Every time I meet a patient with Parkinson’s disease who is a candidate for surgery in the outpatient clinic, I am afraid that I will become a replica of a failed surgery, citing examples of unsuccessful surgeries that I have heard about. In fact, any surgery has a chance of success and a risk of failure. Before making a surgical decision, in addition to considering the indications and maximizing the benefits/risks, both doctors and patients need to consider three elements: harmony, timing, and location. Human harmony: Seeing a doctor is actually seeing a person, so the human factor always comes first. Family harmony is the most important thing, and people harmony is the most important thing. In this case, “human harmony” refers to the right person, including the correct diagnosis, the indications for surgery, the absence of contraindications to surgery, and reasonable expectations for surgery. The right diagnosis is crucial, and the length of disease is often used as a reference, in addition to a case-by-case review of the diagnostic criteria. Because many early Parkinson’s syndromes present very similarly to Parkinson’s disease, the 2012 Chinese Expert Consensus on Parkinson’s Disease DBS recommended a disease duration of 5 years or more. A necessary step in the process of definitive diagnosis is the levodopa shock test (without much explanation, see figure). Think everything is OK once you have mastered the indications and excluded the contraindications? Slow down! Have you communicated with the patient what he expects from the procedure? Often, good intentions do not lead to good results because communication with the patient is neglected. The following two charts will help you in this regard. Timing: Once the right person is chosen, when to do the surgery is another question. It is important to know that DBS surgery is never an emergency surgery, but ideally an elective surgery, where the best results are achieved within the most appropriate time window. If the surgery is done too early, the diagnosis may not be clear enough to ensure the postoperative outcome; if the surgery is done too late, the best window of time for surgery may be missed, which means that the best surgical outcome will not be obtained or even the opportunity for surgery will be missed, which is often the result of the patient’s indecision. I often refer to a patient’s entry into the surgical indication as “a foot in the doorway of the surgical indication”, as if you have entered a warm room full of sunshine. At this stage, you have ample time to choose an “auspicious” date for surgery. But this decision is not always in your hands, the disease is creeping forward and one day you will cross the room. This day may be marked by frequent falls, by a slow and inadvertent decline in intelligence, or by nerves that are so weak and depressed by the disease. Therefore, close follow-up and regular evaluation is essential to not miss the indications for surgery for patients who have already “stepped in the door”. Of course, during this process, the doctor will try to adjust the medication in order to achieve the “optimal medication”, which means that the specialist will adjust the dose and frequency of medication as much as possible according to the available treatment guidelines and the medication that is available. As for how to adjust, it is both a technique and an art, which is a matter of opinion, to be discussed in the future. Geographical advantage: After having the two elements of harmony and timing, we should not neglect the geographical advantage. On the one hand, family support (financial and emotional), and on the other hand, the choice of the surgical site – the experience of the surgical hospital and surgeon, the possibility of postoperative program control. In the 1-2 years after surgery, the patient often needs to have the DBS parameters adjusted by the surgeon, the terminology is called program control. Usually this step needs to be done in the hospital, but some brands now have the ability to do it remotely, and these are also things that patients need to consider before surgery.