Using Emojis in Clinical Texts May Boost Humor, Solidarity

Overflowing inboxes may make physicians ?, but a new study published online this week in JAMA Network Open suggests that using emojis and emoticons when messaging colleagues may have a positive ? and playful effect on communication and relationships.

Researchers at the Indiana University School of Medicine Center for Bioethics analyzed the content of 1% of text message threads exchanged by hospitalists on a secure clinical messaging platform from July 2020 to March 2021 at a large Midwestern hospital. In this subset, 7% of text threads, or 155 unique messages, contained at least one emoji or emoticon, broadly referred to as ideograms. Just under 10% of the messages contained multiple emojis. Emoticons contain letters and punctuation found on a keyboard, and emojis are pictures or illustrations.

Most (61%) ideograms added emotive effects, such as providing information about the sender’s feelings or helping the recipient interpret the message. Of those, about 70% were positive, initiating feelings of happiness, humor, or sarcasm; the rest conveyed feelings of sorrow or disappointment meant to be commiserative or affirming and not a criticism of the recipient, concluded the study’s authors. One third (32%) of ideograms were used phatically, meaning to open, close, or acknowledge a conversation. Just under half (43%) of emojis were modified for skin tone or gender.

Researchers found that emojis and emoticons can soften some phrases and emphasize others, as demonstrated by this sampling of messages analyzed in the study:

“Just add flagyl for anaerobes and ditch the clinda! :)”

“I will strike while the iron is hot…after lunch of course?

And this exchange between two hospitalists:

Physician A: “You following [patient name] today?”

Physician B: “Yes, I have the pleasure of her today”?

Physician A: “Oh, how fun “?

In all, emojis were used three times more often than emoticons. While 42 different types of emojis were documented, the most common was the thumbs-up?; smiley face?; tears of joy face?; and heart❤️. The most popular emoticon was 🙂

Ideograms first cropped up in personal communication over a decade ago, but their use in professional correspondence has generally been frowned upon. Previous research has suggested that using these visual cues can alter how an individual is perceived — and not always for the better. One study noted by researchers found that males thought of their bosses as more likable and effective when they incorporated emojis into their communications. In contrast, women rated these same leaders as less effective and appropriate.

Gary Kreps, PhD, professor of communication and director of the Center for Health and Risk Communication at George Mason University, told Medscape Medical News the ubiquity of social media likely lends itself to new text-based interactions among physicians.

“Healthcare professionals have learned that using visual messages can make their digital communication more engaging, evoke rich meanings that are easily understood by most people, and enliven interactions by providing playful visual cues that convey personality and relationship information,” he said.

Kreps added that physicians should carefully select ideograms that appeal to their audiences and express the intended meaning.

Although the study found that 13% of hospitalists sent messages containing ideograms, how the public or judicial courts may interpret the more casual communication style — for instance, during a malpractice case — remains unclear. Still, the analysis did not uncover any imminent medicolegal concerns or a higher rate of misunderstandings.

JAMA Network Open. Published online June 13, 2023. Full text

Steph Weber is a Midwest-based freelance journalist specializing in healthcare and law.

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