Dr Chloé Labelle
When I learned that I was going to interview Dr. Chloé Labelle who worked to develop the Dopamed medical clinic in Hochelaga-Maisonneuve, I was very anxious to hear her point of view on addiction, her area of expertise within family medicine. I myself have worked as an addiction worker in the past and I have great admiration for the work of Dr. Labelle, who wants to make healthcare more accessible to people with addictions. Furthermore, on International Women’s Rights Day, I was curious to hear from Dr. Labelle about her experience as a woman member of the LGBTQ community in medicine. One morning in February, I met her at the Café Saint-Henry in the Latin Quarter to discuss her career, her passions, and the advice she would like to give to future generations of doctors.
Hello Dr. Labelle and thank you for agreeing to meet me. Can you tell me a little bit about your journey so far?
I have always loved the intellectual side of medicine and the contact with people. Also, a career in medicine allowed me the flexibility to choose from a wide variety of practices. During my pre-clinic at Laval University, I also took an optional course on addictions. It was then that I first heard of the neurobiology of addiction and it really interested me. I think that approaching addiction in the same way as you approach chronic disease allows you to have a non-judgmental approach. This course therefore greatly influenced the rest of my journey. I came to do my family medicine residency in Montreal because it seemed easier to me to get addiction training there. I currently work at Maisonneuve-Rosemont Hospital, where I do 50% of my addiction practice and 50% of my practice is in general family medicine. I also work in an UMF with residents in family medicine. I also work at the Dopamed clinic in Hochelaga-Maisonneuve.
Are there other reasons why you have chosen to serve more marginalized populations?
Being part of a minority like the LGBTQ + community, so having experienced the difference a bit, I was attracted to people who have different backgrounds and lifestyles. I think there’s something beautiful in that. What made me continue in this practice and which feeds me is also that I have a lot to learn from my patients, their experiences, their lifestyle, and their resilience.
Can you tell me a bit about the beginnings of the Dopamed clinic?
It is a project that started two years ago, but the clinic has been officially open since January 2019. This initiative starts from Dopamine, a community organization in Hochelaga-Maisonneuve which supports and accompanies people who are living with addiction problems, or who live in situations of marginality and vulnerability. Dopamine workers have been thinking for a long time that the health system does not meet the needs of their users and that people have difficulty getting care while respecting their realities and the difficulties they are experiencing. Stakeholders therefore had in mind this project to start a medical clinic within the organization. They approached us, my colleague Dr. Juteau and me, to see if we wanted to participate.
What distinguishes the Dopamed clinic from other family medicine clinics in Montreal?
Dopamed is a clinic that responds to the health needs of users differently. The special thing is that our team includes peer-navigators whose role is to welcome users, answer their questions and their anxieties, and offer them coffee. The addition of these peers changes the dynamics of the clinic. It is a pillar on which our health care is based.
Otherwise, Dopamed is like any other family medicine clinic. We are there to meet people’s needs, so we do general family medicine. If a person consumes a lot but expresses that they are worried about having diabetes, we will respond to this expressed need above all.
For those who are not familiar with the challenges our healthcare system poses for people who are addicted, can you give examples?
Relying on what users have told me, I think they feel some judgment when dealing with a healthcare system. They do not necessarily tend to want to openly address their addiction for fear of being judged, but also for fear that everything will then be reduced to their addiction, and that they will not be able to express other needs. However, these are people who have a lot of health problems besides their addiction! I also think that these are people who have often had contact with the health system in emergencies or in crisis situations. So, in this context, they are sometimes made to have bad experiences. Even if we try to change things, health care in general is not always done in cooperation with the patient, i.e. we doctors often have our own agenda and do not always take it into account from the agenda of the person in front of us. All of this is what made us want to do something different at Dopamed.
Is there anything in particular that you would like medical students, whether pre-clinical or clinical, to understand about addiction?
Several things. First, the concept of chronic disease is very important. It kind of lays the foundation. Addiction is made up of periods of stability, relapses, remission like any other chronic disease. More broadly, if I learned anything at Dopamed, it is listening. In medicine, we often arrive with our interview structure, and are constantly thinking about our next question or our differential diagnosis. We are not used to putting our screen or notes aside to fully listen to the person. One last thing: we must be very humble towards the people we meet, especially with regard to their background. There are many patients who have something to teach us, on a human level. For this reason, the relationship between a patient and a doctor should be an equal relationship.
In honor of International Women’s Rights Day, I would like to talk about your experience as a woman and a member of a sexual minority. Are there any prejudices that you have already faced in this regard?
I don’t feel like I’ve faced prejudice as a woman, or because I belonged to the LGBTQ community. I may have been lucky because I don’t feel like it’s the same for everyone. Of course, this is my experience, and I do not speak for the whole community.
With that being said, I am very sensitive to the way we approach sexual minorities in medicine. I follow up on several patients from sexual minorities – especially trans patients – and I notice that it is not always easy for some professionals to use the pronouns and first names that the person prefers. It seems that people go there with their personal instincts. So on that side, I think there is some discrimination in the health care system, but that comes in part from the way we are trained. I think that we are not exposed to a lot of differences in our preclinical years. We are not necessarily taught to communicate our questions in an open, neutral, non-judgmental medical interview. Even I sometimes find myself asking questions that assume that a man is necessarily in a relationship with a woman.
Have you ever had to respond to discriminatory comments made before you during your training?
Yes. As a student or resident, I found it difficult to answer that, but I think we still have to find a way to do it. These little comments are violence, in fact, and should not be overlooked. After that, there is a way to respond. Just to answer by putting things in perspective, saying “maybe this person is having such and such a difficulty, it can sow seeds in people’s heads. These opportunities must be seized. To redo my journey, I would try to do it more as an external and as a resident. I have a lot of respect for externals and residents who question themselves as professionals and as human beings in the face of what people can say.
Do you consider yourself a woman leader?
I’m still having trouble with the word “leader”. I find it difficult to determine if this is a question of personality or if it is linked to being a woman in an environment that was traditionally male (but which is nevertheless less and less.) I still believe that a part comes from being a woman in our society. Having said that, I think women speak differently and have different leadership – that leadership is more of an example than a word. I think it’s just as far reaching.
Is there anything you would like to convey to our readers, in closing.
If there are students who are from minorities or who live in difference and who reads this, you have a lot to bring to medicine. I think that we approach certain things differently and we are also an engine of change for the people around us. I would invite these students to live their difference and to include it in their professional identity, because it is beautiful, but also because it advances medicine, and it allows us to offer more open care.