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When a colleague of mine wanted to discuss a new and somewhat out-of-left-field research project that centered around the use of emojis in digital health care communication, I blanched. To the best of my recollection, I blurted, “Emojis have no place in medicine.”

I’m a practicing ear, nose, and throat physician and also serve as the chief medical officer for a company that provides communication technology for health care organizations. My experience in one world often informs my decisions in the other. In this instance, thinking about doctors and nurses exchanging emojis as part of caring for patients triggered an immediate “BAD IDEA” alert in my brain.

Early in residency, I was taught to never put anything extraneous in writing. Clinicians are supposed to provide facts, not give opinions or get poetic, and should always consider that anything they write may one day require an explanation in front of a jury. Maybe my colleague — who, to be fair, is not a clinician — didn’t know it, but that was why my reaction to his offer was less than enthusiastic.

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A report several of my colleagues at PerfectServe published in February on the use of emojis in clinician-to-clinician communication nudged me to keep thinking about this topic. I was a bit surprised to learn that among the providers using emojis in medical settings, the exchanges were overwhelmingly polite and positive. This got the gears turning in my head, and my perspective started to shift a bit.

I haven’t yet formed a strong opinion on whether emojis in communication among a care team are good or bad. Instead, I came up with some questions. Clinicians once had to respond to how privacy standards in health care affected texting, so why aren’t more health care providers and organizations having a conversation about emojis? And my favorite question: Health care providers understand what it means to have a good bedside manner. But as interactions become increasingly virtual and facilitated by technology, have we thought enough about digital bedside manner?

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The answer to that one is “no,” and I hope we can start rectifying that problem. As it turns out, emojis can help.

Let’s talk emojis

Before Covid-19 emerged, the health care sector churned along with a stodgy, somewhat conservative hum. The pandemic changed things. Clinicians who had never spent a day doing telehealth had to learn quickly how to master the ins and outs of telemedicine. Many of us saw patients who were scared and fighting for their lives, isolated from friends and loved ones.

These changes have had a major impact on the way I do my job and how I now think more broadly about health care. They’ve done the same for many of my colleagues.

Many clinicians are spending more time with their laptops and electronic health records than with their patients. Our research showed that emojis seem to be used to add a refreshing human touch to what is often an intense, stressful, and sterile environment. The findings also pointed to the potential of emojis to do what their name implies — convey emotion — as well as cut down on messaging time and add helpful context to the evolving medium of clinical communication. Overall, this research suggests that emojis are used as a vector for politeness and positive intent in communication among care teams.

I’d be remiss if I didn’t mention that others in the world of medicine have thought about emojis and their potential to impact communication, but the key difference is that those efforts have tended to revolve around provider-to-patient interactions and how these images can be used to enhance understanding and break down language barriers. Many people use emojis in one form or another, so it stands to reason that these commonly understood symbols might be able to convey meaning that would otherwise be lost if a patient speaks a different language or can’t quite grasp the complexities of medical terminology.

But analyzing the way clinicians use emojis to communicate with each other is, to the best of my knowledge, new territory. I’m not saying that emojis are going to revolutionize communication among care teams, but with everything I’ve learned, I do wonder if they can help clinicians turn flat, emotionless words on a screen into something friendlier.

Laying out the risks

The most conceivable risk is obvious: In medicine, anything in writing — emoji or not — is part of a legal record. Just as words can sometimes be understood in different ways by different people, that holds true for emojis. I may think the “thumbs up” emoji is the same as answering “yes” to a colleague’s question, but what if she doesn’t interpret it that way and, as a result, doesn’t take an important clinical action? As a doctor, my brain goes there immediately.

The risk management group for any hospital or health care practice will undoubtedly have an opinion about the use of emojis in clinical settings, and it’s easy to guess what the opinion would be. When text messaging first started becoming popular in health care settings, users forged ahead because there were no concrete regulations to stop them. In a sense, they almost forced conversations about guardrails for texting. But now, even though emojis are ubiquitous in daily communication, conversations about guardrails for emojis in medicine haven’t happened. Clinical communication companies like the one I work for — along with others that offer secure messaging platforms for care teams — came about because clinicians were engaging in risky behavior by using unsecure communication methods. It was the chief security officers and chief information officers who stepped up and said, “Wait a minute, this isn’t okay. We have to stop and find a secure alternative.”

To be clear, we’re not having the same conversation, because unsecure communication has more built-in risks than simply using emojis. But we’re finally acknowledging an existing trend that has received the head-in-the-sand treatment for too long. Emojis are a fact of life, and they are already being used in medical settings. So it’s important to contextualize them, rein them in where necessary to mitigate risk, and still appreciate them for what they may offer.

Maintaining humanity in a digital world

As health care becomes more digital, clinicians are grappling with how to maintain meaningful human connection while embracing the positives that technology can offer.

At the macro level is the rise of machines versus the traditional humanity of the patient/clinician relationship. This relationship has been the basis of medicine from time immemorial, so the idea of incorporating emojis — yet another symbol of the onslaught of technology and the “digitization” of society — into the fold can turn off some people. Clinicians learn about proper bedside manner, but that’s almost always in the context of in-person interactions. We’re still figuring out how to shape our digital bedside manner, especially when it comes to communicating with our colleagues.

The issue of emojis and care teams is mostly uncharted territory, but what we’re seeing initially is that emojis may be able to help break up the sterility of clinician-to-clinician interactions. There also seems to be an implicit reminder that written (or, in this case, texted) words are not always capable of accurately conveying the right meaning or tone by themselves. If an emoji can add some of the subtext that’s lost in the transition from in-person conversation to text exchange, that’s probably a good thing.

But the concept of using emojis in health care goes beyond “it’s right” or “it’s wrong.” The health care community has an opportunity to open up a rich conversation about a long-standing trend that hasn’t been discussed nearly enough. How do you maintain relationships and trust and keep these bonds real and humane while at the same time taking advantage of what technology can do? Answering that question should be a topic for future consideration.

I haven’t yet started using 😊 or 👍 while communicating with my fellow clinicians, but I am looking forward to hearing from others about how to navigate the risks and rewards of thoughtfully weaving emojis into health care communication.

Rodrigo Martínez is an otolaryngologist and the chief medical officer for PerfectServe, a provider of health care communication and provider scheduling technology.

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