5. Stay fit

1. Preventive health

Preventive health is the foundation of safe and sustainable clinical practice. 

The Royal Australian College of General Practitioners Preventive Health Guidelines recommend regular health checks tailored to your age and risk profile. These include mental health screening, cardiovascular risk assessment, stroke and diabetes risk evaluation, appropriate investigations, and cancer screening for cervix, breast, bowel, and prostate cancers where relevant.

Staying up to date with vaccinations is also vital as a clinician. This includes influenza, COVID-19, Hepatitis A and B, and other recommended immunisations. These preventive measures are essential to maintaining long-term fitness for practice, protecting patients, and sustaining your own health.

Routine preventive care also allows you to build a trusted, independent relationship with your GP. Continuity of care provides a reliable safety net during periods of stress, illness, or exposure to trauma. A trusted GP can provide early intervention, coordinate evidence-based treatment, support recovery, and assist with safe return-to-work planning.

As a clinician, you have a professional and legal duty to be fit for work, follow safe instructions, and avoid hazards including substance misuse. This applies whether you are a student, employee, contractor, or visiting consultant.

This requires active self-management. Monitor early signs of fatigue, illness, injury or psychological distress and act early. Where relevant, disclose functional limitations so adjustments can be made to protect both patient care and your own safety. Early discussions with your GP may allow practical solutions such as modified duties, reduced hours, or temporary withdrawal from high-risk work.

Physical health is central to performance, safety, and longevity in clinical practice.   

Small, consistent actions matter.  Balanced nutrition, regular physical activity, hydration, and restorative sleep underpin cognitive function, clinical judgement, emotional regulation, and resilience. When these are neglected, the risk of error, injury and burnout rises significantly.

2. Exercise, nutrition, and physical resilience

Exercise should be viewed as essential preparation for clinical work. Regular physical activity improves cardiovascular health, strength, energy levels, and mental wellbeing, while helping buffer the effects of stress and shift work.

Nutrition should support sustained performance. This includes regular meals, adequate protein, hydration, and minimising reliance on high-sugar foods and excessive caffeine. Irregular eating patterns, dehydration, and poor nutrition contribute to fatigue, impaired concentration, and long-term health risks.

3. Fatigue and sleep are critical safety issues

Fatigue is one of the most underestimated risks in healthcare. Long hours, night shifts, on-call work and sustained cognitive load all contribute to cumulative fatigue. This impairs attention, decision-making, reaction time, and emotional regulation, increasing the risk of clinical error and personal injury.

Shift work and stress commonly lead to insomnia or fragmented sleep. Over time, this creates chronic sleep debt. Clinicians often normalise this, but it is not benign. 

Chronic fatigue is associated with cardiovascular disease, metabolic disorders, mood disorders, and impaired immune function.

Managing fatigue requires both individual strategies and system change. Practical sleep hygiene strategies include:

· prioritising protected sleep periods before and after shifts;

· using strategic napping where possible;

· managing light exposure to support circadian rhythms;

· limiting caffeine to earlier parts of shifts;

· avoiding alcohol as a sleep aid; and

· maintaining consistent sleep routines where possible.

If generic sleep hygiene techniques do not work, try an online advanced online sleep course such as A MINDFUL WAY By Dr Giselle Withers.

Employers have a duty to design work that allows adequate recovery, including reasonable shift lengths, limits on consecutive shifts, and protected breaks. Clinicians should recognise fatigue as a WHS hazard and report unsafe rostering practices. For more information on how to speak up safety, please refer to the main menu 3.

4. Substance abuse 

Substance use in healthcare is a significant but often hidden risk. Alcohol misuse, prescription medication misuse, and self-medication with psychostimulants to cope with night shifts or examinations are maladaptive responses to fatigue, stress, and excessive workload.

Alcohol is often used to unwind or manage sleep, but it disrupts sleep quality, impairs recovery, and can worsen mental health over time. Regular use may progress to dependence, affecting judgement and clinical performance.

Prescription medication misuse, including sedatives, opioids or anxiolytics, may begin with legitimate treatment but can escalate in high-stress environments. 

Psychostimulants, whether prescribed or misused, are sometimes used to maintain performance during prolonged shifts. While they may temporarily improve alertness, they can mask underlying fatigue, impair sleep cycles, and contribute to anxiety, dependency, and cardiovascular risk. Over time, this creates a cycle of exhaustion and reliance that increases overall risk.

The professional expectation around prescription drug misuse or illicit drug use is clear: what you do in your personal life can affect your fitness to practise and your professional standing.

Under professional Codes of Conduct, clinicians are expected to maintain high standards of personal and professional behaviour at all times. This includes responsible alcohol use and a strict prohibition on illicit drug use where it may affect patient safety, public trust, or the reputation of the health professions.

Here are a number of key areas that must be discussed openly in health care workplaces:

Fitness to practise: You must not practise while impaired. This includes impairment from alcohol, illicit drugs, or misuse of prescription medications such as psychostimulants, sedatives, or opioids.

Personal behaviour and professional standards: Conduct outside the workplace may still be relevant if it raises concerns about judgement, reliability, or risk to patients.

Public trust: The community expects clinicians to uphold high standards. Behaviour that undermines trust, including illicit drug use, may result in regulatory action.

Early help-seeking: If substance use is affecting your health or work, you are expected to seek appropriate care and step back from practice if necessary.

Our professional codes of conduct recognise that clinicians, like all people, may experience health conditions including substance dependence. However, the responsibility remains to recognise impairment early, seek treatment, and ensure patient safety is not compromised.

Substance abuse creates significant risks for both clinicians and patients. Early recognition, confidential support, and evidence-based treatment are essential. 

Seeking help is a professional responsibility and a key component of maintaining fitness to practise.

5. Air Quality

Air quality is a critically important WHS issue in healthcare workplaces. Clinicians work for prolonged periods in enclosed environments with ongoing exposure to airborne infectious diseases, chemical agents, surgical smoke, waste anaesthetic gases, strong cleaning products, poor ventilation, mould, dust, and other environmental pollutants.

The COVID-19 pandemic highlighted the profound consequences of inadequate ventilation and airborne transmission risks in healthcare settings, yet concerns about air quality extend far beyond infectious disease outbreaks. Poor indoor air quality contributes to fatigue, headaches, impaired concentration, respiratory illness, and cumulative psychological and physical stress, particularly in overstretched teams working long hours in high-pressure environments.

Under modern WHS laws, healthcare organisations have a duty to identify and control environmental hazards, including risks associated with ventilation and air quality. Safe systems of work now require greater attention to compulsory measures such as appropriate ventilation standards, air filtration, fit-tested respiratory protection where indicated, safe management of hazardous substances, and workplace design that protects both clinicians and patients from preventable harm.

Improving air quality is not simply an engineering issue - it is a workforce safety, patient safety, and organisational leadership issue.

Safe, healthy clinical environments support clearer thinking, reduce occupational risk, and improve workforce wellbeing.

6. Notification of incidents 

Employers have a legal duty to provide safe systems of work, adequate staffing, reasonable hours, and workplaces free from physical and psychosocial harm.

Employers must notify regulators of serious work-related injuries, illnesses, or dangerous incidents, whether a workers’ compensation claim is made. These are known as notifiable incidents.

An incident is notifiable if it results in:

· immediate hospital admission;

· lack of access to urgent treatment;

· required treatment being refused; or

· inability to work for seven days or more.

Clinicians often avoid reporting incidents due to fear of career consequences. 

However, without accurate data, employers may minimise or overlook serious risks. Under-reporting creates dangerous blind spots that allow hazards to persist.

Employees, contractors, and visiting clinicians also have the right to appropriate leave entitlements and workplace protections. Returning to work too early, or without appropriate support, can be unsafe. This applies to both physical and psychological injury. 

Graduated return-to-work plans, light duties, and flexible arrangements are essential to ensure recovery is safe and sustainable.

Without appropriate adjustments, clinicians may sustain further injury, or compromise patient care. Safe return to work is a shared responsibility between the clinician, employer, and treating practitioner.

It is not the responsibility of an unwell clinician to arrange their own cover or feel pressured to return due to poor workforce planning or inadequate organisational foresight.

When clinicians have functional limitations - whether temporary, such as pregnancy or post-operative recovery, or related to other health conditions affecting work capacity - employers are required to provide flexible working arrangements and suitable modified duties to maintain safety.

Clinicians should not be expected to compensate for unsafe systems through personal sacrifice, whether they are fully fit or working with limitations.

7. The role of your GP 

Your GP plays a central role in maintaining your health. They can provide preventive care, early intervention, evidence-based treatment, and support for workplace adjustments and return-to-work planning. They can also provide confidential medical certificates without disclosing sensitive information to your employer.

The Australian Health Practitioner Regulation Agency advises against treating close colleagues or family members except in emergencies, as objectivity cannot be assured.

Mandatory reporting generally applies only where there is a significant risk to patients, such as when a clinician’s insight is impaired due to psychosis or other causes of cognitive impairment, including ongoing substance misuse. 

Seeking help early and stepping back from work when needed usually prevent the need for mandatory reporting.

Protecting your physical health is fundamental to protecting your patients, your career, and your long-term wellbeing. 

For further information, refer to the websites of Safe Work Australia and the Australian Health Practitioners Regulatory Agency. 

if you believe your employer is not adequately addressing physical and psychosocial hazards, please consider sharing the SafeDr website link in your workplace among your colleagues and employers.