It depends a lot on your use case. In my case we have SQL running against tables with trillions of rows, so we need to take a look at every single SQL query in the code that runs more than tens of milliseconds or often enough to get significant. There is no automation for a good DBA looking at an execution plan; I heard about a guy that works in some financial company where his job for the past 10 days was to tune the same ~ 10 queries to the death, but if your app is working with a database that can be hosted comfortably on a smartphone, none of this is needed.
