Curbside Consult with Dr. Jayne 1/19/26

Based on the contents of my inbox, it feels like everyone is talking about recent research from Michigan Medicine on emoji use in the electronic health record. The research letter was published in JAMA Network Open last week. It examined 218 million notes belonging to 1.6 million patients. Researchers found that emoji use was higher than previous studies that looked at clinical texting tools. 

The authors identified 372 emojis within 4,162 notes that were created during the last five years. Of those, 35% were patient portal messages to patients, followed by telephone messages at 28%, encounter summaries at 15%, progress notes at 14%, and patient instructions at 6%. The University of Michigan patient portal doesn’t support patients adding emojis to communications.

The smiling face with smiling eyes was used 1,772 times, with communications emojis such as the telephone receiver and calendar appearing 544 and 429 times, respectively.

The article contains an illustration of the 50 most commonly used emojis along with their official names. Just skimming through them, I’m not sure that I would come up with names or descriptions that matched their official titles.

Take the “briefcase,” for example. Could people be using it because it looks like an old-timey doctor’s bag? I can’t remember the last time I saw someone carrying a briefcase that looked like the emoji. Even looking at the most used one, the smiling face with smiling eyes, I would describe that one more as blushing than having smiling eyes. I also would not have correctly described “beaming face with smiling eyes.”

Some of them were new to me, including “busts in silhouette” and “bar of soap.” The latter got me thinking about how many people actually see or use bar soap these days, given the popularity of liquid soap and body wash products. Similarly, how long will it be before people no longer identify a “telephone receiver” as such?

I wondered about the context for some of the emojis that were used, such as the “P button,” the “small blue diamond,” and the “round pushpin,” and how they might be used in medical communications. The most concerning to me was actually the least used, the “police car light.”

Researchers note the risk of confusion in using emoji to communicate, especially in older patients. While most emoji use occurred among tweens and teens, patients in their 70s had the second highest usage. The authors call for organizations to develop guidelines to promote clear communication and professionalism in clinical communications. I once encountered someone who used a particular emoji extensively before discovering that it wasn’t a Hershey’s Kiss, so I agree with the concern.

The authors go on to note that measuring emoji use is just the beginning, and that future investigation should look at how emoji “might affect patient understanding, trust, and outcomes – and explore whether these playful digital symbols offer new opportunities or pose unintended challenges in electronic health record communication.”

One of my close physician friends sent me a link to a Facebook post about the article. It had some pretty funny comments about which commonly used emojis were missing from the study, along with those questioning whether the AI tools clinicians are using to write messages were responsible for the addition of emojis. A couple of commenters thought the research was frivolous, but those sentiments were countered by others who were clearly concerned with the potential impact on patients.

Another colleague with ties to Michigan Medicine said that emoji use in the medical record was prohibited, although he wasn’t able to find the specific policy. He said that he remembered a conversation with risk management where it was discussed, however, and that there were significant concerns about the meaning of symbols within the context of the legal medical record. Although the policy could have been changed, I’m wondering whether some clinicians still haven’t fully internalized that the patient portal is part of the legal medical record.

He said he’s not opposed to their use, especially with pediatric or teen patients with whom clinicians are trying to build rapport. Still, he advises residents that if deleting the emoji changes the meaning of the message, either the emoji shouldn’t be used, or it should be supplemented by actual words.

I was curious about the previous research that looked at clinical text messages. In 2023, clinicians from Indiana University School of Medicine looked at the content of messages that were sent by hospitalists who used a secure messaging platform during 2020 and 2021. Messages with emojis were identified, as well as those with more old-school emoticons.

The authors found that the majority of the emojis and emoticons “functioned emotively, that is, conveyed the internal state of the sender” where others “served to open, maintain, or close communication.” The authors also noted that “no evidence was identified that they caused confusion or were seen as inappropriate.” They concluded that “these results suggest that concerns about the professionalism of emoji and emoticon use may be unwarranted.”

I believe that differences exist in how clinicians communicate with each other compared to how we communicate with patients. In the former, we are more likely to use medical abbreviations or jargon. With the latter, we should be using terms that are more clearly understood by patients. In my experience with peer review, communications with patients are typically held to a higher standard.

It will be interesting to see what kinds of guidelines or policies organizations come up with as far as regulating the use of emojis in patient communications and charting. I reached out to medical staff leadership at the facilities where I’m affiliated, and none of them recalled this topic coming previously.

I found citations for a half dozen other articles that looked at the content of clinical text messages among hospitalists and other members of the clinical team, as well as norms for emoji use. I didn’t have time to go down that particular rabbit hole this weekend, but I would be interested to hear from readers that have strong opinions on emoji use or those who have been involved in this type of research.

Do you use emojis in patient-facing communications? If so, how do you use them? If not, what do you think about the practice? Leave a comment or email me.

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