Alexander Smith, MD, MPH

TitleAssociate Professor
SchoolUCSF School of Medicine
Address4150 Clement St
San Francisco CA 94121
Phone415-221-4810 ext. 4684
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    Collapse Biography 
    Collapse Education and Training
    University of California, San FranciscoM.D.2002 Medicine
    University of California, BerkeleyM.S.1999 School of Public Health
    University of MichiganBS1996Cellular and Molecular Biology
    Harvard UniversityMPH2005School of Public Health
    Brigham and Women's HospitalResidency2005Primary Care Internal Medicine
    Brigham and Women's Hospital/Dana Farber Cancer InstituteFellowship2006Palliative Medicine
    Beth Israel Deaconess Medical CenterFellowship2008General Internal Medicine
    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
    Project on Death in America 2014  - 2014PDIA National Leadership Award
    Reynolds Foundation 2016  - 2016Eprognosis awarded Product of the Decade
    OnlineColleges.com2012  - 2012One of "50 Best Medical Professors on Twitter"

    Collapse Overview 
    Collapse 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.


    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.

    Collapse Research 
    Collapse Research Activities and Funding
    Developing prognostic models for life expectancy and geriatric outcomes
    NIH/NIA R01AG047897May 15, 2015 - Jan 31, 2019
    Role: Principal Investigator
    P0045982 Late Life Disability: Epidemiology, Symptoms, Quality of Life
    NIH/NIA K23AG040772Sep 1, 2012 - Nov 30, 2017
    Role: Principal Investigator

    Collapse ORNG Applications 
    Collapse Websites
    Collapse In The News
    Collapse Featured Presentations
    Collapse Faculty Mentoring
    Collapse Twitter
    Collapse Featured Videos

    Collapse Bibliographic 
    Collapse Publications
    Publications listed below are automatically derived from MEDLINE/PubMed and other sources, which might result in incorrect or missing publications. Researchers can login to make corrections and additions, or contact us for help.
    List All   |   Timeline
    1. Wong TW, Lang-Brown S, Romo RD, Au-Yeung A, Lee SJ, Moran PJ, Karlawish J, Sudore R, Clayton J, Smith A. Prognosis Communication in Late-Life Disability: A Mixed Methods Study. J Am Geriatr Soc. 2017 Sep 14. PMID: 28905358.
      View in: PubMed
    2. Whitlock EL, Diaz-Ramirez LG, Glymour MM, Boscardin WJ, Covinsky KE, Smith A. Association Between Persistent Pain and Memory Decline and Dementia in a Longitudinal Cohort of Elders. JAMA Intern Med. 2017 Aug 01; 177(8):1146-1153. PMID: 28586818.
      View in: PubMed
    3. Bleijenberg N, Smith A, Lee SJ, Cenzer IS, Boscardin JW, Covinsky KE. Difficulty Managing Medications and Finances in Older Adults: A 10-year Cohort Study. J Am Geriatr Soc. 2017 Jul; 65(7):1455-1461. PMID: 28378345.
      View in: PubMed
    4. Romo RD, Allison TA, Smith A, Wallhagen MI. Sense of Control in End-of-Life Decision-Making. J Am Geriatr Soc. 2017 Mar; 65(3):e70-e75. PMID: 28029695.
      View in: PubMed
    5. Harrison KL, Adrion ER, Ritchie CS, Sudore RL, Smith A. Low Completion and Disparities in Advance Care Planning Activities Among Older Medicare Beneficiaries. JAMA Intern Med. 2016 Dec 01; 176(12):1872-1875. PMID: 27802496.
      View in: PubMed
    6. Smith A, Currow DC, Abernethy AP, Johnson MJ, Miao Y, Boscardin WJ, Ritchie CS. Prevalence and Outcomes of Breathlessness in Older Adults: A National Population Study. J Am Geriatr Soc. 2016 Oct; 64(10):2035-2041. PMID: 27603500.
      View in: PubMed
    7. Ritchie CS, Kelley AS, Stijacic Cenzer I, Smith A, Wallhagen ML, Covinsky KE. High Levels of Geriatric Palliative Care Needs in Hip Fracture Patients Before the Hip Fracture. J Pain Symptom Manage. 2016 Oct; 52(4):533-538. PMID: 27521282.
      View in: PubMed
    8. Smith A, Ritchie CS, Miao Y, Boscardin WJ, Wallhagen ML. Self-Reported Hearing in the Last 2 Years of Life in Older Adults. J Am Geriatr Soc. 2016 Jul; 64(7):1486-91. PMID: 27341383; PMCID: PMC4942375.
    9. Cenzer IS, Tang V, Boscardin WJ, Smith A, Ritchie C, Wallhagen MI, Espaldon R, Covinsky KE. One-Year Mortality After Hip Fracture: Development and Validation of a Prognostic Index. J Am Geriatr Soc. 2016 Sep; 64(9):1863-8. PMID: 27295578; PMCID: PMC5026872 [Available on 09/01/17].
    10. Cagle JG, McClymont KM, Thai JN, Smith A. "If You Don't Know, All of a Sudden, They're Gone": Caregiver Perspectives About Prognostic Communication for Disabled Elderly Adults. J Am Geriatr Soc. 2016 Jun; 64(6):1299-306. PMID: 27321609; PMCID: PMC4955663 [Available on 06/01/17].
    11. Matlock DD, Yamashita TE, Min SJ, Smith A, Kelley AS, M Fischer S. How U.S. Doctors Die: A Cohort Study of Healthcare Use at the End of Life. J Am Geriatr Soc. 2016 May; 64(5):1061-7. PMID: 27195936; PMCID: PMC4882251 [Available on 05/16/17].
    12. Schonberg MA, Smith A. Discussing Long-term Prognosis in Primary Care: Hard but Necessary. JAMA Intern Med. 2016 May 01; 176(5):678-80. PMID: 27064576; PMCID: PMC4994810 [Available on 05/01/17].
    13. Petrillo LA, Dzeng E, Smith A. California's End of Life Option Act: Opportunities and Challenges Ahead. J Gen Intern Med. 2016 Aug; 31(8):828-9. PMID: 27114358; PMCID: PMC4945570 [Available on 08/01/17].
    14. Smith A, Ritchie CS, Wallhagen ML. Hearing Loss in Hospice and Palliative Care: A National Survey of Providers. J Pain Symptom Manage. 2016 Aug; 52(2):254-8. PMID: 27046300.
      View in: PubMed
    15. Paul-Emile K, Smith A, Lo B, Fernández A. Dealing with Racist Patients. N Engl J Med. 2016 Feb 25; 374(8):708-11. PMID: 26933847.
      View in: PubMed
    16. Barnhart C, McClymont K, Smith A, Au-Yeung A, Lee SJ. "Everyone else gets ice cream here more often than I do--It burns me up"--Perspectives on Diabetes Care from Nursing Home Residents and their Doctors. BMC Geriatr. 2016 Jan 26; 16:28. PMID: 26813788; PMCID: PMC4729138.
    17. Romo RD, Lee SJ, Miao Y, Boscardin WJ, Smith A. Subjective, Objective, and Observed Long-term Survival: A Longitudinal Cohort Study. JAMA Intern Med. 2015 Dec; 175(12):1986-8. PMID: 26502331; PMCID: PMC4699655.
    18. Smith A, Cenzer IS, John Boscardin W, Ritchie CS, Wallhagen ML, Covinsky KE. Increase in Disability Prevalence Before Hip Fracture. J Am Geriatr Soc. 2015 Oct; 63(10):2029-35. PMID: 26480970; PMCID: PMC4699653.
    19. Hunt LJ, Covinsky KE, Yaffe K, Stephens CE, Miao Y, Boscardin WJ, Smith A. Pain in Community-Dwelling Older Adults with Dementia: Results from the National Health and Aging Trends Study. J Am Geriatr Soc. 2015 Aug; 63(8):1503-11. PMID: 26200445; PMCID: PMC4778418.
    20. Austin CA, Mohottige D, Sudore RL, Smith A, Hanson LC. Tools to Promote Shared Decision Making in Serious Illness: A Systematic Review. JAMA Intern Med. 2015 Jul; 175(7):1213-21. PMID: 25985438; PMCID: PMC4794743.
    21. Thai JN, Barnhart CE, Cagle J, Smith A. "It Just Consumes Your Life": Quality of Life for Informal Caregivers of Diverse Older Adults With Late-Life Disability. Am J Hosp Palliat Care. 2016 Aug; 33(7):644-50. PMID: 25948041; PMCID: PMC4636480.
    22. Smith A, Jain N, Wallhagen ML. Hearing loss in palliative care. J Palliat Med. 2015 Jun; 18(6):559-62. PMID: 25867966; PMCID: PMC4518876.
    23. Rogers SE, Thrasher AD, Miao Y, Boscardin WJ, Smith A. Discrimination in Healthcare Settings is Associated with Disability in Older Adults: Health and Retirement Study, 2008-2012. J Gen Intern Med. 2015 Oct; 30(10):1413-20. PMID: 25773918; PMCID: PMC4579241.
    24. Romo RD, Wallhagen MI, Smith A. Viewing Hospice Decision Making as a Process. Am J Hosp Palliat Care. 2016 Jun; 33(5):503-10. PMID: 25635114.
      View in: PubMed
    25. Williams BA, Ahalt C, Stijacic-Cenzer I, Smith A, Goldenson J, Ritchie CS. Pain behind bars: the epidemiology of pain in older jail inmates in a county jail. J Palliat Med. 2014 Dec; 17(12):1336-43. PMID: 25265035; PMCID: PMC4268586.
    26. McClymont KM, Lee SJ, Schonberg MA, Widera E, Miao Y, Smith A. Usefulness and effect of online prognostic calculators. J Am Geriatr Soc. 2014 Dec; 62(12):2444-5. PMID: 25516045; PMCID: PMC4273751.
    27. Kelley AS, Langa KM, Smith A, Cagle J, Ornstein K, Silveira MJ, Nicholas L, Covinsky KE, Ritchie CS. Leveraging the health and retirement study to advance palliative care research. J Palliat Med. 2014 May; 17(5):506-11. PMID: 24694096; PMCID: PMC4012620.
    28. Smith A, Lo B, Aronson L. Elder self-neglect--how can a physician help? N Engl J Med. 2013 Dec 26; 369(26):2476-9. PMID: 24369074; PMCID: PMC4035097.
    29. Smith A, Walter LC, Miao Y, Boscardin WJ, Covinsky KE. Disability during the last two years of life. JAMA Intern Med. 2013 Sep 09; 173(16):1506-13. PMID: 23836120; PMCID: PMC3773297.
    30. Lakin JR, Smith A. Opening it up for more questions: racial disparities in hospice use. J Pain Symptom Manage. 2013 Nov; 46(5):617. PMID: 23953597.
      View in: PubMed
    31. Smith A, Lo B, Sudore R. When previously expressed wishes conflict with best interests. JAMA Intern Med. 2013 Jul 08; 173(13):1241-5. PMID: 23712743; PMCID: PMC3741042.
    32. Smith A, White DB, Arnold RM. Uncertainty--the other side of prognosis. N Engl J Med. 2013 Jun 27; 368(26):2448-50. PMID: 23802514; PMCID: PMC3760713.
    33. Smith A, 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. PMID: 23662953; PMCID: PMC3668622.
    34. Smith A. 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. PMID: 23358724; PMCID: PMC3732177.
    35. Bischoff KE, Sudore R, Miao Y, Boscardin WJ, Smith A. Advance care planning and the quality of end-of-life care in older adults. J Am Geriatr Soc. 2013 Feb; 61(2):209-14. PMID: 23350921; PMCID: PMC3760679.
    36. Thai JN, Walter LC, Eng C, Smith A. 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. PMID: 23320808; PMCID: PMC3573246.
    37. Romo RD, Wallhagen MI, Yourman L, Yeung CC, Eng C, Micco G, Pérez-Stable EJ, Smith A. Perceptions of successful aging among diverse elders with late-life disability. Gerontologist. 2013 Dec; 53(6):939-49. PMID: 23231944; PMCID: PMC3826160.
    38. Aragon K, Covinsky K, Miao Y, Boscardin WJ, Flint L, Smith A. 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. PMID: 23026981; PMCID: PMC3732164.
    39. Smith A, Lo B. The problem with actually tattooing DNR across your chest. J Gen Intern Med. 2012 Oct; 27(10):1238-9. PMID: 22810355; PMCID: PMC3445688.
    40. Smith A, 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. PMID: 22665840; PMCID: PMC3736978.
    41. King J, Yourman L, Ahalt C, Eng C, Knight SJ, Pérez-Stable EJ, Smith A. 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. PMID: 22288767; PMCID: PMC3619719.
    42. Yourman LC, Lee SJ, Schonberg MA, Widera EW, Smith A. Prognostic indices for older adults: a systematic review. JAMA. 2012 Jan 11; 307(2):182-92. PMID: 22235089; PMCID: PMC3792853.
    43. Smith A, Williams BA, Lo B. Discussing overall prognosis with the very elderly. N Engl J Med. 2011 Dec 08; 365(23):2149-51. PMID: 22150033; PMCID: PMC3760676.
    44. Ahalt C, Walter LC, Yourman L, Eng C, Pérez-Stable EJ, Smith A. "Knowing is better": preferences of diverse older adults for discussing prognosis. J Gen Intern Med. 2012 May; 27(5):568-75. PMID: 22127798; PMCID: PMC3326105.
    45. Schenker Y, Smith A, Arnold RM, Fernandez A. "Her husband doesn't speak much English": conducting a family meeting with an interpreter. J Palliat Med. 2012 Apr; 15(4):494-8. PMID: 22107068; PMCID: PMC3647542.
    46. Smith A, 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. PMID: 21301985; PMCID: PMC3138974.
    47. Smith A, 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 02; 153(9):563-9. PMID: 21041575; PMCID: PMC3150170.
    48. Raghavan M, Smith A, Arnold RM. African Americans and end-of-life care #204. J Palliat Med. 2010 Nov; 13(11):1382-3. PMID: 21091024.
      View in: PubMed
    49. Kelly A, Conell-Price J, Covinsky K, Cenzer IS, Chang A, Boscardin WJ, Smith A. 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. PMID: 20738438; PMCID: PMC2945440.
    50. Fromme EK, Smith A, Hughes MT, Brokaw FC, Rosenfeld KE, Arnold RM. Update in palliative medicine. Am J Hosp Palliat Care. 2010 Sep; 27(6):420-7. PMID: 20555038.
      View in: PubMed
    51. Smith A, 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. PMID: 20434873; PMCID: PMC2884054.
    52. Rabow MW, Smith A, Braun JL, Weissman DE. Outpatient palliative care practices. Arch Intern Med. 2010 Apr 12; 170(7):654-5. PMID: 20386012.
      View in: PubMed
    53. Micco G, Villars P, Smith A. The death of Ivan Ilyich and pain relief at the end of life. Lancet. 2009 Sep 12; 374(9693):872-3. PMID: 19757512.
      View in: PubMed
    54. Sung AD, Collins ME, Smith A, Sanders AM, Quinn MA, Block SD, Arnold RM. Crying: experiences and attitudes of third-year medical students and interns. Teach Learn Med. 2009 Jul; 21(3):180-7. PMID: 20183336.
      View in: PubMed
    55. Smith A, Sudore RL, Pérez-Stable EJ. Palliative care for Latino patients and their families: whenever we prayed, she wept. JAMA. 2009 Mar 11; 301(10):1047-57, E1. PMID: 19278947; PMCID: PMC2782583.
    56. Smith A, 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. PMID: 19054185; PMCID: PMC2948958.
    57. Smith A, 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. PMID: 18930337.
      View in: PubMed
    58. Smith A, 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 01; 26(25):4131-7. PMID: 18757326; PMCID: PMC2654372.
    59. Smith A, 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. PMID: 18463409.
      View in: PubMed
    60. Smith A, 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. PMID: 17879120; PMCID: PMC2219809.
    61. Smith A, 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. PMID: 17803417.
      View in: PubMed
    62. Smith A, 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 Aug 14-28; 166(15):1597-602. PMID: 16908792.
      View in: PubMed
    63. Smith A, Coakley FV, Jackson R, Gordon RL. CT and MRI of retroperitoneal edema associated with large uterine leiomyomas. J Comput Assist Tomogr. 2002 May-Jun; 26(3):459-61. PMID: 12016381.
      View in: PubMed
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