Alex Smith is an Assistant Professor of Medicine in the Division of Geriatrics.

Dr. Smith received his medical school training at UCSF, primary care internal medicine training at the Brigham and Women's Hospital (BWH). He then completed two fellowships, a one year clinical fellowship in Pain and Palliative Care 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 joined the faculty at UCSF in July 2008. He is a clinician-researcher, and devotes 75% of his effort toward research and 25% effort toward clinical work and teaching on the Hospice and Palliative Care Service at the SF VAMC. Dr. Smith's research program focuses on three primary areas: patient-physician communication, end-of-life care in minority populations, and the provision of palliative care in the emergency department. He is currently funded by a Diversity Supplement Award from the NIA.

Dr. Smith's research focuses on three overlapping areas:

1. Patient-physician communication. Dr. Smith is interested in how physician's communicate with seriously ill elders and their family members about goals of care and symptom management. In a study of internal medicine residents, Dr. Smith found that residents address code status with two-thirds of patients on the day they are admitted to the hospital, twice as often as they discussed any other advance care planning topic.


2. End-of-life care in minority populations. Dr. Smith is interested examining the underlying reasons for differences in end-of-life care by race and ethnicity, and to what extent these differences are due to cultural factors or disparities within the health care system.


3. The provision of palliative care in the emergency department (ED). As the first point of contact with the acute care system, the emergency department has tremendous potential for influencing the symptom experience and intensity of care patients receive. In focus groups with emergency medicine providers on how to improve palliative care in the ED, Dr. Smith found that communication was the highest priority for improvement, followed by improved pain management. In another study, Dr. Smith found that older African Americans with advanced cancer are twice as likely to visit the ED two or more times in the last month of life compared to whites.

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.