“Often people say ‘I can’t believe you do [pediatric neurology] because there’s no treatment for anything and it must be horrible to deal with children’s neurological disorders.’ The truth is, they are much better at dealing with their neurological disorders than adults are… You can really see them grow and bloom as individuals and overcome some really difficult situations… It brings a lot of pride and joy to the specialty.”

Dr. Lewis on working as a pediatric neurologist

1. Profile: Founder (Neurology Centre of Toronto); Assistant Professor (University of Toronto); Clinical Neurophysiology Fellowship (Nicklaus Children’s Hospital, Miami), Epilepsy Fellowship (SickKids, Toronto), Pediatric Neurology Residency (Ottawa), MD (Ottawa)
2. Projects: Cannabinoids in treatment of epilepsy, concussion, headache; Tele-neurology
3. Pitch: Ability to make your mark; Children have a joie de vivre that makes the challenges of treatment worth it
4. Path: Throughout education, Dr. Lewis was never a “gunner,” but fell into Pediatric Neurology from elective experiences; As a staff physician, made the rewarding choice of leaving the hospitalist setting to open up his own centre which he runs on his time and his terms. 
5. Personal: Dr. Lewis was a pioneer in the use of cannabinoids to treat pediatric epilepsy in Canada.
6. Philosophy: Talk to Everyone, Listen to No One – you are in charge of your own destiny, don’t take others’ opinions to heart.

• The reality is that it can be very challenging to work with complex neurological disorders, but kids have an innocence and will to improve that is incredibly inspiring.
• Ability to super-specialize while remaining a general neurological practitioner, potentially even seeing adults.

• Fluid personality – you need to adapt to personalities of both children and their parents. 
• Empathy, adaptability and conscientiousness are vital to healthy communication during complex cases.

• A 2020 medical school survey found perceptions of Pediatric Neurologists as brainy, detail-oriented and bowtie-clad, with complicated patients and limited treatment options.
• Response: Perception is probably created early in medical school, especially because of perception of the brain as especially complicated – many physicians remain fearful of neurological aspects of medicine.
  • Objectively, it is not more detail-oriented than say, cardiology or immunology. Most medicine is cerebral and complicated.
  • At the end of the day, neurology is just about pathways – track the problem backwards and you can figure out what’s going on.

Referenced Material: Jordan et al. Attracting Neurology’s next generation: a qualitative study of specialty choice and perceptions. Neurology 2020 Aug 25;95(8):e1080-e1090

Medical School

• Always liked neurology, but didn’t have the singular drive to pursue it.
  • Explored a variety of specialties including radiology, orthopedic surgery and urology.
• Experiences in Electives and Research piqued his interest and pulled him to neurology.
• Beware the Trap: If you are a good student, people will treat you well and you will feel like you belong. That’s only luck of the draw, positive feedback loop. Make sure you like the specialty, not just the people.

Staff

• Life events shifted focus from hospitalist medicine to more private practice – frustrated with long wait times and hospital’s monopoly on complex cases. 
• Elected to leave SickKids and created the Neurology Centre of Toronto, designed similar to a hospital outpatient clinic. 
• Ability to administrate, lead a team, teach, do research, all on his own terms and with his own standards, with time for hobbies on the side.
  • Allowed him to delve deeper into the use of cannabis in neurologic conditions, which at that time, wasn’t supported at SickKids

• Monday
  • Morning – Off; Afternoon – Overseeing New Physician; Evening – Concussion Clinic
• Tuesday
  • Morning – Off; Afternoon – Headache and Migraine Clinic
• Wednesday
  • All-Day – Follow-up Clinic
• Thursday
  • Morning – Epilepsy Clinic; Afternoon – Cannabis Education Session
• Friday
  • Mostly administrative work and some cannabis appointments
• Morning 8-12, Afternoon 1-4, Evening 5-8
• Admin work is mostly done W-F; Weekends are almost always free.
• Consults last about an hour, Follow-ups last about 30 minutes
• Dr. Lewis and his team of 7 neurologists and many Allied Health Professionals developed “Virtual Rapid Access Clinics”
  • Tackle Epilepsy, Concussion, Migraine, Headaches, Cannabis treatments and soon Stroke
  • Walk-in style virtual clinic – 20-minute visit within 1 week of referral

Personal Story:

“Epilepsy is interesting – you are either having seizures or you’re not having seizures … You give a medication and the seizures go away, which tells you the medication works at stopping seizures – it’s different from headaches, or anxiety or pain, which are more subjective. The big debate was: “Does medical cannabis work for epilepsy?” … One of my very early encounters was a young girl who had an explosive onset of seizures, and she was a perfectly healthy, developed little girl. The seizures were frequent enough that she started to regress in her development. She started losing the ability to walk, her communication wasn’t as good, she seemed obviously tired and down. We tried different medications and nothing worked. Her EEG was horrible. So ultimately, acting independently, we authorized cannabis for this young girl. Within 2-3 days, she stopped seizing and within 4 weeks, her EEG went to completely normalizing and she went from being unable to walk in a straight line to running and climbing and starting to develop perfectly again. This was on cannabis and nothing else.”

Note: While we tried to keep these transcriptions as true to the speaker as possible, some dialogue is paraphrased and/or edited for easier reading.

1. Explore as much as you can, but always keep your core values in the forefront as you make decisions. Don’t let one good or bad experience make you like/dislike an entire specialty.
2. Communication is key – you need to constantly challenge yourself into difficult situations to gain the practice, because you will always need to be able to take on difficult situations. Acronyms aren’t enough; real life never pans out in structure.
3. Talk to everyone, but don’t take what they say to heart. Be honest with yourself – you have to make the ultimate decisions on your career.