Key PointsQuestionHow do clinicians use emoji and emoticons in professional communication with colleagues?FindingsIn this qualitative study of 1319 clinical text message threads, 7% of threads contained an emoji or emoticon. The emoji and emoticons primarily added emotive content (61%) and/or served to open, maintain, or close channels of communication (32%).MeaningThis study’s results suggest that emoji and emoticons are used primarily to convey new and interactionally salient information, and concerns about professionalism in their use may therefore be unwarranted.