Views & Reviews The Bigger Picture


BMJ 2008; 336 doi: (Published 27 March 2008) Cite this as: BMJ 2008;336:724
  1. Mary E Black, public health physician, Belgrade, Serbia
  1. drmaryblack{at}

    Avatar is a lovely word—it conveys a slinky tapestry of the mystical and the technical. It conjures up both blockbuster and friendly pet. It means my online image or presence.

    When I teach I have efficient plans and outcome measures. I like small group learning for medical students. It is no loss; those endless hours of sitting in badly prepared lectures in badly heated rooms, going through the formality of learning. When I learn, materials are now all on line. My MD thesis is coming along nicely, based on global health databases discussed in occasional emails to my supervisor and administered by the mostly intelligible online university support system. I adore virtual reality as it makes my world of teaching and of learning bigger and more efficient.

    I Skype my retired doctor mother to catch up and discuss her various ailments. Google is my first point of call on finding out what her treatment options are and she scans me her results. I telecommute part time with UNICEF in New York. I have working relationships around the world with people I have never actually met—I have only encountered their emails or a photo or two online. I am part owner of an IT company, and we have virtual management meetings between three countries every week.

    We all exist online these days; our electronic selves are purposeful and busy. Our case files, radiographs, and data stream from place to place and we expect so much more—lost patient notes are passé (unless some government agency catastrophically loses the entire electronic file). My financial identity was stolen last year, but I retrieved it with some online detection.

    But oh, don’t I miss people sometimes. Humans seek order and they seek to gather together. Calendars are not just to mark tasks, monitor objectives, tick off the to-do list, and plan trips abroad—they provide meaning and the rhythm of the seasons. Gatherings are an important ritual; to sit in a room full of real people conveys sense and purpose well beyond the expected outcome of the moment. When lost in the electronic nightmare of MTAS, it is people who will soothe shattered nerves and lost self esteem. We need our strangers and acquaintances glimpsed across a crowded room as much as we need our close friends and families . . . or avatars.

    One day, when my avatar meets yours in some virtual meeting space, buttons will be pushed to deliver the consensus opinion, underline the diagnosis, accept the degree, or award the accolade. We will celebrate the interconnectedness of our efficient global world, sure in the knowledge that our interaction has been effective, efficient, and up to date. The electronically submitted applause will be sincere.

    But won’t we be lonely?

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