10% Gives You 90%

by Dr. John Beasley, M.D.
Aviation Medical Examiner
Professor Emeritus and Clinical Professor
Department of Family Medicine
University of Wisconsin – Madison
Published in Midwest Flyer – June/July 2017 issue

Dr. Beasley, if you give me one more pill, I won’t even have to eat breakfast!” snapped the feisty 93-year-old woman in my office, recently. She made me think. Each one of the medications I had prescribed had a purpose and made sense as I treated her various problems. But when I looked at the whole list (there had to be a half dozen or more pills she was taking), I had to wonder, “Am I crazy to give her all this stuff?”

When we increase the number of medications a patient is taking, the incremental benefits of each new one are less and the probability of side effects and medication interactions goes up – probably exponentially. More is not necessarily better. Probably the first 10% of what we do gives us most of the benefit, and there is decreasing benefit with all the other stuff.

So does the same 10% gives you 90% rule also apply to aviation?

EAA AirVenture Oshkosh is always a highlight of the year and gives us the chance to buy lots of things we can use to improve our flying. While wandering through the exhibit buildings, I saw a veritable cornucopia of things that are available for my Mooney and realized I could buy enough stuff to fill a DC-3. And as with the medications my patient was taking, each would have a laudable purpose. But how much stuff can we add to the cockpit before there is little added value, and the distractions become not just a nuisance, but a hazard? When more become less? For both patients and my airplane, there is a decreasing value to each added procedure or medication or gadget.

We start with the basics. For you as a patient, let’s get the diabetes under some reasonable control and the blood pressure out of the stratosphere.

The basics. For my Mooney, needle, ball and airspeed are still the basics. In each case, we are about 90% of the way to what we really need with about 10% of the “stuff.”

We need to be judicious in what we decide to do both medically and in aviation. When you are with your personal physician, physician assistant or nurse practitioner, and they propose something new – perhaps a test or a medication – ask them how important is the drug to your health, really, and what are the risks or downsides?

Likewise, when you are thinking of a new gadget for the airplane, you may want to ask yourself, how much will this really increase comfort or safety, and is it really worth the expense?

In both medicine and flying we want the Goldilocks amount… Not too little, not too much. Just right. Whether in medicine or aviation, about 10% of whatever we do will give us 90% of the benefits.

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