Vilfredo Pareto, an Italian economist, observed that there in general, there is an 80/20 split to all things.

• 80% of a businesses income will come from 20% of the customers
• 80% of the commodities will be owned by 20% of the people
• 80% of the work will take 20% of the time

Interestingly, this also seems to apply to the treatment of patients.

x = time, y = improvement

If we take the above plot (y = log x +2, where x = 0 to 10) we can see that, for a greater value of x, y takes proportionally longer to increase. A simplistic interpretation and a mathematician will be able to show that it never truly will be horizontal, (y will always change) but it can also be seen that the greatest increase in y happens very quickly (approximately within the first 20% of the graph).

We can therefore use this tool and curve as a multilayered example to discuss with our patients.

• Intial improvement should be rapid, within the first few treatments. If it isn’t, are we as clinicians missing something important?
• 80% of their improvement will take 20% of the treatment time
• They will never reach 100% better. We are all carrying compensations from the moment we are born, there will always be niggles. Our job is also to educate the patient on when these are mild or serious.
• Treatment is progressive and dynamic. As they pass the 80% improvement point (on the y axis) then they should be encouraged to take more responsibility for their improvement, through exercises, diet and behavioural changes.

The Pareto pricinple can also be applied to others areas of practice. We will get 20% of clients who are unusual presentations, 80% of problems will be resolved with 20% of our treatment techniques and so forth. It is that 20% that requires our focus and skill.