I am a medical student and not a doctor, so I'm absolutely not taking sides, or criticising anyone here, but let me try to give you a view of the potential problem, from the other side
Having looked at the thread in question I absolutely do agree that moving the goal posts, or at very least failing to specify where they were in advance, seems very unfair. In my opinion you certainly should have been made aware of where he was going to set the bar BEFORE you got there.
As regards his refusal however, sadly there have been numerous cases where doctors who sign letters too far in advance have then been subjected to professional misconduct and/or legal proceedings later when someone appears to have had subsequent regrets. So from a professional point of view it's very difficult because unfortunately the courts are less trans friendly than doctors and do tend to want to believe that all trans people are nutters – and that therefore that anyone who "says" that they weren't properly assessed "must be telling the truth", because the lawyers all seem to believe that no one in their right mind would ever genuinely WANT such a procedure.
The ONLY defence that works against this line of legal reasoning is that the doctor involved followed the agreed treatment guidelines TO THE LETTER! This places any medical professional in a very awkward position, because much as they might like to believe the strong intelligent professional person in front of them, sadly experience also shows that these are quite often the ones most likely to sue if something later changes...
I speak from somewhat personal experience, because my best friend, a doctor of some considerable experience, was sued by a trans patient under just those circumstances, because she claimed that in failing to enforce the 1 year rule TO THE LETTER he had failed in his duty of care, because had he done so she would have changed her mind... there is in fact no way to prove or disprove this. It becomes his word against hers. This despite the fact that at the time she was probably calling him all the bastards under the sun for suggesting that she should maybe wait.
So the doctor is often placed in a no win situation. You bend the rules for one, and sod's law means it's the one you should have stood up to. You don't bend for someone else and they will almost inevitably turn out to be the one that really needed it! The problem is if we don't have any guidelines, then it becomes open season on the medics, who then have no solid defence, other than "well in my judgement..." which a skilled lawyer can and often will rip to pieces.
So what I do think was very unfortunate is that you were unaware of what his attitude was going to be, because that denied you the chance to save your fee and go elsewhere, which of course has to be your right!
