RESUMEN
OBJECTIVE: To describe three methodological challenges experienced in studying patients' expressions of emotion in a sample of periodic health exams, and the research and practice implications of these challenges. METHODS: Qualitative analysis of empathic cues in audio-taped and transcribed periodic health examinations of adult patients (n=322) in an integrated delivery system. The empathic and potential empathic opportunities methodology was used. RESULTS: Identifying emotional cues that constitute "empathic opportunities" is a complex task. Three types of ambiguity made this task particularly challenging: 1) presentations of emotional cues can be "fuzzy" and varied; 2) expressions of illness can be emotionally laden in the absence of explicit "emotion words"; and 3) empathic opportunities vary in length and intensity. CONCLUSION: Interactional ambiguities pose a challenge to researchers attempting to document emotional cues with a binary coding scheme that indicates only whether an empathic opportunity is present or absent. Additional efforts to refine the methodological approach for studying empathy in medical interactions are needed. PRACTICE IMPLICATIONS: The challenges discussed likely represent the same types of situations physicians find themselves in when talking with patients. Highlighting these ambiguities may aid physicians in better recognizing and meeting the emotional needs of their patients.