average amount of reviews, good or bad. "

I might have found it now. I called the 2nd best oogle-rated doc in
Seattle and asked the receptionist whether they encourage their
patients to rate them on Dr. Oogle. She said she does not think so;
however, many of their patients came from Dr. Oogle in the first place,
and those who have, come back on Dr. Oogle and leave their own
feedback. That would explain 20 feedbacks to me. This can be legit
then.
Alexei - 04 May 2006 07:11 GMT
>This sounds pretty worthless to me
>
[quoted text clipped - 3 lines]
>
>carabelli

My dentist is on there and I'm positive she didn't pay anyone. Also,
her name is mildly misspelled. It looks like they're selling
additional services (photos and such) while the listing itself is free
(possibly culled from the phone book?).

--Alexei
Mark & Steven Bornfeld - 21 Mar 2006 23:14 GMT
> Steve,
>
> So, if I am reading you right, you know his lab is good, which is
> important, but would not be able to comment about the dentist based on
> the photos.

    I can't even say that much.  I can only say that the ceramist does
pretty work.  In many (perhaps most) labs, the work is divided
up--there's a bit of a caste system too.  Supposedly an entry level
position might be a "plaster man".  The ceramist is the top of the heap.
 Certainly it's nice to have pretty ceramists.
    Once I started with a new lab that made gorgeous crowns.
Unfortunately, the crowns didn't fit.  I changed labs.

>>But I want to see case #5. ;-)
>
> What do you mean?

    In a website like this, you're not going to see the failures.

Steve

> FWIW, he is the 2nd most recommended dentist in town according to Dr.
> Oogle, which I understand does not tell me much anyway. 20 patient
> reviews - is it possible, or a potential red flag? Unless his customers
> are somehow way more internet-savy than the rest of the population, I
> am not sure there is a legitimate way for one dentist to get 10 times
> the average amount of reviews, good or bad.

Signature

Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

Mark & Steven Bornfeld - 21 Mar 2006 20:45 GMT
> Wow. Lots of excellent advice, thanks!
>
> Maybe I should stick to prosthodonstists then? The Is there a lot of
> differences between general dentists and prostho?

    A prosthodontist is a specialist in complex restorative treatment,
including crowns, bridges, dentures, and restoration of implants.  A
prosthodontist who restricts practice should not be doing fillings,
cleanings, extractions, periodontal treatment, root canals, etc.
    Your restorative needs may well be best addressed at a prosthodontist's
office.  However, IMO you should get an exam by a general dentist, who
will make a referral as necessary.
    If you go to a first-rate prosthodontist, he/she will likely refer you
back to a general dentist for periodic exams to evaluate other dental needs.

Steve

Signature

Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

abc - 21 Mar 2006 21:46 GMT
Thanks again. I've been recommended a prosthodontist who also does
general practice, and has a hygienist in the office. Which brings yet
another question: is it good to stick with a prosthodontist who also
does general practice? Or is it preferrable to go to a prosthodontist
for complex restrorative cases, and to a general practice dentist for
fillings?

I know it's a long shot, but the doctor's name is Dr. Cary Halpin, here
in Seattle. Anyone who knows him, please do give me some info, either
on usenet or by email, your feedback will be much appreciated.
abc - 21 Mar 2006 18:45 GMT
Also,  I understand that the cost of a second opinion is in the
ballpark of $150, and not covered by most plans?
abc - 21 Mar 2006 18:45 GMT
Also,  I understand that the cost of a second opinion is in the
ballpark of $150, and not covered by most plans?
 
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