Eating your veggies? Thumbs up.
With computerized records and messaging through patient portals, some doctors have traded their infamous chicken scratch handwriting for easier-to-decipher hieroglyphics.
And a new study aims to understand emojis’ emerging use within the medical profession, specifically clinical notes and patient portal messaging.
As part of their work, researchers from University of Michigan Medical School found which emojis doctors used most — and there are a few you might not expect.
The report summarized emoji use found in 218.1 million electronic health record clinical notes — including patient portal messages from doctors — pertaining to 1.6 million patients at Michigan Medicine between 2020 and 2025.
Researchers found 372 distinct emojis within the note sample.
The most common emoji by far was the smiling face with smiling eyes, with the telephone receiver, calendar, prohibited symbol (red circle with a line through it), and eye icon rounding out the top five.
Perhaps not surprising, other emojis found in the notes include a pill, a stethoscope, a brain, a test tube, praying hands, a hospital, soap and a hot face. More urgently, there were 18 instances of the police car emergency light.
Among the more head-scratching emojis was a maple leaf, a rainbow, cooked rice, fire and a fax machine.
Roughly 25% of notes that included emojis contained more than one, with a maximum use of 32 and an average use of 4.
According to the review, 58.5% of emojis fell into the smiley or emotion category, followed by objects (21.2%), people and body (17.6%), symbols (11.9%), animals and nature (10.6%), travel and places (8.9%), and food and drink (3.4%).
Emoji use was most common in portal messages to patients, accounting for 35.5% of usage, followed by telephone encounters, encounter summaries, progress notes and patient instructions.
And it seems the use of the digital abbreviation is on the rise in the medical field. From 2020 to 2024, emoji use remained stable at 1.4 instances of emojis per 100,000 notes. However, by 2025, that number had increased to 10.7 per 100, 000 notes.
Researchers found that while emoji use is still rare in the electronic health record, emoji use was significantly higher in that context than in clinician-to-clinician texting.
They are hopeful that future research will further investigate the role and effect of emojis in clinical communication.
Experts caution that when emojis are used in a clinical context, especially within patient-directed communications, there is an increased risk of misinterpretation.
And anyone who has ever texted someone of a different generation knows that interpretations of emojis can vary across age groups.
While emoji use was highest in portal messages to patients ages 10 to 19, the second most frequent occurrence was in messages to patients aged 70 to 79.
The adoption of emojis into medical messaging could reflect a larger communication preference among patients. In fact, a 2024 survey of 2,000 Americans aged 21+ found that 41% believe a message needs an emoji to be complete.
Younger respondents were most likely to agree with this statement: 70% of Gen Z said emojis should be included in a message, compared to 46% of Gen X.
The authors of this latest research hope their findings will inspire institutions to develop guidelines for clinical documentation and messaging.
