Mr AngrySometimes I think my patients are being referred to me by Roger Hargreaves. In the past I've had Mr Happy, Mr Noisy, Mr Bump (complete with bandages) and Little Miss Awkward. In fact the only one I haven't met is Mr Tickle. Which is something of a relief. Today, however, I screened Mr Angry.

At the time, I was unaware of the drama which was unfolding in the waiting room. The first I knew was when I waved goodbye to a patient, and emerged from the consulting room to call my next victim. One of the receptionists promptly came running (literally) up to me, and took me straight back inside, where she told me what was going on. Apparently one of my patients, a man in his sixties, had arrived ten minutes late for his appointment, and immediately been abusive to one of the ladies on reception.

There were three different clinics taking place there this morning, so having established the patient's name, the receptionist asked him what he was there for. He'd taken offence at this request for personal information, refused to say, and ended up shouting and throwing the appointment letter at her. He'd then proceeded to the waiting room where he'd apparently upset a couple of other patients with his complaining.

The question is how to deal with someone like that. I've talked to other screeners who take the line that if a patient treats others (whether they be healthcare profesionals or fellow patients) in an unacceptable manner, then they don't deserve friendliness and helpfulness from the screener. As a result they receive a cool and curt service, possibly with an admonishment for their behaviour.

I take a slightly different line. I agree that they don't deserve to get service with a smile, but I give it to them anyway. In bucketloads. When I called this gentleman into the room, he was exuding silent rage from every pore, his body language screamed anger, and he was clearly spoiling for a verbal fight. So I greeted him like a friend, turned on the charm, and took niceness to new heights. By the time he left, I'd killed him with kindness and turned him into Mr Happy.

Morally, this is a bit of a dilemma. The receptionist in question is a lovely lady, and she was genuinely upset by this man's conduct. As was one of her colleagues. I would have been within my rights to refuse to see him, and have him removed from the building for unacceptable behaviour. So to choose instead to reward that behaviour by being extra nice to him seems somehow morally wrong. But the thing is, it works.

I began the appointment with a man so angry that both a receptionist and another patient had felt the need to warn me about him, and express concerns for my safety. Twenty-five minutes later, he and I were such good friends that I couldn't get rid of the man. He was so enjoying telling me anecdotes about his life, swapping tips about superfoods, and even making me laugh with his jokes, that he didn't want to leave. He told me he's such a coward about eye drops that if he was fighting in Afghanistan, the Taliban would only need to arm themselves with Tropicamide and he'd surrender immediately.

To be honest, I think that joke speaks volumes. A lot of anger comes from fear, and I think this was a man driven to rage by his fear of the appointment. That doesn't excuse his behaviour, of course, but it did enable me to solve the problem. By responding to his stress with compassion, treating him with respect, and showing him that he had nothing to fear, the man's anger was dissipated within minutes. He left with a smile on his face, and even said a cheerful "Bye bye!" to the receptionist he'd abused.

The receptionist didn't deserve the treatment she'd received from Mr Angry, and Mr Angry didn't deserve the treatment he received from me. But two wrongs don't make a right. I could have treated this patient the same way he'd treated our staff - it would have been no more than he deserved - but I'd have got exactly the same treatment back, probably tenfold. By ignoring what he'd done and letting it go unpunished, I got the best out of a potentially difficult patient, and he left relaxed and happy, with a positive experience of retinal screening. It might seem morally wrong, and I feel bad for the receptionist who suffered, but it's the only way I can work.