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    Alexander Smith, MD, MPH

    TitleAssociate Professor
    SchoolUCSF School of Medicine
    DepartmentMedicine
    Address(Database place holder)
    Phone415-221-4810x4684
    vCardDownload vCard

      Collapse Biography 
      Collapse Education and Training
      University of California, San FranciscoM.D. Medicine2002
      University of California, BerkeleyM.S. School of Public Health1999
      University of MichiganBSCellular and Molecular Biology1996
      Harvard UniversityMPHSchool of Public Health2005
      Brigham and Women's HospitalResidencyPrimary Care Internal Medicine2005
      Brigham and Women's Hospital/Dana Farber Cancer InstituteFellowshipPalliative Medicine2006
      Beth Israel Deaconess Medical CenterFellowshipGeneral Internal Medicine2008
      Collapse Awards and Honors
      Brigham and Women's Hospital2004 - 2005Outstanding Resident Mentor Award
      University of Michigan1996Phi Beta Kappa
      Greenwall Foundation2010 - 2014Greenwall Faculty Scholar in Bioethics
      American Federation for Aging Research/NIA2012 - 2017Paul Beeson Career Development Award In Geriatrics
      Society of General Internal Medicine2012 - 2012Best Paper of the Year Award
      Annals of Internal Medicine2012 - 2012Top Reviewer
      Medical Students in Aging Research2013 - 2013Research Mentor of the Year

      Collapse Overview 
      Collapse Overview
      Overview:
      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.

      Research:
      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.

      Clinical:
      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.

      Collapse Interests
      Implementation Science, Older adults, Persons with physical disability, Clinic, Hospital, Community-based organization, Decision aids, Prognosis in medical decision making in the elderly, Brief implementation science training courses, Implementation & dissemination science listservs

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