UCSF Department Of Medicine | Division of Geriatrics

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, UCSF's institutional KL2 program, and the SGIM/ACGIM/ASP T Franklin Williams Scholars award in Geriatrics. Dr. Smith works clinically on the Hospice and Palliative Care Service at the SF VAMC. Dr. Smith is Director of the SGIM Research Dataset Compendium. 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.

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.

Selected Publications

Smith AK, Ries AP, Zhang B, Tulsky JA, Prigerson HG, Block SD. Resident approaches to advance care planning on the day of hospital admission. Arch Intern Med. 2006;166:1597-1602.
Smith AK, Fisher J, Schonberg MA, Pallin D, Forrow L, Block SD, Phillips RS, McCarthy EP. "Am I doing the right thing?" Provider perspectives on improving palliative care in the emergency department. Ann Emerg Med. 2009;54:86-93.
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 Amer Geriatr Soc. 2009;57:153-8.
Smith AK, Sudore R, Perez-Stable E. Palliative care for Latino patients and their families: "Whenever we prayed, she wept." JAMA. 2009;301:1047-1057.
Smith AK, Stijacic Cenzer I, Knight S, Puntillo K, Widera E, Williams B, Boscardin, WJ, Covinsky KE. The epidemiology of pain during the last two years of life. Ann Intern Med; 2010; 153:563-569.
Smith AK, Ayanian, J, Covinsky, K, Landon, B, McCarthy, E, Wee, C, Steinman, M. Research with Large Datasets: An Introductory Guide and Resources. J Gen Intern Med; 2011; 26:920-929.
Ahalt, C, Yourman, L, Walter, L, Eng, C, Pérez-Stable E, Smith, AK. “Knowing is Better”: Preferences for prognostic information among diverse elders with late life disability. J Gen Intern Med;e-pub 11/30/11.
Smith, AK, Williams, B, Lo, B. Discussing Overall Prognosis with the Very Elderly. N Eng J Med; 2011; 365:2149-2151.
Yourman, L, Lee, S, Schonberg, M, Widera, E, Smith, AK. Prognostic Indices for Older Adults: A Systematic Review. JAMA; 2012; 387:182-192.
King J, Yourman L, Ahalt C, Eng C, Knight S, Pérez-Stable E, Smith AK. Quality of Life in Late-Life Disability: “I don't feel bitter because I am in a wheelchair.” J Amer Geriatr Soc; e-pub 1/31/12.