Bill and I (and many of my clients) have an HSA-qualified high deductible health plan. The premiums are wonderfully low, but of course we had to give up a few things to get those low premiums - like office visit and prescription drug copays. We have found it an excellent trade-off. (And, by the way, we do have full coverage for our annual physicals.)

What hadn't occurred to me was how differently doctors tend to practice medicine when there aren't any copays. A key part of this has been that we're not bashful about communicating to our doctors the fact that we'll be paying for this test or that prescription "out of pocket."

I've found that doctors are wonderfully accommodating when I utter that three-word phrase. Many of them fully understand what I mean when I say I have an HSA-qualified health plan, and I'm surprised when some say that they have the same type of plan themselves!

When I ask if the test or prescription is really necessary, I've been amazed that the doctors are usually quite straightforward, honest and downright helpful. It's almost as if I've given them permission to practice medicine the old-fashioned way.

Too often, I think we forget that many doctors are, by nature, people-pleasers -- which is probably what drew them into one of the helping professions to begin with. And I think many of them feel that a patient expects them to do something, even when the best course of action would be to do nothing -- no expensive prescription or fancy test needed. Just a little time!