Grey market clinics in Quebec

A Montreal relative of mine has leukemia that’s been in remission. Unfortunately it returned and I’ve found myself back trying to help the family navigate a socialistic medical system that is outside my experience. The first time around we fought vigorously to get him chemo –which the oncology team wanted to deny– and it worked well.

A few months ago we brought my relative to Boston for a second opinion. The Boston specialist said to let him know when the cancer came back so we could discuss options.

When my relative saw his doctor in Montreal this week the doctor ordered a complete blood count but didn’t bother ordering the liver and renal function tests that would be needed to determine whether further treatment was an option. So we found ourselves struggling over the Labor Day weekend to figure out how to get the tests done. Turns out there are now a number of private clinics and labs in Montreal. Theoretically they are only allowed to offer tests and treatments that are not covered by the government, but in practice they ignore that rule.

Through the help of a Quebec-licensed physician we know in the US, we got an order for the blood work and had it completed the same day for about $100 Canadian, which seemed like a good deal. We did have to put pressure on the clinic to get that turnaround –they wanted to wait till the next day.

Meanwhile, my relative has been referred to palliative care. But even though the oncologist gave him only 3 weeks to live the initial palliative consultation was set for one week out.

In contrast to the US system, I haven’t heard anyone in the medical system here advocating or even discussing aggressive treatment. There are pluses and minuses to that. For one thing it certainly costs more. But I’m more comfortable with a system that offers up a range of treatment options rather than censoring the more expensive ones from the discussion. Without going around the system and leaning on our US relationships we wouldn’t have even been able to learn about whether treatment was possible.

September 5, 2005

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