Intended for healthcare professionals

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Feature Christmas 2018: Heart of the matter

Is it time to start using the emoji in biomedical literature?

BMJ 2018; 363 doi: (Published 12 December 2018) Cite this as: BMJ 2018;363:k5033

Rapid Response:

Medical Emoji a New Paradigm for Virtual Medical Counseling

Now is the virtual communication age and healthcare professionals are commonly involved and use various communicative tools, e.g. messengers, social media and other web-based services. At present, many physicians, nurses, and clinicians utilize these communication methods in their tele-consultation interactions for counseling about their patients. Hence, their input text might be accompanied by emojis (1).

However, the challenge is that no previously defined emoji is available for medical practice. Meanwhile, some regular emojis -- e.g. syringe, hospital, doctor’s face or conventional emotion emoji -- might be available and can be applied for medical communications in virtual spaces (2, 3).

Nevertheless, there are more than 100 medical signs and symptoms that nine of them is possible to be visualized by a regular emoji. Therefore, in a new study we endeavored to develop medical emojis for the first time to our knowledge. So, the simple shapes (emoji-like) were asked to be drawn by a panel of medical experts representing a single sign or symptom. Then, their peers were invited to rate them at the same time.

From each group one emoji scored the highest was selected to be forwarded to a digital graphics designer to be re-drawn in a digital-format. As soon as, each emoji was designed by the graphics designer then they were re-evaluated by a medical doctor expert in art. Then, the final images were uploaded to the web for public rating (

So, we do not just agree with the concept of this paper about the necessity of the addition of emojis to literature as they upgrade routine text to a higher level for better communication, but we would suggest extension to create new emojis for clinical/medical communications. Hypertext was an improvement of simple text to linked-text that generated the World Wide Web. Emoji-enriched-text have upgraded neutral text to illustrative-text that can be very useful in complex communications such as medical practice.

This is especially essential for those clinical communications elaborated in the virtual space to be valid, reliable and reckless. As mentioned above, there are more than one hundred general clinical signs and symptoms and much more special symptoms (e.g. raccoon eyes) that are utilized by physicians, nurses and other health providers when they are communicating in a virtual environment e.g. various messengers and presentation of a case with an emoji-enriched text, might lead to more effective communication (5).

There are reports of the usage of emojis in medical records, including the daily notes. These reports have offered the usefulness of emojis in communicating with peers in clinical practice (6).

Emojis are Unicode graphic symbols, used as a shorthand to express concepts and ideas in texting and must be compatible by various platforms that use texting for communication including Android, IOS or others. Each emoji has a simple Unicode that is unique for it and is defined by the developers. This step is essential for each emoji, otherwise it will not be demonstrated in the text as an illustration.

Consequently, just drawing a medical/clinical emoji does not make it available for usage, but also it is vital that developers of various communicative platforms collaborate with the medical society in adding them to their devices/platforms. Consequently, it is not in a straightforward way and medical society should support this paradigm and boom it by attempting to use them by various methods to become available online (4).

Currently, 35 medical emojis have been designed and are uploaded to our website (, and are ready for voting on. In addition, they are open to be copied to other platforms for conversion to a sticker or any other use. A sticker is an emoji-like illustration that is bigger and can be animated. They can be created easier than emojis by using some applications and be used in texting. However, they cannot be used in in-text format and they will be presented separately as an attachment to text, so they cannot be used appropriately for in-text communication of health professionals as a medical consultation. However, in the beginning they might be useful to let the health professional get aware of this paradigm in virtual medical communications and be informed that the illustrative text is added to clinic as well (7).

1. Hall AK, Cole-Lewis H, Bernhardt JM. Mobile text messaging for health: a systematic review of reviews. Annu Rev Public Health. 2015;36:393-415.
2. Gaube S, Tsivrikos D, Dollinger D, Lermer E (2018) How a smiley protects health: A pilot intervention to improve hand hygiene in hospitals by activating injunctive norms through emoticons. PLOS ONE 13(5): e0197465.
3. Kralj Novak P, Smailović J, Sluban B, Mozetič I (2015) Sentiment of Emojis. PLOS ONE 10(12): e0144296.
4. Aronson J. Medical emoticons. BMJ. 2005;330(7482):87.
5. List of ICD-9 codes 780–799: symptoms, signs, and ill-defined conditions, [Internet], Wikipedia[cited 1 Jan 2019]. Available from: symptoms,_signs,_and_ill-defined_conditions
6. GomerBlog. (2019). Orthopaedics to Begin to Use Emojis in Progress Notes | GomerBlog. [online] Available at: [Accessed 7 Jan. 2019].
7. O’Reilly-Shah Vikas N, Lynde Grant C, Jabaley Craig S. Is it time to start using the emoji in biomedical literature? BMJ 2018; 363 :k5033

Competing interests: No competing interests

07 January 2019
Reza Assadi
Assistant professor of epidemiology and dean of E-Learning center
School of Medicine, Mashhad University of Medical Sciences
Mashhad, Iran