--- title: "Ambiguity in coding empathy in primary care. | Sutter Health" description: "We examine challenges experienced in studying patients' expressions of emotion in a sample of periodic health exams, and the research and practice implications." url: "https://www.sutterhealth.org/research/publications/ambiguity-in-coding-empathic-interactions-in-pc-1055312573" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Ambiguity in coding empathy in primary care. # Three types of ambiguity in coding empathic interactions in primary care visits: implications for research and practice. Stone A, Tai-Seale M, Stults C, Luiz J, & Frankel R. _Patient Educ Couns. 89(1):63-8. doi: 10.1016/j.pec.2012.06.013. Epub 2012 Jul 17._ 2012-10-01 ## Abstract 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. [PubMed abstract](http://www.ncbi.nlm.nih.gov/pubmed/?term=Three+Types+of+Ambiguity+in+Coding+Empathic+Interactions+in) ![Cheryl Stults, Ph.D.](https://dyn.mktgcdn.com/p/3IhveEwq-t5WoqAzSNGeAr-4g4yrj4v7x1QcPGdCX_s/fit=crop,gravity=auto,dpr=2,width=188,height=250,quality=100) Cheryl Stults, Ph.D. Principal investigator [View profile](https://www.sutterhealth.org/research/investigators/cheryl-stults-phd-1049681000) ## Research topics - [Aging and Longevity](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Aging+and+Longevity%5C%22%22) - [Disease Management](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Disease+Management%5C%22%22) - [Health Services](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Health+Services%5C%22%22) - [Mental Health](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Mental+Health%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [Analyses of nursing home residents with multiple sclerosis and depression using the Minimum Data Set.](https://www.sutterhealth.org/research/publications/nursing-home-residents-ms-depression-1055312585) Buchanan RJ, Wang S, Tai-Seale M, Ju H. Mult Scler. 9(2):171-88. 2003 Mar 01 - Publication ### [Two-minute mental health care for elderly patients: inside primary care visits.](https://www.sutterhealth.org/research/publications/two-minute-mental-health-care-for-elderly-patients-1055312643) Tai-Seale M, McGuire T, Colenda C, Rosen D, Cook MA. J Am Geriatr Soc. 55(12):1903-11. 2007 Dec 01 - Publication ### [Research priorities to advance the health and health care of older adults with multiple chronic conditions.](https://www.sutterhealth.org/research/publications/research-advance-healthcare-srs-chronic-conds-1055312387) Tisminetzky M, Bayliss EA, Magaziner JS, Allore HG, Anzuoni K, Boyd CM, Gill TM, Go AS, Greenspan SL, Hanson LR, Hornbrook MC, Kitzman DW, Larson EB, Naylor MD, Shirley BE, Tai-Seale M, Teri L, Tinetti ME, Whitson HE, Gurwitz JH. J Am Geriatr Soc. doi: 10.1111/jgs.14943. \[Epub ahead of print\] 2017 May 26 - Publication ### [Expressing uncertainty in clinical interactions between physicians and older patients: what matters?](https://www.sutterhealth.org/research/publications/expressing-uncertainty-in-clinical-interactions-1055312608) Tai-Seale M, Stults C, Zhang W, Shumway M. Patient Educ Couns. 86(3):322-8. doi: 10.1016/j.pec.2011.06.005. Epub 2011 Jul 20. 2012 Mar 01 - Publication ### [How do primary care physicians respond when patients cry during routine ambulatory visits?](https://www.sutterhealth.org/research/publications/how-pcps-respond-when-pts-cry-in-outpt-visits-1055312766) Stults CD, Elston Lafata J, Diamond L, MacLean L, Stone AL, Wunderlich T, Frankel RM, Tai-Seale M. J Comm Healthcare. 7(1):17-24. DOI: http://dx.doi.org/10.1179/1753807614Y.0000000044 2014 Mar 01 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/ambiguity-in-coding-empathic-interactions-in-pc-1055312573#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Ambiguity in coding empathy in primary care."}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/ambiguity-in-coding-empathic-interactions-in-pc-1055312573#medicalscholarlyarticle","name":"Three types of ambiguity in coding empathic interactions in primary care visits: implications for research and practice.","headline":"Ambiguity in coding empathy in primary care.","abstract":"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. 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