I still remember the day when the Dean personally called and asked if I would like to attend medical school. Like you Bert, one of the happiest days of my life too. I agree with you David too, this profession is very fragile, and even 18 years into my career I still have to pinch myself when people not only listen to me but keep coming back to see me. Maybe its because there is a nationwide shortage of primary care docs, and my patients are stuck with me, but I still feel enormously grateful to have been given this opportunity. When I was engaged to be married, my sister gave me a book called the 5 love languages--one of the languages of expressing love is acts of service, and I suspect Walter this may be what drives your wife to the point of exhaustion, by showing her appreciation to her patients and obviously by your writings they recompense her by coming back for more. Walter, one other thing you need, in my opinion, to diagnose, is good old fashioned horse sense, to tie the 4 steps you mentioned together. But being face to face with a patient and picking up on body language, nonverbal cues, sound, and actually examining and touching someone really aid in the ability to diagnose and trying to do diagnose via a medical booth over a computer screen would vastly impair one's horse sense.
