Like them or not, emoji and emoticons add information, context to clinical text messages
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As institutions increasingly make use of clinical texting applications, emoji and emoticons have become a common feature of medical communications.
However, some clinicians have given a “thumbs down” to emoji use in the context of medical practice, criticizing it as potentially unprofessional.
“The question we wanted to ask was, with all this discussion of the inappropriateness or the joking nature or the unprofessional tone of emoji, does this actually hold up?” study lead author Colin Halverson, PhD, faculty investigator at Indiana University Center for Bioethics, assistant professor of medicine at Indiana University School of Medicine, and adjunct assistant professor of anthropology at Indiana University, told Healio. “We found that it doesn’t hold up. Emoji seem to be doing actual linguistic work in the context where they’re being used.”
Halverson spoke with Healio about the function emoji serve in communication, the findings of his study, and the possible generational divide regarding emoji and other relatively recent technologies.
Healio: What inspired you to study this?
Halverson: I had done some work with emoji before, although not in a clinical context. Another piece I wrote about emoji looked at skin tone modifiers and how people understood them, whether they saw them as an indication of a person’s race or not. It turns out that English-speaking Americans do associate skin tone modifiers with particular races. That study had a similar impetus as this one, because there was a lot of discourse on the subject, but not a lot of empirical data.
One of my colleagues had been doing work on emoji use in the clinical tech context, and she came to me about it. I’m a linguistic anthropologist, and she wanted more of a linguistics perspective on this. She had a great database with access to texts through Diagnotes, a clinical texting system that several large health systems use. It was very serendipitous; she was already a collaborator and a friend of mine, so it really worked out.
Healio: How did you conduct this study?
Halverson: We had access to more than 100,000 threads, with more than 5,000 individual users. We limited that to just a random sample of 1% — that’s still more than 1,000 threads, which are not just single texts but a whole conversation. We ran through them and found every single thread that had an emoji or emoticon in it. Then we manually went through and made sure everything that was flagged as an emoticon actually was an emoticon, and not just a colon or a closed parenthesis.
We pulled all of the different instances within their ongoing flow of conversation and analyzed them based on the linguist Roman Jakobson’s functions of language, which spoke directly to the question we wanted to ask.
Healio: What did you find?
Halverson: We found that emoji and emoticons definitely added new information. Almost all of them were adding some context. Primarily, that was emotional, like emotive disambiguation. Text is notorious for being difficult to interpret tonally. Emoji do a lot of that work. We found they are being used that way in the vast majority of instances.
There were very, very few instances where the emoji were used solely as visual flair.
One of the other things I’d like to look into is what clinicians consider to be useless exchanges, because my colleague, Joy Lee, PhD, MS, previously found that clinicians may often be bothered by the number of texts they receive. They are especially bothered by texts that don’t tell them anything new or are simply affirming what was said in the previous text.
Healio: Did emoji or emoticons help soften the tone of texts?
Halverson: That was one of the primary ways they were used, in what we call the emotive function, a lot of times as an indication of politeness. If there was a request being made, a little smiley could soften the request and make it seem like less of a demand. It’s very difficult to modulate the tone of a request using only alphanumeric text.
Drawing on Jakobson’s work, the second most common function was the phatic function. This is used primarily for purposes of opening or closing a line of communication, and less for adding salient information. We did not find that the phatic uses unduly burdened the interchange. There were a lot of thumbs up — that was by far the most used emoji. We didn’t find any reason to believe that those thumbs up were any more burdensome to the ongoing conversation than a “yes” or an “OK” would be.
We did not find that emoji were conveying a lack of professionalism independent from the rest of the communication. If you want to be unprofessional, you don’t need an emoji to do it.
Healio: Some clinicians may have difficulty communicating their emotions. Could emoji be helpful in providing emotional subtext?
Halverson: Yes. Another thing I think deserves more research is the generational aspect of this. One of the reasons emoji seem unprofessional to some people is due to the generational divide. People who grew up without emoji may view them as a novelty, but people who have always been exposed to them don’t necessarily have that same perspective.
Healio: What is next in your research on this topic?
Halverson: My co-author, Dr. Lee, and I have talked about doing more qualitative work on this. We haven’t figured out the methods just yet, but we’d like to talk to clinicians about their experiences and perspectives on specific modalities of using emoji and emoticons. With this study, we have information on how clinicians are using emoji and emoticons, but we don’t have their interpretation of them. I think that missing piece is probably the next step for us.
References:
- Halverson CME, et al. JAMA Netw Open. 2023;doi:10.1001/jamanetworkopen.2023.18140.
- Halverson CME. Social Semiotics. 2021;doi:10.1080/10350330.2021.2000333.
- Lee JL, et al. JAMIA Open. 2020;doi:10.1093/jamiaopen/ooaa051.
For more information:
Colin Halverson, PhD, can be reached at Indiana University School of Medicine, 340 W. 10th St., Fairbanks Hall, Suite 6200, Indianapolis, IN 46202-3082; email: chalver@iu.edu.
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