Disbarred for three months for misgendering a trans patient
A Montreal doctor has just been given a three-month disbarment period for adopting "an inappropriate and disrespectful attitude" towards a trans patient who was consulting him for hormone treatment. Dr. Raymond Brière repeated to the patient that he was biologically female "despite the patient's explicit requests to refer to him as male."
The Disciplinary Council also criticized Dr. Brière for having terminated the patient's medical follow-up
without referring him to a colleague, as desired.
Dr. Brière, who obtained his license to practice in 1980, practiced family medicine in the Magdalen Islands, Rimouski and Kuujjuaq before coming to Montreal, to the Hochelaga-Maisonneuve neighbourhood. He follows between 700 and 900 patients, mainly vulnerable.
He had been the patient's family physician since 2018. He consulted him about once a year.
Recorded without his knowledgeOn May 17, 2022, the patientconsulted Dr. Brière to be prescribed hormone treatment. Unbeknownst to his doctor, he recorded the consultation on his cell phone.
At the beginning of the meeting, the patient told Dr. Brière that he had been in a social transition for a year and that he had changed his pronoun. He is a trans man and wants to "move on to the next stage of his transformation, which is taking hormones," reads the Disciplinary Council's decision.
The patient told Dr. Brière that he had learned extensively about the transformation process from various associations for transgender people.
Dr. Brière has "little experience with trans people and does not provide medical care to any other patient with a different gender identity or non-heterosexual," it said. During the consultation, the doctor asks the patient various questions. The latter details his intentions to take it slowly in the transition process. He also states that he is under the care of a psychologist.
At one point, Dr. Brière mentions that taking male hormones can lead to aggressive behaviour. The patient replies that these claims seem to be based on stereotypes. Dr. Brière says that some women take testosterone gel "to better lead a board of directors and communicate the non-verbal message: 'Heil, boys, I'm the boss!'" »
"The patient responds by emphasizing ... that her status as a trans person is distinct from women who use testosterone to assert their authority," the decision reads.
At one point, Dr. Brière said that "he has never prescribed hormones to a person who wants to 'turn into a gentleman.'" He says that a colleague at the CLSC follows patients who want a gender transformation and offers
to refer the patient there, which the patient eventually accepts.
"You were a woman, dear madame."During the consultation, the patient mentioned that he wanted to use a testosterone gel
"to promote a slow and gradual transformation of his body".
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 reminded Dr. Brière that he was 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 that "if a chromosomal analysis is performed, it will be shown that his chromosomes carry the XX genes and not XY." The patient repeats that he is a trans man. The doctor says, "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 accused Dr. Brière of having "preconceived opinions." Dr. Brière gets impatient and replies that "it's because your circle is the absolute truth."
The patient reproaches the doctor for his aggressive behaviour. The doctor, overcome with emotion, chases the patient out of his office, saying that he "doesn't need to be lectured by a patient."
The patient re-indicates that he or she is "a patient." In spite of this clarification, Dr. Brière said, "
A patient until now, you were a woman, dear madame."
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 for a referral for a consultation with Dr. Brière's colleague, which Dr. Brière will refuse. The doctor will also state that he no longer wants to have him as a patient because of a breach of trust.
No mutual trustThe patient filed a complaint with the local complaints commissioner of the CIUSSS de l'Est-de-l'Île-de-Montréal, alleging that the respondent had been discriminatory and aggressive. The medical examiner in charge of 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 any discriminatory behaviour. Dissatisfied with this response, the patient submitted a request for an investigation to the Office of the Syndic of the College of Physicians.
Dr. Brière eventually pleaded guilty to both counts. However, he indicated that "the attitude of the patient, who shows up at the appointment of May 17, 2022 by recording the meeting and having a certain mistrust to consult 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, however, the Disciplinary Council noted that "it is the physician's obligation to seek to establish and maintain a relationship of mutual trust with the patient, not the patient's."
The Council adds that if a patient "feels that their gender identity does not match the sex on their birth certificate, they may request to be referred to by the identity they express. The medical encounter must then take place in a way that respects this gender identity."
In Council's view, listening to the recording made by the patient shows that the patient had a respectful attitude towards the physician. "There is no indication that the patient is 'difficult', i.e. demanding, fussy, scrupulous or anxious. On the contrary, he remains calm and listens to the respondent most of the time. »
For the Conseil, listening to the recording "raises concerns about Dr. Brière's personal qualities" such as the ability to recognize one's limits, listening, empathy, introspection and awareness of one's cognitive biases as well as the control of emotions." Two periods of disbarment of three months and two months, to be served concurrently, were imposed for the two counts of offence against Dr. Brière.
The Disciplinary Council also criticized Dr. Brière for having terminated the patient's medical follow-up
without referring him to a colleague, as desired.
Dr. Brière, who obtained his license to practice in 1980, practiced family medicine in the Magdalen Islands, Rimouski and Kuujjuaq before coming to Montreal, to the Hochelaga-Maisonneuve neighbourhood. He follows between 700 and 900 patients, mainly vulnerable.
He had been the patient's family physician since 2018. He consulted him about once a year.
Recorded without his knowledgeOn May 17, 2022, the patientconsulted Dr. Brière to be prescribed hormone treatment. Unbeknownst to his doctor, he recorded the consultation on his cell phone.
At the beginning of the meeting, the patient told Dr. Brière that he had been in a social transition for a year and that he had changed his pronoun. He is a trans man and wants to "move on to the next stage of his transformation, which is taking hormones," reads the Disciplinary Council's decision.
The patient told Dr. Brière that he had learned extensively about the transformation process from various associations for transgender people.
Dr. Brière has "little experience with trans people and does not provide medical care to any other patient with a different gender identity or non-heterosexual," it said. During the consultation, the doctor asks the patient various questions. The latter details his intentions to take it slowly in the transition process. He also states that he is under the care of a psychologist.
At one point, Dr. Brière mentions that taking male hormones can lead to aggressive behaviour. The patient replies that these claims seem to be based on stereotypes. Dr. Brière says that some women take testosterone gel "to better lead a board of directors and communicate the non-verbal message: 'Heil, boys, I'm the boss!'" »
"The patient responds by emphasizing ... that her status as a trans person is distinct from women who use testosterone to assert their authority," the decision reads.
At one point, Dr. Brière said that "he has never prescribed hormones to a person who wants to 'turn into a gentleman.'" He says that a colleague at the CLSC follows patients who want a gender transformation and offers
to refer the patient there, which the patient eventually accepts.
"You were a woman, dear madame."During the consultation, the patient mentioned that he wanted to use a testosterone gel
"to promote a slow and gradual transformation of his body".
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 reminded Dr. Brière that he was 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 that "if a chromosomal analysis is performed, it will be shown that his chromosomes carry the XX genes and not XY." The patient repeats that he is a trans man. The doctor says, "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 accused Dr. Brière of having "preconceived opinions." Dr. Brière gets impatient and replies that "it's because your circle is the absolute truth."
The patient reproaches the doctor for his aggressive behaviour. The doctor, overcome with emotion, chases the patient out of his office, saying that he "doesn't need to be lectured by a patient."
The patient re-indicates that he or she is "a patient." In spite of this clarification, Dr. Brière said, "
A patient until now, you were a woman, dear madame."
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 for a referral for a consultation with Dr. Brière's colleague, which Dr. Brière will refuse. The doctor will also state that he no longer wants to have him as a patient because of a breach of trust.
No mutual trustThe patient filed a complaint with the local complaints commissioner of the CIUSSS de l'Est-de-l'Île-de-Montréal, alleging that the respondent had been discriminatory and aggressive. The medical examiner in charge of 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 any discriminatory behaviour. Dissatisfied with this response, the patient submitted a request for an investigation to the Office of the Syndic of the College of Physicians.
Dr. Brière eventually pleaded guilty to both counts. However, he indicated that "the attitude of the patient, who shows up at the appointment of May 17, 2022 by recording the meeting and having a certain mistrust to consult 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, however, the Disciplinary Council noted that "it is the physician's obligation to seek to establish and maintain a relationship of mutual trust with the patient, not the patient's."
The Council adds that if a patient "feels that their gender identity does not match the sex on their birth certificate, they may request to be referred to by the identity they express. The medical encounter must then take place in a way that respects this gender identity."
In Council's view, listening to the recording made by the patient shows that the patient had a respectful attitude towards the physician. "There is no indication that the patient is 'difficult', i.e. demanding, fussy, scrupulous or anxious. On the contrary, he remains calm and listens to the respondent most of the time. »
For the Conseil, listening to the recording "raises concerns about Dr. Brière's personal qualities" such as the ability to recognize one's limits, listening, empathy, introspection and awareness of one's cognitive biases as well as the control of emotions." Two periods of disbarment of three months and two months, to be served concurrently, were imposed for the two counts of offence against Dr. Brière.
