Some Doctors Are Using Emojis With Patients More Often

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EMojis have long infiltrated all kinds of communications, including text messages and even business emails. Today, doctors place these expressive icons in medical records.

Healthcare providers have already been found to incorporate emojis and emoticons (their vintage counterparts) into texts with colleagues on a clinical messaging platform, according to a 2023 study. Open JAMA Network study. Now, researchers say they have conducted the first study examining emoji use in clinical notes in electronic health records, which include portal messages sent to patients. Compared to the 2023 article, doctors seem to use them much more when talking with their patients than with their colleagues.

A team from the University of Michigan and Cornell University sifted through more than 200 million notes from 1.6 million patients created between 2020 and 2025 at the University of Michigan Medical Center. They identified 372 unique emojis used in 4,162 notes, results recently published in Open JAMA Network.

While the emoji inclusion rate remained relatively stable at 1.4 ratings with emojis per 100,000 ratings between 2020 and 2024, it suddenly jumped to 10.7 at the end of 2025.

“These were scattered throughout the clinical notes, but were primarily found in brief messages sent to patients through the portal,” study co-author David Hanauer, a clinical informaticist at the University of Michigan, said in a statement. “While the use of emojis in medical records is still rare, their use appears to be on the rise, raising important questions about age-related differences in usage and interpretation, as well as best practices for digital clinician-patient communication.”

They noticed that smiley faces (😀) or emoticons like the classic 🙂 were the most commonly used type of emoji, appearing in 58.5 percent of the notes, with objects, like a pill (💊) and a maple leaf (🍁), in 21.2 percent, and emojis related to people and bodies in 17.6 percent. As for the most popular specific emoji, the smiley face comes out on top, with far more appearances (1,772) than the second most popular, the telephone handset (📞, 544).

Read more: “Your 🧠 on Emoji”

Emojis were very rarely incorporated into messages to replace a word, such as a pill bottle for the word medicine – this only occurred among 1% of all emojis analyzed by the researchers. Most served to emphasize a point or were included “for their own sake,” the statement said. This is consistent with previous findings that emojis tend to be used to reduce ambiguity and shape the tone of a message.

But these symbols don’t always clarify things: they could create confusion, particularly among older patients, the authors note. Patients ages 10 to 19 received the most emojis per 100,000 portal messages from providers, followed by patients ages 70 to 79. Some studies suggest that older people are less likely to accurately interpret emojis than younger people, but researchers haven’t reached clear conclusions. Other factors, such as gender and culture, can also affect understanding.

“Given the small but growing presence of emojis in clinical documentation, we recommend that healthcare organizations proactively develop guidelines for their use to maintain clarity and professionalism in clinical communications,” Hanauer said in the release.

Further research should examine how emojis appear to influence “patient understanding, confidence and outcomes and determine whether these playful digital symbols provide new opportunities or pose unintended challenges in electronic health record communication,” he added.

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Main image: Roman Samborskyi / Shutterstock

• Molly Glick

  Published on January 16, 2026

  Molly Glick is the newsletter editor of Nautilus.