Faculty ProfilesAlexander Smith, MD, MPH
4150 Clement Street, BOX 181G
Alex Smith is a clinician-researcher who is at the forefront of efforts to integrate Geriatrics and Palliative Care. Dr. Smith received his medical school training in the UC Berkeley/UCSF Joint Medical Program. He completed a primary care internal medicine residency at the Brigham and Women's Hospital (BWH) followed by two fellowships, a one year clinical fellowship in Palliative Medicine at BWH and Dana Farber Cancer Institute, followed by a two year General Internal Medicine Fellowship at Beth Israel Deaconess Medical Center, including an MPH from the Harvard School of Public Health. Dr. Smith returned to UCSF in July 2008 as an Assistant Professor in the Division of Geriatrics.
Dr. Smith's research program focuses on improving palliative care for vulnerable and dependent elders. He has strong interests in bioethics and improving patient-physician communication. He is currently funded by the Greenwall Faculty Scholars Program in Bioethics and a Paul Beeson National Institute on Aging K23 career development award. Dr. Smith works clinically on the Hospice and Palliative Care Service at the SF VAMC. Dr. Smith and Dr. Eric Widera co-founded GeriPal, a Geriatrics and Palliative Care Blog, the leading source for news and commentary related to Geriatrics or Palliative Care on the web. GeriPal received nearly 1.5 million page views between 2009 and 2013. Also working with Dr. Widera and Drs. Sei Lee and Mara Schonberg, Dr. Smith launched ePrognosis, an online set of prognostic calculators for the elderly. ePrognosis had over half a million page views in the first week, and over 1 million between 2012 and 2013.
Dr. Smith is a general internist dually trained in palliative medicine and health services research, focused on integrating geriatrics and palliative care.
Dr. Smith's research is motivated by a recognition that the overwhelming need for palliative care services occurs in the elderly. Unfortunately, however, older persons are severely underrepresented both in the receipt of palliative care services and in palliative care research. This gap in our understanding exists for a reason: the challenges of studying palliative care needs in frail elders with multiple diagnoses, and frequently with functional and cognitive impairment, are much more complicated than studying these needs in younger patients with cancer. Dr. Smith embraces the challenge of research in this complex area.
While Dr. Smith is broadly interested in issues at the intersection of geriatrics and palliative care, his research has largely been organized around three primary areas: end-of-life experiences, patient-doctor communication, and cultural attitudes toward care. In a series of studies examining nationally representative group of older adults who died, Dr. Smith demonstrated that: (1) pain due to arthritis is under-recognized in the last years of life; (2) lengths of stay in nursing homes for patients who die are shorter than generally appreciated (median 5 months, average 14 months); and (3) emergency departments and skilled nursing facilities are common sites of care in the last months of life and should be a focus of efforts to improve the quality of palliative care. Dr. Smith has a strong interest in understanding how cultural factors influence the perspectives and experiences of patients with serious illness or disability and their families. For example, in a recent study, Dr. Smith found that two-thirds of Chinese American, African American, Latino, and white elders with disability would want to be told their prognosis if they had less than 5 years left to live. He therefore argues that clinicians should offer to discuss prognosis with their very elderly patients, both because it allows for more informed medical decision making and because many patients want to know so they can prepare for the future.
Dr. Smith's primary clinical work is on the Hospice and Palliative Care service at the SF VAMC. In this capacity, he consults on the management of patients with palliative care needs in the hospital and cares for patients who reside in the Hospice facility located within the Community Living Center. Dr. Smith also attends on the inpatient medicine wards at the SF VAMC.
Awards and Honors
Outstanding Resident Mentor Award, Brigham and Women's Hospital, 2004-2005
Recent Articles (37)
Thai JN, Walter LC, Eng C, Smith AK. Every patient is an individual: clinicians balance individual factors when discussing prognosis with diverse frail elderly adults. J Am Geriatr Soc. 2013 Feb; 61(2):264-9.
Romo RD, Wallhagen MI, Yourman L, Yeung CC, Eng C, Micco G, Pérez-Stable EJ, Smith AK. Perceptions of successful aging among diverse elders with late-life disability. Gerontologist. 2013 Dec; 53(6):939-49.
Aragon K, Covinsky K, Miao Y, Boscardin WJ, Flint L, Smith AK. Use of the Medicare posthospitalization skilled nursing benefit in the last 6 months of life. Arch Intern Med. 2012 Nov 12; 172(20):1573-9.
Smith AK, McCarthy E, Weber E, Cenzer IS, Boscardin J, Fisher J, Covinsky K. Half of older Americans seen in emergency department in last month of life; most admitted to hospital, and many die there. Health Aff (Millwood). 2012 Jun; 31(6):1277-85.
King J, Yourman L, Ahalt C, Eng C, Knight SJ, Pérez-Stable EJ, Smith AK. Quality of life in late-life disability: "I don't feel bitter because I am in a wheelchair". J Am Geriatr Soc. 2012 Mar; 60(3):569-76.
Smith AK, Ayanian JZ, Covinsky KE, Landon BE, McCarthy EP, Wee CC, Steinman MA. Conducting high-value secondary dataset analysis: an introductory guide and resources. J Gen Intern Med. 2011 Aug; 26(8):920-9.
Kelly A, Conell-Price J, Covinsky K, Cenzer IS, Chang A, Boscardin WJ, Smith AK. Length of stay for older adults residing in nursing homes at the end of life. J Am Geriatr Soc. 2010 Sep; 58(9):1701-6.
Smith AK, Schonberg MA, Fisher J, Pallin DJ, Block SD, Forrow L, McCarthy EP. Emergency department experiences of acutely symptomatic patients with terminal illness and their family caregivers. J Pain Symptom Manage. 2010 Jun; 39(6):972-81.
Smith AK, Fisher J, Schonberg MA, Pallin DJ, Block SD, Forrow L, Phillips RS, McCarthy EP. Am I doing the right thing? Provider perspectives on improving palliative care in the emergency department. Ann Emerg Med. 2009 Jul; 54(1):86-93, 93.e1.
Smith AK, McCarthy EP, Paulk E, Balboni TA, Maciejewski PK, Block SD, Prigerson HG. Racial and ethnic differences in advance care planning among patients with cancer: impact of terminal illness acknowledgment, religiousness, and treatment preferences. J Clin Oncol. 2008 Sep 1; 26(25):4131-7.
Smith AK, Ladner D, McCarthy EP. Racial/ethnic disparities in liver transplant surgery and hospice use: parallels, differences, and unanswered questions. Am J Hosp Palliat Care. 2008 Aug-Sep; 25(4):285-91.
Smith AK, Davis RB, Krakauer EL. Differences in the quality of the patient-physician relationship among terminally ill African-American and white patients: impact on advance care planning and treatment preferences. J Gen Intern Med. 2007 Nov; 22(11):1579-82.
Smith AK, Buss MK, Giansiracusa DF, Block SD. On being fired: experiences of patient-initiated termination of the patient-physician relationship in palliative medicine. J Palliat Med. 2007 Aug; 10(4):938-47.