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Starting Tuesday, the McGill University Health Centre’s blood-testing services are not only inaccessible for people who don’t live on the island of Montreal, but also for the patients of family doctors in the city, including those working in the neighbourhoods close to the hospital.

The move is intended to unclog the busy testing centre for those seeking specialized care or receiving emergency treatment at the MUHC. However, some fear the policy will erect new barriers for patients and further complicate the work of family physicians.

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The MUHC is only the latest hospital to limit use of its facilities to internal doctors. The Centre hospitalier de l’Université de Montréal has had a similar policy on the books since 2021.

There has been a growing trend toward regionalizing care to ensure people can obtain health services close to home, although it limits choice and mobility for patients. But these latest protectionist measures represent a fragmentation within regions that is creating confusion and frustration.

Dr. Michael Kalin, a physician at a clinic in Côte-St-Luc, said refusing to honour referrals from family doctors is “demeaning” at a time when many already feel undervalued, are leaving the profession, going private or avoiding practising family medicine altogether, resulting in a shortage. But he said the more serious impact is on patients, who now have to chase around trying to make sure they get the right test, ordered by the right doctor, at the right place — or risk being turned away.

“It’s sort of silly. The patient goes to the institution and says, ‘I’m a patient of the cardiologist; can you do my blood test?’ Yes. ‘Oh, while I’m here, can you do one for my family doctor at the same time?’ ’No, we won’t do his, but we’ll do the specialist’s.’ I don’t understand,” Kalin said.

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“One has to ask: What are we accomplishing here? It seems like, honestly, we’re creating these little pockets of care that are refusing to work with each other, and this seems to be counterintuitive and counterproductive to everything we hope to achieve in health care, which is the sharing of information, the idea of making seamless care.”

One MUHC specialist, who didn’t want his name used, said limiting who can use the hospital test centre based on their postal code is more than an inconvenience.

He shared the case of a patient who recently went for a test in his home region, only to have his samples discarded because the facility doesn’t perform the type of blood work requested.

“A few weeks later, I received a fax stating that the tubes had been thrown because the local laboratory was unable to perform the analyses,” the doctor said. “I had to do another requisition for this patient.”

This not only wastes the valuable time of doctors and patients, it could contribute to delays in diagnosis or treatment.

In a way, these hospitals are victims of their own popularity. Because of their reputations for excellence, people go out of their way to seek care there. And in the case of the MUHC, its bilingual status reassures patients they can receive service in English. The community may also feel a sense of belonging, attachment and pride in the institution.

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But the funding for this high volume of patients doesn’t necessarily follow, and the additional traffic can strain budgets and operations.

As MUHC spokesperson Annie-Claire Fournier explained, the goal of the new policy is to reduce delays for patients seeking specialized care at the hospital.

“We aim to continually improve care for patients from all over Quebec, whether they are being treated for complex pathologies such as cancer and heart disease or visiting our emergency services. Right now, these patients are struggling to access care in a timely manner,” she said.

“Therefore, as other specialized establishments in the network have already done, as of Oct. 1, 2024, the blood collection centres at the Royal Victoria Hospital (Glen site — adults) and the Montreal General Hospital will mainly serve patients with requisitions prescribed by an MUHC prescriber.”

The change will not affect the blood testing services offered at the Montreal Children’s Hospital and Lachine Hospital. And it does not cover tests like X-rays, obstetric ultrasounds, mammograms, or more complex diagnostics like cardiac MRIs.

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CHUM spokesperson Jessie-Kim Malo said that since 2021, “testing services have been reserved for patients under the care of prescribers within the institution,” due to high demand and limited capacity. This already amounts to about 2,000 tests per week.

Patients should instead visit new external points of service that have opened over the past year, such as the one at Décarie Square. Time slots can be booked via Clic Santé.

The decision to restrict access to blood-testing centres comes as the Quebec government looks for budgetary savings and as a major transformation shakes the health system. A new agency, Santé Québec, is being set up to manage and deliver public services.

After the story of patients being vetted by their area code broke last week, Health Minister Christian Dubé voiced his concern on the social media platform X.

“This is not representative of what Quebecers should experience with health care,” he said. “With the arrival of Santé Québec, we’re aiming to put an end to institutional silos, starting now.”

But so far, things are going in the opposite direction.

As Kalin said, centralizing health care isn’t necessarily improving access.

“What we see now is just an incredible amount of frustration and confusion — exasperation — on the part of patients and physicians,” he said. “People say to me: ‘I don’t understand how things work anymore. I don’t have a doctor, I don’t know where to go for my testing.’ And it’s just everything becomes harder and harder.

“We spend so much energy trying to access services and this is just one more obstacle.”

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