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This chapter describes the impact of acute and chronic stress, including discussion of the long-term health risks associated with chronic stress. The chapter focuses on factors that contribute to chronic stress in physicians, including individual factors, professional/practice factors, and organizational factors. It includes discussion of both physical and mental health sequelae, as well as discussion of the impact of chronic stress on relationships and connection.

This chapter explores three important sources of psychological morbidity in the medical field: compassion fatigue, vicarious trauma, and burnout. The authors describe these concepts and examine how the process of delivering medical care has the potential to erode the ability to provide compassionate care over time, particularly when the occupational environment offers limited access to support, self-care, and trauma stewardship. The authors discuss strategies to reduce psychological morbidity and enhance resilience with the view that prevention, recognition, and intervention are possible with early adoption and sustained practice of wellness strategies.

Objective Pseudoephedrine is a stimulant that can be purchased over-the-counter to relieve symptoms of nasal and sinus congestion. Owing to its similar composition to ephedrine and other amphetamines, pseudoephedrine mirrors some of its ergogenic effects. This study investigates its possible ergogenic effect through a systematic review. Our primary aim was to determine the effects of pseudoephedrine in sport and its potential for performance enhancement. Design We searched EMBASE, MEDLINE, PsychINFO and The Cochrane Library for trials conducted from their beginning to March 2015. Any published trial that used randomised assignment to the intervention and control groups in full text and measured pseudoephedrine as an independent variable were included. Results Overall, the review showed that the ergogenic effect of pseudoephedrine is dose-dependent. None of the reviewed studies showed an ergogenic effect at the therapeutic dose of the drug (60–120 mg); however, supratherapeutic doses (≥180 mg) yielded clinically significant results. Conclusions Owing to the limitations of the published studies in this field, we were unable to make any firm conclusions with respect to the overall effect of pseudoephedrine and its ergogenic effect. It is evident that there is a correlation between the dose administered and its ergogenic effects, but it is also evident that the side effects of using above the therapeutic dose outweigh the possible benefits of using pseudoephedrine in sport. Further research with larger sample sizes is required to determine the relationship between doses (≥180 mg) and concentrations in urine that cause an ergogenic effect.