I adhere to the principles outlined by the American Board of Neurological Surgery & Neurology. First, I meet with patient and family to improve their understanding of their disorder by means of direct face to face communication, aided by models and discussion of the imaging studies, and only then, discuss treatment options. I keep in mind our discipline’s motto, First Do No Harm. I encourage non-operative, conservative measures first; that failing then a Surgical option is discussed. I also encourage open discussion of the surgical intervention or medical outcome and expectations to see what can be done to achieve better results.