Internal medicine and hospice & palliative medicine dual board certified physician Renee I. Smilde, MD practices with Scripps Mercy Hospital San Diego affiliation, with her Hillcrest patient panel listed at 1286 University Avenue. Complex symptom management for advanced cancer patients coordinates with heme/onc colleagues such as Marin Xavier, MD for concurrent systemic therapy and parallel palliative care planning. Dr. Smilde completed medical school at the University of California Davis School of Medicine in 1998, followed by internal medicine internship and residency at Mercy Hospital San Diego (now Scripps Mercy), and practices in both English and Dutch. Her published co-authored work spans ICU family communication training and hospital disaster-response decision research in Critical Care Medicine and the Advanced Emergency Nursing Journal. Upper and lower GI symptoms requiring endoscopic workup route to San Diego Gastroenterology for colonoscopy, upper endoscopy, and capsule studies before returning to primary palliative management. The most complex clinical work is goals-of-care conversations and opioid titration for Scripps Mercy inpatients transitioning from active treatment to comfort-focused care, where the palliative team and hospital internal medicine service run parallel documentation.