A Montreal doctor has just been given a three-month radiation period for having adopted “an inappropriate and disrespectful attitude” towards a trans patient who consulted him to obtain hormonal treatment. The Dr Raymond Brière repeated to the patient that he was biologically a woman “despite the latter’s explicit requests to refer to him using the masculine gender.”
The Disciplinary Council also criticizes Dr Brière for having ended the patient’s medical follow-up without directing him to a colleague, as desired.
The Dr Brière, who obtained his right to practice in 1980, practiced family medicine in the Îles-de-la-Madeleine, Rimouski and Kuujjuaq before coming to Montreal, in the Hochelaga-Maisonneuve district. He follows between 700 and 900 patients there, mainly vulnerable.
He had been the family doctor of the patient in question since 2018. The latter consulted him approximately once a year.
Recorded without his knowledge
On May 17, 2022, the patient consulted the Dr Brière to be prescribed hormonal treatment. Unbeknownst to his doctor, he records the consultation on his cell phone.
From the start of the meeting, the patient indicates to the Dr Brière that he began a social transition a year ago and that he changed his pronoun. He is a trans man and wants to “move to the next stage of his transformation which is taking hormones”, we can read in the decision of the Disciplinary Council.
The patient indicates to the Dr Brière learned extensively about the transformation process from various associations aimed at transgender people.
The Dr Brière has “little experience with trans people and does not provide medical care for any other patient with a different or non-heterosexual gender identity,” it is written. During the consultation, the doctor asks his patient different questions. The latter details his intentions to take it slowly in the transition process. He also specifies that he is being followed by a psychologist.
At one point, the Dr Brière mentions that taking male hormones can lead to aggressive behavior. The patient responds that these statements seem to be based on stereotypes. The Dr Brière claims that some women take testosterone gel “to better lead a board of directors and communicate the following non-verbal message: ‘Hello, boys, I’m the boss!’ »
“The patient reacts by emphasizing […] that her situation as a trans person is distinguished from women who use testosterone to assert their authority,” it is written in the decision.
At one point, the Dr Brière says “he has never prescribed hormones to a person who wants to ‘transform into a gentleman'”. He states that a colleague from the CLSC follows patients wanting a gender transformation and offers to refer the patient to it, which the latter ends up accepting.
“You were a woman, dear madam”
During the consultation, the patient mentioned wanting to use a testosterone gel “to promote a slow and progressive transformation of his body”.
The Dr Brière explains that, for a woman, the gels can be applied using a pump. The patient indicates that he refuses to use a pump. The doctor insists. The patient then reminds the Dr Brière that he is a trans man. The doctor replies that he is “genetically a woman”. The patient reiterates that he considers himself a trans man. The Dr Brière responds that “if a chromosomal analysis is carried out, it will be shown that his chromosomes carry XX and not XY genes”. The patient repeats that he is a trans man. The doctor said: “Yes, that’s in your brain. »
The tension continues to rise. Patient and doctor alternately blame each other for being “defensive”. At one point, the patient accuses the Dr Brière for having “ready-made opinions”. The Dr Brière becomes impatient and replies that “it’s because your circle is the absolute truth.”
The patient blames the doctor for his aggressive behavior. The doctor, overcome with emotion, chases the patient from his office, saying “he has no lesson to learn from a patient”.
The patient again indicates that he is “a patient”. Despite this clarification, the Dr Brière said: “A patient until this day, you were a woman, dear madam. »
The patient will repeat that he is “a patient” and the doctor will tell him that he is “biologically a woman”.
Before leaving, the patient will ask to obtain the reference for a consultation with the colleague of the Dr Brière, which the latter will refuse. The doctor will also say that he no longer wants to have him as a patient due to a breakdown in trust.
No mutual trust
The patient filed a complaint with the local complaints commissioner of the CIUSSS de l’Est-de-l’Île-de-Montréal, alleging that the respondent demonstrated discrimination and aggressiveness. The examining doctor responsible for this investigation concluded that there was “a problem with the quality of the professional relationship and a lack of respect towards the patient”, but ruled out any discriminatory behavior. Unsatisfied with this response, the patient submitted a request for an investigation to the Office of the Syndic of the College of Physicians.
The Dr Brière ultimately pleaded guilty to the two charges against him. However, he indicated that “the attitude of the patient, who presents himself at the appointment on May 17, 2022, recording the meeting and having a certain distrust in consulting him to agree on a treatment plan for masculinizing hormones, denotes at best, a problem or the non-existence of the mutual trust necessary for the professional relationship.”
In its decision, the Disciplinary Council, however, recalls that “it is the doctor’s obligation to seek to establish and maintain a relationship of mutual trust with his patient and not the latter.”
The Council adds that if a patient “believes that their gender identity does not correspond to the sex appearing on their birth certificate, they can request that they be referred to by the identity they express. The medical encounter must then take place while respecting this gender identity.”
According to the Council, listening to the recording made by the patient allows us to see that the latter had a respectful attitude towards the doctor. “There is no indication that the patient is ‘difficult’, that is to say demanding, finicky, scrupulous or anxious. On the contrary, he remains calm and listens to the respondent most of the time. »
For the Council, listening to the recording “raises concerns regarding the personal qualities” of the Dr Brière “as the capacity for humility to recognize one’s limits, listening, empathy, introspection and awareness of one’s cognitive biases as well as mastery of emotions”. Two periods of deregistration of three months and two months, to be served concurrently, were imposed for the two counts of offense against the Dr Briere.