This, of course, was palpably untrue, it was only his hometown and the surrounding network of villages and countryside that considered him repulsive, the rest of the world had not yet suffered any exposure to his unique charm. Sometimes, I realised, I was his only friend (it comes with the job).
I had recently persuaded Joe to take the flu jab, and he hadn't, to his extreme disappointment, developed the flu afterwards, so he had reckoned it was pay-back time. He had also just discovered a veritable gold-mine of possibilities, an encyclopaedia of reasons to be obnoxious.
'Those tablets you gave me,' he protested, trying in vain to hide his satisfaction, 'I got awful side-effects.'
'And what side-effects were these?' I said, pretending to care.
'All of them,' he said.
'Oh,' I said, putting two and two together, 'you read the patient information leaflet, did you?'
'Yeah,' he said, licking his lips with relish. 'Brilliant, isn't it?'
It's a paradox we face every day; the more informed a patient is, the more we invite them to share our doubts and uncertainties, the less likely the treatment is to work and the more likely they are to experience side-effects. When asked directly about side effects, with some notable exceptions, I am deliberately vague; dissembling is one of the core skills of general practice.
There are a few stock multi-purpose answers; 'Let's wait and see', 'Most people have no problems', 'Try them for a while and we'll see how we get on', 'The side-effects are terrible, you'll swell up like a blow-fish and spend the night vomiting your guts up; that's the reason I'm prescribing them, don't you know, I really don't like you very much, and torturing you is one of the perks of the job'. OK, I didn't really say that last bit.
Directly implicate a specific side effect and as sure as eggs is eggs that side effect will be experienced. 'This drug may make your tongue turn blue and your genitals become hypersensitive, and you may have nightmarish hallucinations about Tony Blair becoming president of Europe.'
It's Tony Blair's best chance, I reckon.