Faculty Profiles

Alexander Smith, MD, MPH
Associate Professor

(Database place holder)

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 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 faculty 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 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 and Palliative Care on the web. GeriPal received nearly 2.5 million page views between 2009 and 2015. 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 2015.

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 a 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.

Awards and Honors

2013   Research Mentor of the Year, Medical Students in Aging Research, 2013
2012   Paul Beeson Career Development Award In Geriatrics, American Federation for Aging Research/NIA, 2012-2017
2012   Best Paper of the Year Award, Society of General Internal Medicine, 2012
2012   Top Reviewer, Annals of Internal Medicine, 2012
2010   Greenwall Faculty Scholar in Bioethics, Greenwall Foundation, 2010-2014
2004   Outstanding Resident Mentor Award, Brigham and Women's Hospital, 2004-2005
1996   Phi Beta Kappa, University of Michigan, 1996

Recent Articles (13)

Lakin JR, Smith AK. Opening it up for more questions: racial disparities in hospice use. J Pain Symptom Manage. 2013 Nov; 46(5):617.

Smith AK, Lo B, Sudore R. When previously expressed wishes conflict with best interests. JAMA Intern Med. 2013 Jul 8; 173(13):1241-5.

Smith AK, Thai JN, Bakitas MA, Meier DE, Spragens LH, Temel JS, Weissman DE, Rabow MW. The diverse landscape of palliative care clinics. J Palliat Med. 2013 Jun; 16(6):661-8.

Smith AK. Palliative care: an approach for all internists: comment on "Early palliative care in advanced lung cancer: a qualitative study". JAMA Intern Med. 2013 Feb 25; 173(4):291-2.

Smith AK, Lo B. The problem with actually tattooing DNR across your chest. J Gen Intern Med. 2012 Oct; 27(10):1238-9.

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.

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.

Smith AK, Cenzer IS, Knight SJ, Puntillo KA, Widera E, Williams BA, Boscardin WJ, Covinsky KE. The epidemiology of pain during the last 2 years of life. Ann Intern Med. 2010 Nov 2; 153(9):563-9.

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, Sudore RL, PĂ©rez-Stable EJ. Palliative care for Latino patients and their families: whenever we prayed, she wept. JAMA. 2009 Mar 11; 301(10):1047-57, E1.

Smith AK, Earle CC, McCarthy EP. Racial and ethnic differences in end-of-life care in fee-for-service Medicare beneficiaries with advanced cancer. J Am Geriatr Soc. 2009 Jan; 57(1):153-8.

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.

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