'That is in your brain:' Doctor suspended for 5 months called a transmasculine patient 'madam' and insisted he was genetically a woman

A Quebec doctor has been suspended for five months after he told a patient being a trans man was “in your brain” and refused to provide a referral to another physician who can provide care while he undergoes gender-affirming procedures.Dr. Raymond Brière, a Montreal family physician, was also ordered by the Collège des médecins du Québec to pay investigation and hearing costs as well as the cost to publish the disciplinary board’s decision.The complaint against Dr. Brière was based on an appointment that occurred on May 17, 2022 which the patient recorded on his phone without the doctor’s knowledge, according to the decision document. (Under the Canadian Criminal Code, it is not illegal to secretly record private conversations if one of the participants—including the one recording—consents to the recording.)During this visit, the patient told Dr. Brière about plans to start taking hormones to transition physically. He revealed that over the past year, he has been transitioning socially among his family, friends and employer and that he had changed his pronoun.The patient said he had been advised by the support group Aide aux Trans du Quebec to consult a family doctor about the planned hormone treatment. After a discussion that covered topics such as the patient’s menstrual flow and the counter indication between breast cancer and hormones, Dr. Brière spoke about the “potentially irreversible” nature of gender confirming procedures as well as the impact it could have on the patient’s hair.Read: The medical management of trans youth in Canada, 2023According to the decision document, Dr. Brière also warned about possible changes to the patient’s character because of hormones—including aggressive behaviour resulting from taking male hormones—which the patient countered as a “big stereotype.”During the course of this debate over hormones, the patient reiterated that he was a trans man, to which Dr. Brière responded that genetically the patient is a female and that a chromosomal analysis would reveal he carries XX genes, not XY.When the patient once again stated he was a trans man, Dr. Brière replied “Yes, that is in your brain.” Each of the parties accused the other of being defensive and the patient subsequently criticized Dr. Brière for his stubborn attitude and aggressive behaviour. At this point, Dr. Brière became impatient and told the patient to “go away, go away.” He also insisted that the patient was, until this point, a woman and addressed him as “dear madam” before asking him again to leave.When the patient asked for a referral to a doctor with experience in masculinizing hormone therapy, Dr. Brière refused and told the patient to make his own referral, stating that “it’s over because there is no trust. Find . . . another doctor.”Read: More gender-affirming procedures now covered by public insurance in PEIDr. Brière learned the appointment had been recorded when the patient took out his mobile phone as he was leaving the office and turned off the recording function in front of Dr. Brière.In arriving at its decision, the disciplinary board considered the observations of the doctor assigned by the college to review the complaint. This doctor concluded that Dr. Brière had been disrespectful in his refusal to acknowledge the patient as a trans man, and that he acted unprofessionally when he denied the patient’s request for a referral to another doctor.“The growing animosity perceived during the exchanges which took place between (Dr. Brière) and the patient, and the subsequent loss of confidence do not justify the (refusal) from (Dr. Brière) in view of the patient’s clear request to be referred to a doctor familiar with (masculinizing) hormone therapy,” wrote the college-assigned doctor.In his response to the complaint, Dr. Brière argued that the patient bore some responsibility for the breakdown of trust in the physician-patient relationship. By coming in with an intention to record the appointment—and subsequently going ahead with that plan—the patient had already eroded the foundation of mutual trust necessary for the professional relationship.However the college viewed this argument as erroneous, citing Article 18 in the Code of Ethics, which the college says states unequivocally that the it is the doctor's obligation to establish and maintain trust with the patient. This responsibility does not rest with the patient, concluded the college.Read: England’s health service says it won’t give puberty blockers to children at gender clinics

'That is in your brain:' Doctor suspended for 5 months called a transmasculine patient 'madam' and insisted he was genetically a woman

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