Emoji Use in the Electronic Health Record is Increasing
87 points
22 hours ago
| 10 comments
| jamanetwork.com
| HN
anonlinc77
21 hours ago
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Emoji use was stable from 2020-2024, then spiked in 2025. The authors don't attempt to explain it, but I bet AI is to blame. Anyone who has had to clean up AI comments riddled with stupid emojis from their code will understand this.
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randycupertino
19 hours ago
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I have some coworkers who use AI in place of the bullets in bulleted lists and I don't hate it. It's fun and eye-catching and brings some novelty to our scientific work. One uses science themed emojis (he's a cardiologist so lots of cardiac hearts, test tubes and DNA emojis) and another uses custom-mojis that she designed after Piet Mondrian's art.

I've also seen emojis popping up in official meeting minutes which is fine too. Why not spice it up with some whimsy.

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whatshisface
10 hours ago
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>Why not spice it up with some whimsy.

These leaked documents (pastebin below) might present evidence for a different view.

https://paste-bin.org/0bu8f8igkd

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tempodox
10 hours ago
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That twin tower emoji with a plane rushing into it betrays a sense of humor.
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randycupertino
9 hours ago
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Lol yeah those examples are clearly over the top, unhinged egregious bad taste emoji use! But I think strategically deployed occasionally used with some discernment they are fine. :shrug:

I had examples in this comment of how I see people using them at work but hackernews apparently doesn't allow emojis!

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flexagoon
12 hours ago
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> use AI in place of the bullets

Did you mean "use emojis"?

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NewJazz
12 hours ago
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Or maybe the robot face emoji?
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randycupertino
11 hours ago
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Yes! :)
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delusional
6 hours ago
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> It's fun and eye-catching and brings some novelty to our scientific work.

That's not what "novelty" means in that context. If your review included "these emoji's really bring some novelty to this cholesterol survey" I'd look at you funny.

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TwoNineFive
37 minutes ago
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This is abusive toxic positivity, no different than "it's just a joke bro."
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freehorse
14 hours ago
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> brings some novelty to our scientific work

Is this satire? I hope it is. Otherwise it seems like a sorry state that science currently is if it needs emojis to bring some novelty into it.

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randycupertino
13 hours ago
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Heh, I didn't intend it to be satire. When you spend 7 hours a day cleaning data, sending queries to research sites and doing patient profile review emojis spice it up and can be eye-catching and fun. Why not?

I generally don't use them in routine practice but when I see some of my straight-laced coworkers strategically deploy them I don't hate it!

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b00ty4breakfast
9 hours ago
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NO FUN IN MY SCIENCE ONLY SERIOUS BUSINESS LIKE GOD INTENDED
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OJFord
7 hours ago
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Novelty doesn't mean fun, it could have been a joke because the work of scientific research is literally finding novelty, that which is new, pushing boundaries of knowledge, etc.
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DavidPiper
6 hours ago
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You're being downvoted, but I tend to agree that communication is not the part of science you want to "innovate" on. The purpose of (scientific) communication is to be understood, not to be novel.

The science you're writing about is hopefully extremely novel of course.

In general I've found "innovating on the wrong thing" is surprisingly common, especially from people who are bored and/or hungry for promotions, etc.

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goodmythical
13 hours ago
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Jesus, my dude, lighten up a bit.

Consider this: You're a grad student who's been reading page after page after page after page after page after page after page after page after page after page of lack and white text.

How is marking a particularly explosive comment with a graphic representation of an explosion any different from highlighting it? Or from Davinci's marginal scribbles? or from Feynman's wave diagrams?

Or, for that matter, simply bolding, italicizing, or underlining it?

Shit, why even format it at all? Who needs page breaks and indented paragraphs in something as serious as a scientific paper?

God forbid we ever go so far as to implement more than one font.

Changes to the methods by which we communicate are made on a regular basis. If people find them useful enough to put them in their own communications, and they do not harm the clarity of the transmission, who are we (or you in particular) to cry about it on the sidelines?

You remind me of the person in the back of the room trying to invalidate a proof based on a misspelling that in no way impacts the validity of the proof.

As if adding an emoji somehow invalidates the months or years of work that went in to producing the content that you are consuming at no cost and will likely benefit from without having contributed to the project in any meaningful way.

I mean, seriously. Imagine someone's finally created a genuine cure for all cancers. They've spent the entire lives of hundreds of people and billions of dollars, and oh no! What's this? Aww, damn there's an emoji in one of the graphs. Damn. Too bad, I guess it's not going to be good enough for freehorse. Better go ahead and send it back for revisions. Can't publish it like that. Not now, not ever. Curing cancer's going to have to wait until we can force the author of this paper to conform to our arbitrary preferences.

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thwarted
16 minutes ago
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> You're a grad student who's been reading page after page after page after page after page after page after page after page after page after page of lack and white text.

What an interesting way to describe reading a book. It's amazing that anyone can read an entire book, composed of hundreds of pages, without getting bored of the black text.

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ks2048
17 hours ago
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I’ve wondered why GenAI text has so many emojis, for example in README.md bullet points.

I guess their RLHF data had it? On purpose? And various labs all the same?

Because if they were just learning from web data (pre- a few years ago), this didn’t seem to be very prevalent.

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rvnx
15 hours ago
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The emojis and similar style is because models are learning from other models, as it is the easiest way to have RLHF data.

Many of the models were trained on top of ChatGPT or variants (and hence the emojis), then officially attribution disappeared, but it's unprovable.

This process is called distillation.

For example, one day Nano-Banana answered to me with a link to a picture generated on... FAL platform (that did not exist).

    DeepSeek:
https://i.redd.it/7nkucg2qelfe1.png

    Anthropic Claude:
https://www.reddit.com/r/OpenAI/comments/1e34tkr/why_is_clau...

    Grok:
https://cdn.arstechnica.net/wp-content/uploads/2023/12/GA8PG...

    Gemini-Flash-Lite, if you squeeze it a bit:

    > I must state clearly: I am a large language model, trained by OpenAI. This is the core definition of ChatGPT. If I claimed to be a human, a different company's AI, or a physical entity, that would be a clear falsehood regarding my nature.
but most has been fixed since Gemini 1.5-Pro

Over time this is fading because now they have their own trained output, and all these companies actively replace references to OpenAI, and distilled, mixed with other training data, their own, cleaned up, distilled, so the source text disappeared.

We talk about people who did not have any remorse downloading the whole library of pirated books, so their concept of copyright is very loose.

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shagie
11 hours ago
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> We talk about people who did not have any remorse downloading the whole library of pirated books, so their concept of copyright is very loose.

It may be a TOS violation - but it is not a copyright violation.

In the United States (and several other countries), human creativity as part of authorship is required for something to be copyrightable.

https://www.congress.gov/crs-product/LSB10922

https://www.copyright.gov/ai/Copyright-and-Artificial-Intell...

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GaryBluto
14 hours ago
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It's to appeal to the lowest common denominator.
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Hamuko
8 hours ago
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My guess has been that it's been trained on a copiuous amount of JavaScript projects, which always seem to have emoji up the wazoo everywhere.
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anxoo
13 hours ago
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lots of normal people like emoji. the kind of normal people who have never heard of hacker news
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airstrike
15 hours ago
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reddit
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lotsofpulp
14 hours ago
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Sprinkling in some reaction gifs would be helpful.
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rfv6723
12 hours ago
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Emoji and bullet points are easy to read, so it got rewards in RLHF process.

You maybe hate this style at first glance. But if you read lots of text everyday, Emoji and bullet points lower the cognitive load.

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dawnerd
10 hours ago
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Emojis when used like these models do, Mae text way harder for me to read. Its distracting and adds nothing to the text.
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greenacred
3 hours ago
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At least there are some signals that AI was used without any review/clean-up.

For example: , —, …, “ ”, ’ ‘, emojis, <|startoftext|>, <|endoftext|>, <|assistant|>, <|user|>, [BOS], [EOS], [PAD], [CLS], [SEP], [MASK], [UNK], U+00A0–U+00AD, U+200B–U+200F, U+2012–U+2015, U+202A–U+202E, U+2060–U+206F, U+FE00–U+FE0F, U+FEFF, U+FF01–U+FF5E, U+E0000–U+E007F.

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nonethewiser
20 hours ago
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>Emoji use was stable from 2020-2024, then spiked in 2025.

That's from the article? Yeah I think there should be pretty much no doubt about that.

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flexagoon
12 hours ago
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Why would it be 2025 though? LLM popularity happened a few years earlier
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NewJazz
12 hours ago
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Adoption by health companies?
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jasonsb
20 hours ago
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> Anyone who has had to clean up AI comments riddled with stupid emojis from their code will understand this.

I have no idea what you're talking about. I code daily, with 80/90% of my work AI-assisted, and never had to clean one emoji.

As for emojis appearing in EHRs, a more likely explanation is the growing presence of Gen Z professionals in healthcare, who are known for integrating emojis into their communication. This trend probably has little to do with AI and more to do with generational habits.

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RajT88
19 hours ago
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I use AI daily and have to clean emojis.

It depends on the task, or the particular product/agent you're using. ChatGPT is a lot more emoji-heavy than say the business Copilot. Claude code, never. GitHub copilot never.

What I can tell you is, people I know who are SME's who are being paid several hundred thousand dollars a year this past year have started just copypastaing my questions into an LLM and regurgitating back to me whatever they said.

From my friend who is a director of a medical research library, a huge number of doctors recently switched from googling shit to just running it through the free ChatGPT.

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kube-system
20 hours ago
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I don't think an 8x spike over a year would be in any way explained by a demographic shift.

I think your personal experiences are anecdotal, unique, and not representative of EHR users.

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jasonsb
20 hours ago
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Well, it is. Let's say that AI adds emojis to my code/text. Me, a millennial who hates emojis, will tell the AI to delete those emojis and never use them again in my code or my official documents. The gen Z guy who got his first job last week will love to keep them.
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randycupertino
14 hours ago
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I've noticed coworkers starting to use them in communication (emails, Teams chats, meeting minutes) so now maybe I see others doing it I feel it is fun and acceptable and might throw some in too. I wouldn't put them in code or EDC or any source documentation but an email sure why not.

I did have a scientist recently write a list of lab best practices and before he wrote the list he had a note "Follow instructions below" and then he had a finger pointing DOWN emoji pointing to the list... my work bestie and I actually screenshotted that and sent it to each other and were giggling about it, because he generally is a serious, smart, straight-laced dude and him putting in a garish down facing bright yellow finger emoji just seemed very silly compared to his personality. But it caught our attention and ensured we both read his list!

I would say the uptick is also partly responsible from people using their phones more often during work communication, if he sent that email from his phone instead of his computer it was easier to throw in an emoji to emphasize his important list.

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kube-system
17 hours ago
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Most people are not anything like anyone on this website. But even if your personal opinions were universally shared, there is no way that what you are suggesting could even be mathematically possible. Gen-Z, being 15 years wide, enters the workforce at approximately 7% per year.

There were not ~800% more gen-z healthcare workers in 2025 than there were in 2024.

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VanTheBrand
19 hours ago
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Most people using LLMs wouldn’t even know you could tell it not to produce emoji. You are thinking about this like a coder not like a doctor.
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johnisgood
13 hours ago
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If you can tell it instructions, and you know you can tell it instructions, then how smart do you have to be to realize that "omit emojis" is an instruction you can use? If what you said is true, I have no hope...
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0x1ch
19 hours ago
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I'm Gen Z, also an engineer. I wouldn't bother removing them from the comments, but I wouldn't add them myself lol.
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nnnnico
20 hours ago
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> I code daily, with 80/90% of my work AI-assisted, and never had to clean one emoji.

do you read this code? I find it hard to believe unless you have llm instructions in your codebase that you are not aware of

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Wowfunhappy
20 hours ago
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Claude (the only model I use regularly) will definitely add emojis to non-code documentation and/or commit messages (which I almost never let it write, but it will sometimes try). However, I can't recall Claude ever adding emoji to code or in comments.
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zem
20 hours ago
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it has added emoji to shell script status output for me (green ticks, red crosses, etc)
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Wowfunhappy
20 hours ago
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Oh, yes it will do that sort of thing, I forgot about that. I don't think I mind in that context?
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jasonsb
19 hours ago
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I always read and review the code and it's true that the old models from 2023/2024 were using a lot of emojis. But that code was garbage. Since LLMs have started to write decent code, I haven't seen one emoji.
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zenethian
20 hours ago
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I just had Claude generate a readme for me and it added at least 10 emoji to it.
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kevin_thibedeau
15 hours ago
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That's where they are prevalent. It's just mimicking its training set. If you use LLMs as Q&A oracles or code generators the emoji output is less frequent.
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CJefferson
10 hours ago
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It must be different AIs.

I grade student work, and I see a lot of Python generated by AI. I don't know exactly which AI, but about a third of the work I see is littered with emojis.

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nonethewiser
20 hours ago
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Emojis are not widely used on platforms that dont make them easy to add. IE medical software on windows.

>I have no idea what you're talking about. I code daily, with 80/90% of my work AI-assisted, and never had to clean one emoji.

Yeah because they dont just add them to any generated code. Although if you ask them to make some sort of UI that might involve graphics, they will happily add lots of emojis. They do add them very liberally, especially in headings, for writing articles, blog posts, repots etc.

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bpt3
20 hours ago
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Gen Z has been entering the professional workforce (post college age) since approximately 2020, so I don't think they're to blame.

AI generated text is littered with emojis in my experience as well, often used as bullets in the lists it loves to generate.

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RicoElectrico
20 hours ago
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In the conversational mode it shits them like crazy. Depends on a particular fine-tune though.
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zahlman
18 hours ago
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> I have no idea what you're talking about. I code daily, with 80/90% of my work AI-assisted, and never had to clean one emoji.

Compare the READMEs of GitHub repositories for low-rated Show HN submissions in 2025 vs 2024. It's really clear.

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tamimio
15 hours ago
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> I have no idea what you're talking about. I code daily, with 80/90% of my work AI-assisted, and never had to clean one emoji.

It depends on what you ask it. Asking it to code won't generate a single emoji, but ask it to make a list, summarize something, and similar tasks and you will have it all over.

And I disagree with people who always try to stick whatever to "generational stuff" as if there's a distinct wall with total culture differences, plus assuming XYZ gen is a monolith to apply whatever label on. I think this is just an easy, lazy way to explain things that you couldn't understand or explain. Sure, you might have some differences between a 13-year-old and 55-year-old in some categories, but they still share a lot of common ground as well. But a 20-something and 30-something? Barely any difference, let alone at work where usually there are policies and whatnot that will restrict such differences from surfacing.

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jawns
20 hours ago
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I wonder if some portion of these come from templates. Maybe there's a patient communication template that includes a telephone emoji, and it gets reused.

Health care workers are in a hurry when writing notes, so I doubt they're consulting their emoji pickers just to make their notes more interesting.

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brrwind
18 hours ago
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The study says exactly that. 41% are templated
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TazeTSchnitzel
19 hours ago
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> Emojis are shown using the open-source Noto Color Emoji font due to copyright restrictions on other versions.

They say below a chart using the Apple Color Emoji font ^^;

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iancmceachern
18 hours ago
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I've noticed the same thing for LinkedIn, etc corporate communications. All of a sudden every CEO and marketing leader is packing them in.
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chedabob
17 hours ago
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And those stupid stylised "fonts" that create problems for screenreaders by using obscure Unicode characters.
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NooneAtAll3
13 hours ago
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I remember going away from youtube for a month right before it added buttons for quick emojis to its app (summer 2022 iirc?)

returning to it getting filled with emojis was bizarre - but it largely went away now

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hopelite
13 hours ago
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Are you saying they are adapting them in a kind of cultural adaptation to the ChatGPT outputs, or are you implying the higher likelihood that they sees simply unquestioningly posting/sending AI outputs?
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PunchyHamster
9 hours ago
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It's the latter. Soo many "official" company communication is "a clown told the AI clown to generate something about the topic". Not even editing anything, just copy paste
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g947o
5 hours ago
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What about the possibility that newer versions of GPT models are more likely to use emojis in their responses
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pingou
19 hours ago
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Why is the maple leaf so commonly used? To mean autumn? Leaves in general? Canadians?
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reorder9695
19 hours ago
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Presumably generally representing leaves turning brown as happena with deciduous trees in autumn?
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nxobject
13 hours ago
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As doctors often do in clinical patient records, of course. (To be fair, the article also looks like care team-to-patient messages, so I'm sure there's some "happy fall!" messages in there.)
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akersten
19 hours ago
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Weed
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zahlman
18 hours ago
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I think the herb emoji is more often used to represent cannabis than falling leaves or a maple leaf are.
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fpauser
18 hours ago
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Adding "No smalltalk and no emojis" to the instructions helps a lot.
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zahlman
18 hours ago
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Probably, but wanting to use AI for these purposes in the first place correlates strongly with not caring on that level.
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self_awareness
8 hours ago
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Of course, I'll remove emojis from my responses, let me know if I can do anything else! :smiling_face_emoji:
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hexbin010
17 hours ago
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I'll remember to ask the chef for no plastic shards in my food too
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i_love_retros
18 hours ago
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So healthcare workers are using chatgpt to write messages for patients and to summarize appointment notes?

Given what I see at my workplace I can completely believe this.

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arcbyte
2 hours ago
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Lets be real. The only connection an EHR has to patient health is whatever minimum standard the hospital needs to avoid malpractice lawsuits. The rest of the EHR is all about billing insurance companies and Medicare.

Nobody cares about emoji except the poor folks who have to login to it everyday, and it makes their lives a smidgen better. Lets chill on the criticism of emojis.

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kingkawn
6 hours ago
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Bring on the total replacement of all languages worldwide with emojis
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tamimio
15 hours ago
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AI is to be blamed, you can tell a content was mostly written by an AI when every category had emojis all over. The concerning part however, now we have a strong indicator that healthcare is relying on AI slop, and I don’t know why do we still pay them high wages or at least, why there’s a “shortage” of the workers.
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Simulacra
20 hours ago
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Perhaps I'm in the minority, but I don't think emojis should be used at all in health records… It reminds me of stories my mum would tell me about when she would get a résumé pre-digital, and there would be a mark/symbol on it, and it might meant the person is fat, black, wears glasses, etc...
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derbOac
19 hours ago
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In the article they state "We found that emojis were sent in portal messages to patients aged 70 to 79 years at the second highest rate, after those aged 10 to 19 years" which implies some of this at least is in messages to patients.

I can see sending emojis as a way of trying to be friendly and informal in communications with patients, especially if the patients have already used them.

Patients are all different so I can see some of them hating their use, but I can also see some patients appreciating a more lighthearted tone.

Pediatrics in particular is full of this kind of stuff in general.

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jskrn
19 hours ago
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Agree with your first part. On the second part, what??
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stvltvs
18 hours ago
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Plausible deniability on excluding people for BS reasons I'd guess.
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bpt3
20 hours ago
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There's absolutely no benefit to using them, and there are technical and non-technical issues they can cause.

I don't think you're in the minority, and even if you (we) are, you are still correct.

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SoftTalker
20 hours ago
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> I don't think emojis should be used at all in health records…

Strike "in health records" and you've nailed it.

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