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When the doctor refuses to let Huck into the canoe with him, Huck is effectively separated from Jim and Tom. The fate of his two friends is now out of his hands.
The effect on the narrative and on the reader is two-fold. Huck now has to hold his tongue and wait to find out if Tom is alright. (Tom has been shot in the leg.) He also has to wait to find out what happens to Jim (recently freed in an elaborate escape).
As Huck is made to wait, so is the reader. This creates anticipation that builds to the novel's climax wherein Tom is returned to the Phelps house and blurts out the whole tale of Tom's escape after coming back to consciousness.
This climactic scene is made possibly by the doctor's refusal to share a canoe with Huck.
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