Larry Merkel | University of Virginia (original) (raw)

Papers by Larry Merkel

Introduction This is a lecture about the vicissitudes of the doctor-patient relationship; especia... more Introduction This is a lecture about the vicissitudes of the doctor-patient relationship; especially how psychological and contextual factors may impact upon it. Discussions of the "Difficult Patient" and boundary issues, especially boundary violations, share the common element of being examples of the doctor-patient relationship gone awry. The discussion of these two topics will bring out issues of defense mechanisms, character style, and personality disorder. The idea of a difficult patient rests upon the assumption of an ideal doctor-patient relationship, in which there is mutual respect and cooperation in an effort to heal the patient. The patient is expected to be open, honest, obedient, and motivated to get better, displaying gratification and pleasure at improvement. The physician, on the other hand, is expected to be thoughtful, to listen, to be empathic, to be non-judgmental, to do no harm, and to be competent. As physicians we strive for this ideal and are often ...

Applied Psychophysiology and Biofeedback, 1998

Attention-Deficit/Hyperactivity Disorder (ADHD) is reported to have an incidence of 3–5%, and is ... more Attention-Deficit/Hyperactivity Disorder (ADHD) is reported to have an incidence of 3–5%, and is associated with a variety of interpersonal, academic, and social problem behaviors. There is controversy as to whether ADHD is a learned behavioral or brain dysfunction. Research has explored a variety of measures to assess behavioral and brain dysfunctions in this population, with no consistent and clearly diagnostic

Bulletin of the History of Medicine, 2010

Archives of Internal Medicine, 1983

Bulletin of the History of Medicine, 2014

Driving assessment 2005 : proceedings of the 3rd International Driving Symposium on Human Factors in Driver Assessment, Training, and Vehicle Design

Driving simulation is the best way to safely and reliably assess the impact of medical parameters... more Driving simulation is the best way to safely and reliably assess the impact of medical parameters on driving in a controlled, replicable environment, Driving performance should be evaluated using a composite driving score, since the pathway to impaired driving is highly idiosyncratic and could involve any number of individual driving parameters. Although simulators still do not have accepted standards for hardware, driving scenarios, or performance variables, we propose a partial solution to permit comparisons of composite scores across simulators. We recommend presenting simulator data via a standardized average effect size, which we call the Impaired Driving Score (IDS). We describe how the IDS is calculated, and present data comparing 16 male and 15 female teenage drivers with ADHD who participated in a double-blind, placebo-controlled, crossover study. Using an equivalent-dose regimen, we compared the effects of 72 mg of OROS ® MPH (Concerta ®), 30mg of se-AMPH XR® (Adderall XR ®) and placebo on driving performance. Participants drove our Atari Research Driving Simulator at 5, 8, and 11 pm under all three medication conditions with at least a week between conditions/drives. The primary outcome measure was participants' IDS. Across all three times, performance on Concerta ® was superior to placebo (p=.005), while Adderall XR ® was not (p=.14). When analyzed separately, however, only one variable was statistically significant (seconds spent speeding, p<.01). Composite driving scores permit the comparison of driving performance across various experimental conditions and with a normative database. Furthermore, since the IDS is based on a multi-faceted assessment of driving performance, it is less vulnerable to random effects and offers a more robust indicator of driving performance.

Anthropological Quarterly, 2014