Emoticon-Based Progress Notes

Warning: Satire ahead.

The field of psychiatry has been a pioneer in the use of telemedicine. Providing therapy by phone has been used for years, but this is limited due to lack of nonverbal cues. Because our exam can generally be performed in a hands-off manner, remote audio and video allow close approximation to a face-to-face exam. Skype, Facetime, Google+ Hangouts, and similar applications are being increasingly used to provide ongoing treatment for existing patients, especially when they may be out of town or cannot travel because of illness or weather.

©Lack-O'Keen/Fotolia.com

When these modalities are not available, some have also used e-mail to make decisions, such as decreasing a medication dose based on side effects or refilling a prescription. Text messaging is being used to deliver reminders and communicate changes in appointments or even medication doses. This had me wondering about the typical lack of nonverbal cues in these text-based communications.

I then realized that emoticons, those smiley faces people use to express emotion, can be extremely useful in helping us to assess our patients’ mood, and even side effects, based on their e-mails and text messages to us. Their use of common Internet shorthand, such as LOL for laughing out loud, can also be helpful. But it can be hard for some of us, especially those who did not grow up with an Internet, to tell the difference between, for example, a :-) [smile] and a ;-) [wink]. or to know that :-p is a tongue sticking out or :-* is a kiss.

I have compiled a highly refined guide below to help psychiatrists make appropriate treatment decisions based on their e-mail or text message communications with their patients. This guide is derived from the latest evidence-based medicine research on textual language processing of emotionally-laden content based on fMRI evidence from frequent web-using subjects. I hope it is helpful to you in your practice.

If you have additions to this guide, please share them in the comments section.

<[QM]>—Steven Roy Daviss, M.D., DFAPA

Dr. Daviss is chair of the department of psychiatry at Baltimore Washington Medical Center, clinical assistant professor at University of Maryland, chair of the APA Committee on Electronic Health Records, and co-author of Shrink Rap: Three Psychiatrists Explain Their Work, published by Johns Hopkins University Press. Find him @HITshrink on Twitter and on the Shrink Rap blog, where humor and seriousness mix regularly.

Warning: Satire ahead.

The field of psychiatry has been a pioneer in the use of telemedicine. Providing therapy by phone has been used for years, but this is limited due to lack of nonverbal cues. Because our exam can generally be performed in a hands-off manner, remote audio and video allow close approximation to a face-to-face exam. Skype, Facetime, Google+ Hangouts, and similar applications are being increasingly used to provide ongoing treatment for existing patients, especially when they may be out of town or cannot travel because of illness or weather.

©Lack-O&#039;Keen/Fotolia.com

When these modalities are not available, some have also used e-mail to make decisions, such as decreasing a medication dose based on side effects or refilling a prescription. Text messaging is being used to deliver reminders and communicate changes in appointments or even medication doses. This had me wondering about the typical lack of nonverbal cues in these text-based communications.

I then realized that emoticons, those smiley faces people use to express emotion, can be extremely useful in helping us to assess our patients’ mood, and even side effects, based on their e-mails and text messages to us. Their use of common Internet shorthand, such as LOL for laughing out loud, can also be helpful. But it can be hard for some of us, especially those who did not grow up with an Internet, to tell the difference between, for example, a :-) [smile] and a ;-) [wink]. or to know that :-p is a tongue sticking out or :-* is a kiss.

I have compiled a highly refined guide below to help psychiatrists make appropriate treatment decisions based on their e-mail or text message communications with their patients. This guide is derived from the latest evidence-based medicine research on textual language processing of emotionally-laden content based on fMRI evidence from frequent web-using subjects. I hope it is helpful to you in your practice.

If you have additions to this guide, please share them in the comments section.

<[QM]>—Steven Roy Daviss, M.D., DFAPA

Dr. Daviss is chair of the department of psychiatry at Baltimore Washington Medical Center, clinical assistant professor at University of Maryland, chair of the APA Committee on Electronic Health Records, and co-author of Shrink Rap: Three Psychiatrists Explain Their Work, published by Johns Hopkins University Press. Find him @HITshrink on Twitter and on the Shrink Rap blog, where humor and seriousness mix regularly.

Warning: Satire ahead.

The field of psychiatry has been a pioneer in the use of telemedicine. Providing therapy by phone has been used for years, but this is limited due to lack of nonverbal cues. Because our exam can generally be performed in a hands-off manner, remote audio and video allow close approximation to a face-to-face exam. Skype, Facetime, Google+ Hangouts, and similar applications are being increasingly used to provide ongoing treatment for existing patients, especially when they may be out of town or cannot travel because of illness or weather.

©Lack-O&#039;Keen/Fotolia.com

When these modalities are not available, some have also used e-mail to make decisions, such as decreasing a medication dose based on side effects or refilling a prescription. Text messaging is being used to deliver reminders and communicate changes in appointments or even medication doses. This had me wondering about the typical lack of nonverbal cues in these text-based communications.

I then realized that emoticons, those smiley faces people use to express emotion, can be extremely useful in helping us to assess our patients’ mood, and even side effects, based on their e-mails and text messages to us. Their use of common Internet shorthand, such as LOL for laughing out loud, can also be helpful. But it can be hard for some of us, especially those who did not grow up with an Internet, to tell the difference between, for example, a :-) [smile] and a ;-) [wink]. or to know that :-p is a tongue sticking out or :-* is a kiss.

I have compiled a highly refined guide below to help psychiatrists make appropriate treatment decisions based on their e-mail or text message communications with their patients. This guide is derived from the latest evidence-based medicine research on textual language processing of emotionally-laden content based on fMRI evidence from frequent web-using subjects. I hope it is helpful to you in your practice.

If you have additions to this guide, please share them in the comments section.

<[QM]>—Steven Roy Daviss, M.D., DFAPA

Dr. Daviss is chair of the department of psychiatry at Baltimore Washington Medical Center, clinical assistant professor at University of Maryland, chair of the APA Committee on Electronic Health Records, and co-author of Shrink Rap: Three Psychiatrists Explain Their Work, published by Johns Hopkins University Press. Find him @HITshrink on Twitter and on the Shrink Rap blog, where humor and seriousness mix regularly.