Michel Foucault's analysis of "the birth of the clinic" describes the genesis of a unified discourse that, in retrospect, has shaped western medicine for two centuries. However, in looking prospectively toward a 21st century medicine, Foucault's analysis is necessary but not sufficient. To better critically address medicine and medical education in the era of simulation, we could draw on frameworks developed by futurists such as Jean Baudrillard. Foucault's analysis does not account for contemporary, complex developments of the clinical gaze as (...) the gaze is distributed across practitioners in increasing use of sophisticated, representational diagnostic imaging. Further, Foucault's antihumanist rhetoric sometimes strays into the antihumane, and this is disturbing for those who support the development of patient-centered medicine. Yet we are increasingly teaching aspects of medicine, such as communication, in simulated learning environments in which complex reality is absent, perhaps inadvertently creating an "inhumanity" in medical education. (shrink)