Montreal physician Dr. Raymond Briere has been suspended for three months after arguing with a transgender patient about pronoun usage and whether or not he was a woman. “It should also be noted that this case calls into question the rights of the patient, the obligations of the doctor towards the patient to whom he provides services and care and the doctor-patient relationship,” said the Disciplinary Board of the College of Doctors of Quebec (DBCDQ) in a ruling. The DBCDQ listed one count of failure to behave irreproachably towards a patient and one count of failure to ensure medical follow-up of a patient. During the investigation, Briere entered a guilty plea to the charges. Briere has been registered as a doctor since 1980. At the beginning of his practice, he practiced medicine in remote Quebec and returned to Montreal for family reasons. He had been responsible for caring for the patient since 2018. When he began caring for him, he learned he was born to an unknown father, had a mother with severe endometriosis, and suffered from endometriosis, borderline personality disorder and depression. On an agreed date and time for an appointment in 2022, the patient presented himself to Briere. His cellphone recorded the meeting without his knowledge. The patient informed him he began a social transition with his family, friends and employer one year ago and that he changed his pronouns. He added he came to see him to move to the next stage of the transformation, which was taking hormones. Briere said he had never prescribed hormones to a person who wanted to “transform into a gentleman.” If the patient followed through on taking testosterone, he warned his character could change. While Briere had concerns, the patient said they were based on stereotypes. He responded by banging his fist twice on his work table to illustrate the possibility of aggressive behaviour linked to testosterone. The patient reminded Briere he was a a transgender man and had female genetics. While he considers himself a man, he said if a chromosomal analysis was carried out, it will show his chromosomes carry XX and not XY genes. “Yes, that’s in your brain,” he said. Despite Briere citing biology, the patient said he had a different gender identity and did not want to be called a woman. Under the influence of emotion, he demanded he go away. He condemned him for not listening and referred to him using the feminine form in French. Despite more clarifications, he refused to listen. “A patient until this day, you were a woman, dear madam,” he said. While Briere had recommended a colleague more experienced with hormones, he refused to comply after the argument. Briere said he would no longer be the patient’s family doctor. When the patient left the office, he took his cellphone and stopped recording. Briere said the conversation was recorded without his knowledge and affirmed such interception of communication is illegal. He acknowledged in his file he had been recorded without his consent, which was illegal. “ABSOLUTE BREAKING OF CONFIDENCE, so I thank her immediately and must appear without appointment of Dr. Picard — the only one who takes care of the transformations at the CLSC,” he said. “Finding another treating MD because it has become the patient who analyzes the actions of a MD = NOT RECEIVABLE.” Since Quebec has human rights protections, the DBCDQ said this “means that if the patient believes that their gender identity does not correspond to the sex appearing on their birth certificate, they can request that they be designated by the identity they express.” It added the medical encounter must take place while respecting gender identity, regardless of if the patient has undergone any medical treatment or surgical interventions. Based on this premise, it said the care a doctor is called upon to offer a patient requires he or she be professional at all times. This is through the quality of his services, his attitude and his behaviour. The high expectations people are justified in having with doctors are proportionate to the significant privileges they have and the inequality in the balance of power characterizing the doctor-patient relationship. For doctors to be trustworthy, DBCDQ said they must engage in genuine dialogue with patients to attempt to establish the best treatment plans. “To this end, he must avoid the pitfalls of cognitive biases, stereotypes and preconceived opinions as well as trying at all costs to convince the patient that he is wrong or to lecture him,” it said. “Clearly, these behaviors and a confrontational attitude on the part of the doctor constitute barriers to communication and undermine the patient's confidence.”
