The patient-physician relationship (PPR) refers to all verbal and nonverbal exchanges during medical interactions between the practitioner and the patient, including, possibly, the patient’s family. The essential components of PPR are listening, empathy, respect, patient examination, information, and trust, which are foundational to therapeutic alliances. PPR is not necessarily friendly but must be cordial, satisfying both parties as much as possible, and is essential for optimizing outcomes and psychological effects. This is particularly true in neurology, where symptoms and diseases remain mysterious, chronic, and disabling. The traditional PPR model could be described by the pejorative term paternalistic, which is an unequal and asymmetric patient-physician relationship. Nowadays, new factors influence the PPR, illustrated by words such as participation, shared decision-making, free and informed consent, self-empowerment, autonomy, and patient-centered care. Furthermore, patients are better equipped with knowledge and education, leading to a more critical, and perhaps more demanding, attitude but the need for clear and factual information is possibly greater to minimize misunderstanding or misuse. Additionally, time, administrative, legal, and technological advances impact the PPR. There is also the impression that the PPR is becoming increasingly dehumanized, a concern shared by patients and doctors. Patients may feel frustrated, helpless, and vulnerable in the face of impersonal technoscience; they become users, asserting their rights, but also consumers within the economic system. Doctors may be seen as service providers and may become dismayed and demotivated; however, they must not abandon the benevolence and respect for autonomy and should retain faith in their clinical encounters, which is the essence of good medicine. Neurology has always been an art and should remain so, evaluating the person holistically with appropriate interventions developed individually, and the PPR is a cornerstone of these goals.