How much power lies in that smiley face or thumbs up that embellishes a text?

It turns out that may depend on the context. And when it comes to emoji and emoticons in clinical texts among doctors — even possibly pulmonologists, urologists or gastroenterologists — there actually is research to answer that question.

Researchers at Indiana University wanted to know if the thinking by some clinicians — that emoji set an unprofessional tone — would stand up to study.

And lead author Colin Halverson said in an interview in Healio that it doesn’t hold up: “Emoji seem to be doing actual linguistic work in the context where they’re being used.”

The findings were based on a random sample of more than 1,000 threads from 80 clinicians, according to the research by the authors. Halverson is a Ph.D. faculty investigator at the university’s Center for Bioethics, assistant professor of medicine at Indiana University School of Medicine and an adjunct assistant professor of anthropology.

In very few cases were the emoji simply used for visual appeal, he noted — rather, they added new information or context.

Tone, of course, can be difficult to interpret in a text. Enter emoji — first introduced in Japan in the 1990s, they were not available to users internationally until 2009.

The study found that emoji can denote politeness, for instance in cases where a request was being made, or they could serve to soften the demanding element of the ask. The symbols were not found to convey a lack of professionalism independent from other elements of the communication.

“When clinicians use emoji and emoticons in secure clinical texting systems, these symbols function primarily to convey new and interactionally salient information,” the authors wrote.

Next, the researchers plan to conduct a qualitative study to further examine clinicians’ interpretation of emoji and emoticons and also may consider how much a generational divide contributes to interpretation of the symbols.