The case for uncertainty

Cate Swannell
Med J Aust || doi: 10.5694/mja18.2105C1
Published online: 21 May 2018

Simon Lewis has a passion for helping people with neurodegenerative brain diseases that keeps him on the cutting edge of research in the field …

SIMON Lewis enjoys uncertainty.

In what he calls a “road to Damascus moment” as a young registrar in the UK, Professor Lewis found himself on a neurology rotation, facing a couple of outpatients.

“I screwed both [cases] up,” he tells the MJA.

He was hooked.

As the director of the Parkinson’s Disease Research Clinic at the University of Sydney’s Brain and Mind Centre, Professor Lewis now gets to indulge in what has become his passion – changing the lives of people living with neurodegenerative brain diseases for the better.

“Initially I wanted to be a vet but, in the end, going into medicine was the best thing I ever did,” Professor Lewis says.

A hankering for surgery was his first idea but then, “I realised how dull surgery was”.

“As a surgeon you’re always certain what you’re going to do. You can’t be a surgeon and not be certain how you’re going to cut into someone.”

Neurology, he says, is a different kettle of fish.

“As a neurologist you have to live with uncertainty every day and that not knowing very much appeals to me. The truth of the matter is that I have no idea what I’m going to see each day.”

Professor Lewis is a consultant neurologist at the Royal Prince Alfred Hospital specialising in newly diagnosed and advanced Parkinson disease and other neurodegenerative diseases, with “expertise in freezing of gait, hallucinations, memory problems and sleep disturbances”, according to his website (

“Neurology is not as hard or mysterious as people make it out to be,” Professor Lewis tells the MJA.

“You’re using a basic wiring diagram – what is the patient experiencing, and where is that coming from. Where is the lesion? It’s common sense.”

It was a quirk in the UK system of training junior doctors that led Professor Lewis to deep dive into neurology. After graduating from the University of Wales in Cardiff in 1995, he hit a road block.

“I couldn’t get a training position number,” he says. “There was a huge bottleneck of registrars in the UK and you had to be a researcher to get a [place]. So, I went to the University of Cambridge to do some research.”

It was while at Cambridge that he interviewed hundreds of people with Parkinson’s disease in their own homes, learning how they coped and adjusted in their own environments, a perspective not available to many doctors (

“Seeing the difficulties experienced by patients and their families led me to specialise in this field and I remain committed to making a difference,” he writes on his website. “You could say that I am passionate about this, some might argue obsessed.”

Now he heads up a team of bright, young researchers at the Brain and Mind Centre. Their current research includes “trying to develop diagnostic blood tests, better understanding and management of specific symptoms such as gait disturbance, memory problems, hallucinations and sleep problems, as well trying to predict who will develop neurodegenerative diseases to allow treatment at the earliest possible stage”.

Professor Lewis has made a series of videos providing explanations and guides for people with neurodegenerative diseases and those caring for them ( He also interviews other experts in the field, including those in community support services, as a resource for other physicians.

His advice to medical students and junior doctors contemplating a career in neurology is simple.

“If you wake up in the morning and you have no idea what the day is going to bring, and you like that idea, then you are already halfway to being a neurologist.”

Podcasts with Professor Simon Lewis are available (open access) at (Broadening our view of Parkinson disease) and (REM sleep behaviour disorder).

  • Cate Swannell



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