A new study published in JAMA Network Open found that the use of emoticons in medical records has increased significantly—in the last quarter of 2025, emoticons were present in more than 10 notes for every 100,000, compared to fewer than two notes for every 100,000 between 2020 and 2024. Researchers analyzed data from 1 million Michigan Medicine patients and identified 372 different emoji used in 4162 clinical notes. Patient portal messages were the most common form of emoticon notes (35.5%), followed by phone call notes (28.5%), appointment summaries (15.3%), progress notes (13.9%), and patient instructions. Although official guidelines for doctors prohibit the use of symbols in medical records, some doctors still use the practice. The study looked exclusively at emoticons in medical records, not doctors' texts.