When Medicine Gets Irritating: Interactional and Structural Triggers of Uncertainty in Family Medicine Residency Training.

backgroundUncertainty is part of everyday medical practice, especially in family medicine. Former studies have focused on how clinicians manage uncertainty, but its emotional experience has received less attention. This study looks at irritation as a distinct affective entry point through which family medicine residents first perceive disruptions in clinical, interactional or organisational issues.

methodsBetween 2019 and 2021, we spoke with 15 residents in Hesse, Germany. In semi-structured interviews, they described situations where they felt uncertain, including the context, their emotions, and what they did next. We transcribed, pseudonymised and analysed the interviews using Kuckartz's qualitative content analysis.

resultsIn many cases irritation was the first emotional reaction when something in the consultation didn't feel right. We identified three common triggers: (1) a mismatch between intuition and medical findings, (2) irritation during patient interactions and (3) irritation caused by structural issues. The last two were our main focus, as they disrupt usual ways of working rather than pointing to hidden diagnoses. These moments of irritation could be confusing at first, but in some cases, they led residents to dig deeper into what shaped the patient's perspective, to ask colleagues for advice or pay more attention to systemic and organisational issues.

conclusionIrritation acts as a harbinger of uncertainty by embodying those small breaks in routines and expectations from which uncertainty first arises. At first, it might throw residents off balance, but if they take the time to reflect on it, irritation can help them see things differently, stay attentive and improve their clinical skills. Residency programmes should give residents room to talk about these experiences, helping them handle uncertainty more effectively in their daily work.