Emoji in clinical messaging: results of a focus group study

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Background: Clinicians are increasingly using emoji in digital communication, but limited qualitative work has examined how they assess the appropriateness, risks, and benefits of this practice. Objective: To characterize clinicians' reported utilization of and attitudes toward emoji in clinical messaging. Design: Qualitative study using focus groups and a survey from August to October 2025. Participants: Twenty-nine clinicians at a large academic health system were recruited from 4 specialties and included physicians and advanced practice providers, genetic counselors, medical students, and other healthcare workers. Approach: Rapid qualitative analysis was used to identify both the benefits and drawbacks of emoji use in clinical messaging. Key results: Emoji were seen as clarifying tone, building rapport, softening directives, and reducing notification fatigue. However, participants also reported concerns about ambiguity, informality, and potential medicolegal risk due to messages' discoverability. Their assessment of appropriateness was context-dependent, including power hierarchies, personal familiarity, clinical gravity, generational differences, and the technical affordances of specific platforms. Emoji were viewed as more acceptable in informal contexts and among peers with whom they had established relationships, and as inappropriate in high-stakes and sensitive clinical contexts. Participants felt formal guidelines could be seen as condescending but suggested modifications to promote the clear and effective use of emoji in professional settings. Conclusions: Clinicians view emoji as useful but context-sensitive communication tools that should be used conscientiously. They disprefer universal, prescriptive guidelines. However, they promote explicit conversations about emoji use at onboarding and the modification of which emoji are available in local messaging platforms.

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