A Montreal doctor was just sentenced to a three-month period of radiation therapy for taking “an inappropriate and disrespectful attitude” toward a transgender man who consulted him about hormone treatment. Dr. Raymond Brière reiterated to the patient that he was biologically female, “despite his explicit request that he be referred to as male.”
Published at 1:20 am. Updated at 5:00 am.
The disciplinary board criticizes Dr. Brière also for ending the patient's medical follow-up care without referring him to a colleague as requested.
Dr. Brière, who received his medical license in 1980, practiced as a family doctor on the Îles-de-la-Madeleine, Rimouski and Kuujjuaq before coming to Montreal in the Hochelaga-Maisonneuve district. There he looks after between 700 and 900 patients, most of whom are at risk.
He had been the patient's family doctor since 2018. He consulted him about once a year.
Taken without his knowledge
On May 17, 2022, the patient consulted Dr. Brière to have him prescribed hormone treatment. Unbeknownst to his doctor, he records the consultation on his cell phone.
At the beginning of the meeting, the patient tells Dr. Brière said that a year ago he began a social change and changed his pronoun. He is a trans man and wants to “move to the next stage of his transformation, which is taking hormones,” the disciplinary board’s decision said.
The patient told Dr. Brière said that he had received detailed information about the transformation process from various transgender associations.
Dr. Brière has “little experience with transsexuals and does not provide medical care for other patients with a different or non-heterosexual gender identity,” it says. During the consultation, the doctor asks his patient various questions. The latter explains his intention to approach the transition process slowly. He also states that he is being observed by a psychologist.
At one point Dr. Brière that taking male hormones can lead to aggressive behavior. The patient replies that these statements are obviously based on stereotypes. Dr. Brière says some women take testosterone gel “to better manage a board and communicate the nonverbal message: 'Hey, guys, I'm the boss!'” »
“The patient responds with emphasis […] that her situation as a trans person is different from that of women who use testosterone to assert their authority,” the decision says.
At one point Dr. Brière: “He has never prescribed hormones to a person who wants to transform into a gentleman.” He states that a colleague from the CLSC accompanies patients who want gender reassignment and offers to refer them there, which he ultimately does accepted.
“You were a woman, dear woman.”
During the consultation, the patient mentioned that he would like to use a testosterone gel “to promote a slow and progressive transformation of his body.”
Dr. Brière explains that gels can be applied to women using a pump. The patient states that he refuses to use a pump. The doctor insists. The patient reminds Dr. Brière then remembers 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. Dr. Brière replies: “When a chromosome analysis is carried out, it is shown that his chromosomes carry XX and not XY genes.” The patient repeats that he is a trans man. The doctor said, “Yes, it’s in your brain. »
The tension continues to rise. Patient and doctor take turns accusing each other of being “defensive.” At one point the patient accuses Dr. Brière suggests having “preconceived opinions”. Dr. Brière becomes impatient and replies, “That’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 out of his office and says, “He can’t learn a lesson from a patient.”
The patient again states that he is “a patient.” Despite this clarification, Dr. Brière: “As a patient until today, you were a woman, dear woman. »
The patient will repeat that he is “a patient” and the doctor will tell him that he is “biologically a woman.”
Before departure, the patient will ask to provide a reference for a consultation with Dr. to get Brière, which he refuses. The doctor will also say that he no longer wants him as a patient due to a loss of trust.
No mutual trust
The patient filed a complaint with the local complaints officer of the CIUSSS de l'Est-de-l'Île-de-Montréal, alleging that the defendant had shown 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 for the patient,” but ruled out discriminatory behavior. Since the patient was not satisfied with this answer, he submitted a request for examination to the office of the Syndic of the College of Physicians.
Dr. Brière ultimately pleaded guilty to the two charges against him. However, he pointed out that “the attitude of the patient who appears at the appointment on May 17, 2022, records the conversation and, with a certain degree of suspicion, consults him to agree on a treatment plan for masculinizing hormones, suggests at best that… problem or the lack of the mutual trust necessary for the professional relationship.”
However, in its decision, the Disciplinary Board recalls that “it is the duty of the doctor to establish and maintain a relationship of mutual trust with his patient, and not with the patient.”
The council adds that if a patient “believes that their gender identity does not correspond to the gender stated on their birth certificate, they may request to be addressed based on the identity they expressed.” The medical encounter must then take place in a way that respects this gender identity.”
The Council considers that the patient's notes show that he had a respectful attitude towards the doctor. “There are no signs that the patient is 'difficult' – demanding, fussy, conscientious or anxious. On the contrary, he remains calm and listens to the interviewee most of the time. »
For the council, listening to the recording raises “concerns about the personal qualities” of Dr. Brière on, “e.g. B. the ability to humility, recognize one's own limitations, listening, empathy, introspection and the conscience of one's cognitive biases as well as the control of emotions”. For the two crimes against Dr. Brière was given two periods of irradiation of three months and two months simultaneously.