Emojis in Clinical Text Messaging May Facilitate Team Communication

Clinicians primarily use emojis and emoticons in clinical text messaging to convey new and interactionally salient information, according to a study published in JAMA Network Open.

Researchers conducted a qualitative study of 1,319 clinical text message threads at a Midwestern hospital from July 2020 until March 2021.

Overall, seven percent of threads contained an emoji or emoticon. The ideograms primarily added emotive content (61 percent).

The researchers noted that while some tokens in the sample were clearly aimed to be humorous, others had a more practical purpose. In some cases, ideograms substantially shifted the interpretation of messages, such as by reframing the message thread as sarcastic rather than sincere.

“This disambiguation is a particularly useful affordance in textual healthcare communication, where ambiguity is notoriously high, as is the need for appropriate affect maintenance in the midst of emotionally demanding situations,” the authors wrote.

Clinicians in the sample also regularly used ideograms phatically (32 percent), meaning that they used them to open, maintain, or close a channel of communication.

The most used emoji in the sample (the thumbs-up) comprised 39 percent of all emojis.

Clinicians often used the thumbs-up emoji in a similar way to the thumbs-up button available in the clinical text messaging interface to react to messages.

“Phatic uses signaled that a message had been received or that a plan of action had been acknowledged,” the authors wrote.

This usage is notable, as one study found that some clinicians are frustrated by receiving messages like “Okay, thanks” because they believe the additional message is a time burden.

“However, such acknowledgment may also serve the clinically relevant function of confirming a shared understanding of a given medical situation,” the researchers emphasized.

“Moreover, the phatic use of ideograms may also soften the tone or increase the politeness of a message,” they added. “It is in this way that ideograms have the potential to manage and even improve interpersonal relationships and promote positive interactions in the setting of text messaging as the de facto alternative to voice-based communication.”

Clinicians tended to use ideograms to communicate positive rather than negative feelings. Even ideograms that conveyed negative affect usually did so in a way that could improve the sender’s relationship with the addressee, the authors pointed out.

“For instance, many of these ideograms were used to apologize or to commiserate, thereby potentially working to repair interpersonal dynamics,” they explained.

While popular media has implied that using emojis and emoticons in professional communication may be inappropriate, the study’s results suggest these concerns may be overstated.

“The complexity and challenges of team communication in healthcare are well documented,” the authors wrote. “The phatic and emotive functions of emoji, as we observed in our data, may serve to facilitate team communication by efficiently conveying positive affect and agreement.”

“More importantly, we have found no reason to characterize their use as professionally worrisome,” the researchers continued. “They appear primarily to be used to add new, interactionally salient information to communication; to convey primarily positive affect; and to have the potential to improve interpersonal dynamics.”

However, they noted that further research is needed on emoji and emoticon use among clinicians, including through analysis methods like natural language processing (NLP).