Shouldn't a doctor understand basic anatomy?

I am so frustrated with the medical system and the need to have a separate doctor for everything. I just moved across the state and am in the process of getting established at all new doctor's offices. This is something I just dread. It is such a hassle making appointments, finding childcare, waiting in the office and then going through the process interviewing a new doctor. And it is especially difficult when you have a medical history as long as mine.

At first I was having good luck. I found a good GI who referred me to the surgeon in the area who does the J-Pouch surgery. He indicated that once his patients have surgery, it is standard practice that the surgeon follow their cases so he didn't see why mine would be any different. That is how my case was going to be followed previously so I was comfortable with this approach. So I met with the surgeon and we discussed the plans for follow-up. He also recommended that I have my incisional hernia repaired in the next year or so. I am comfortable with his reasoning and his plans for follow-up. Great so far.

So then it was on to finding a family physician. My husband had already seen someone for his cholesterol and he liked her so I also made an appointment. I went through my medical history with the nurse and that is where we got to the first hiccup. Of course I explained the history of UC and total colectomy and J-pouch surgeries first. She wanted to get records for my most recent colonoscopy. I told her that this didn't show much other than I had UC and that she probably wanted the pathology records from the hospital where they removed the colon as this showed the extent of displasia that I had. Of course this threw her for a loop and she had no idea what to do with that as it wasn't on her tick box checklist. After several more minutes of explaining she said she would just ask the doctor.

So enter the doctor. Mainly I wanted to talk to her about whether we needed to be doing anything special to monitor my bone health as I had been on steriods for over 20 years and am concerned about the damage it may have done. I was thinking she would probably refer me to an orthopedist. So again I explain my history of UC and surgery. I explicitly said I had a total colectomy and construction of a J-pouch out of my small intestine. I told her I saw a GI doctor who referred me to a surgeon for follow-up on the pouch. She then argued with me that I needed to be still seeing a GI doctor for my ulcerative colitis and as the one I had seen didn't want to follow me she would recommend some good GI doctors. Hello? I don't have UC- no colon remember? So I remind her of this and she gets a confused look at first and then says "OH, that right". Oh, that's right? She also didn't agree with the surgeon that I should have my incisional hernia repaired and since she didn't know much about the surgeon she was going to check around for a good one and wanted to know if I was open to going out of town for surgery. For a hernia repair? Uh, well no. I would think if the guy can successfully do a J-pouch surgery he should be able to handle a hernia repair. Plus I had already explained he had offered to send me to general surgeon for a second opinion for the hernia but I told him I only would be comfortable with someone who had experience with J-pouchers as there could be adhesions and such he might need to deal with.

So I left with no resolution on the bone concerns as her only response was she thought I probably needed a DEXA but the insurance wouldn't cover it because I was too young and didn't have any unexplained fractures. No referal either- just instructions to eat high calcium foods. She also ran bloodwork for calcium, iron, and B-12 as she was concerned I wasn't absorbing nutrients, however I don't have loose stools and I have NO trouble gaining weight so that probably wasn't necessary either, but I figured it wouldn't hurt.

I don't expect most doctors and certainly most nurses to understand the J-Pouch. I realize it is not common and it takes a specialist to follow it. But come on- shouldn't they understand basic anatomy? And more importantly- shouldn't they stick to their areas? If the GI doctor and GI surgeon agree on an approach why am I getting flack from a family physician who doesn't even understand that I don't have a colon anymore?

So back to square one in finding a QUALIFIED family physician to follow my general care. And I will be out my copay and another portion of my deductible. And I still need to find an OB/GYN.