Almost before I am inside his front door, Jonathan Miller is telling me that next month’s Boheme at English National Opera will be the last opera he ever directs and that he should have stuck to practising medicine. ‘I was very good at it,’ he reports, prescribing me a large glass of malt whisky.

I have no idea why he needs to do this. Miller has an irritating habit of publicly quitting opera. There was the hissy fit a decade back saying he would never work again in Britain. In 2004 he lamented that nobody wanted him any more. Two years ago in the New York Times he officially retired: ‘I can’t go on with it. It’s driving me mad and making me very desolate and depressed.’

And here he is, 74 years old on an icy winter’s night, after a ten-hour rehearsal day in Bromley with a bunch of singers hanging onto his every word, trying to convince me that nobody loves him, nobody cares. Sir Jonathan (he was knighted in 2002) seems to be crying out for an embrace of recognition when all the laurels lie at his feet and his place in art history is secure.

Miller is one of very few opera directors who can lay claim to lasting innovation. With a 1982 Rigoletto set among the 1950s mafiosi of New York’s Little Italy, he invented the time-shift opera – underscoring the drama by placing the work in a different period. ‘There were other directors who did opera in modern costumes,’ he concedes. ‘I think I was the first to update the context.’

This is no small achievement. Rigoletto is still in repertoire at ENO a generation later. His Armani-suited Cosi fan tutte is on its fourth revival at Covent Garden. He has four shows on the go at the Metropolitan Opera, New York, including a Pelleas et Melisande placed in Marcel Proust’s Paris and a Rosenkavalier taken out of baroque pantaloons and relocated to Richard Strauss’s living room.

‘By and large,’ Miller explains, ‘if a composer has conspicuously backdated a work, I get worried about historical kitsch. Put Rosenkavalier in 1911, when it was written, and you suddenly hear the shot in Sarajevo. The Marschallin goes around the house trying to stop the clocks. It’s not because she’s old – she’s 35 – it’s because she knows the old world is finished. Octavian will die on the first day at the front.’

Every production he creates is rooted in a philosophical rationale and a specific visual impetus. The time-traveller of modern opera, Miller as Doctor Who is an omnivorous intellectual with an eye for telling detail. His ENO Boheme has been shifted forward from the 1850s of Murger’s novel and the 1890s of Puccini’s opera to Paris in the year of hunger, 1932. ‘I’ve always been obsessed by the photographic world of Brassai, Cartier-Bresson and Kertezsz, men looking for work stacking their bicycles against a wall, lesbian girls looking through café windows. I cannot bear to see artists in smocks and berets in Boheme. These characters are not artists. They are rich young men living a couple of years in a squat before they go back to work in Daddy’s firm.’

‘Where I do have endless regrets,’ says Miller, ‘is having left the world of scientific medicine’

Boheme is his first return to the Coliseum for 12 years and it is only with kindly tuts and shushes on my part that he is deflected from having a go at the company’s present management and slamming the door in his own face once again. Miller lacks some neurological barrier that stops the bile rushing unchecked from brain to mouth. His litany of those who did him wrong, or damage art, is limitless, acute and often unrepeatably hilarious. He dismisses ‘Jurassic Park singers’ of the Pavarotti and Domingo style, ‘over-applauded and overpaid, can’t act their way out of a paper bag’. The last boss of the Met, who booted him out after he tried to stop Cecilia Bartoli singing two extra arias, enters the Miller lexicon as ‘that Tony Soprano’. Lately, he lashed out at the casting of a West End Hamlet ‘with the man from Doctor Who’. He seems incapable of suppressing rage yet, in rehearsal, you could not find a gentler, more avuncular manner of connecting singers with their inner selves.

He found a way of stopping the formidable Anghela Gheorgiu from over-emoting in the last act of La Traviata. ‘I said to her: “Take it from me, I’m a doctor. Dying is a fulltime business. You haven’t time to do a lap of honour. Chances are you’re incontinent, anyway. Do stay in bed.’ She resisted me. Then she suddenly started crying and talked about sitting beside her sister as she was dying…’

The Miller method, based on clinical observation, can be exceptionally efficient: rehearsals for the first act of Boheme were finished in a day. With singers, he tries ‘to touch some sensibility of what they knew anyway. Most of the singers I have worked with are the nicest, simplest, most straightforward, most practical people, who don’t, like actors, have all sorts of theories about acting. They are like athletes. They need to make sure they can sprint, they can do these high leaps. The rest of the time they are very sensible.’

Miller took to stage, he says, by accident. The son of an eminent psychiatrist and a dedicated writer, he insists there was no music in the house when he was growing up, only walls covered with bookshelves and art. At Cambridge, reading medicine, he went up to the Edinburgh Festival with some friends, ‘between medical jobs’, never anticipating the success of Beyond the Fringe. Stints at the Royal Court and the BBC taught him how to direct actors and make films.

Then Laurence Olivier took him to the National to direct The Merchant of Venice. ‘He said: “Dear boy, we are about to embark on the most difficult play,”’ quotes Miller in drawled imitation. ‘“We must at all costs avoid offending the Hebrews. God, I love them so.”’ Miller got Olivier to shed the beard and Jewish mannerisms. ‘Just play Shylock like a businessman,’ he directed.

Roger Norrington called and asked him to work with Kent Opera. ‘But I can’t read music,’ protested Miller. ‘That’s all right, I can,’ laughed the conductor.

The Earl of Harewood, who was running ENO, brought him to the Coliseum, where the idea for the Mafia Rigoletto was sparked by Miller’s wife, Rachel, herself a family doctor, coming up with a line from the movie Some Like It Hot, where the gangster, asked ‘where were you on 14th February’ replies, ‘we was at Rigoletto’s’.

‘It’s been pretty much all opera since then,’ says Miller, momentarily forgetting the dozen Shakespeare plays he produced for the BBC, the series on atheism, the books, the film of Alice in Wonderland, the happenstances of an improvised life that has made him an internnational figure, if not altogether a treasure.

Because at every stage he pauses to list the places that won’t have him back. ‘The National don’t want to know me, Covent Garden don’t call, the BBC is not what it was …’ This need to stand apart, to criticise, not to belong, is what makes Jonathan Miller the artist he is. ‘Two things I can’t bear about opera,’ he volunteers. ‘I can’t bear that Zeffirelli-esque, picturesque historical kitsch, which seems to me to be just sedentary tourism on the part of the audience. And on the other hand I can’t bear what has infected England which is a German konzept-regie where you disfigure it, make it interesting in order to show there’s a director at work. It’s fraudulent rubbish.’

There is a technological add-on to his new show, with Sky Arts showing the opera live on one channel and the backstage action on another. Miller is less excited by this than by Alfie Boe’s enthusiasm at playing Rodolfo on something that looks like the monochrome film set of Hotel du Nord.

Miller likes to quote his mother to the singers. She once told him ‘great fiction is about making the negligible considerable’ and he urges them to pay attention to the simplest gestures. ‘If you’re any good as a doctor, at least thirty percent of the diagnosis is done as the patient comes in to the room,’ he says. ‘The rest is done by taking a history, by look, by touch.’

Betty Miller died at 53 of early-onset Alzheimer’s. A bust of her, by his father, sits on Miller’s mantelpiece. Her novels are still in print. I wonder whether he feels he has lived up to parental expectations.

‘Where I do have endless regrets,’ says Miller, ‘is having left the world of scientific medicine. I was very good at it. I ought to have carried on. I really regret not having stuck with it. Neuropsychology is what I would have done, defects of perception.’

But he’s not finished yet. While showing me the art works that he carves and paints in every spare moment, he mentions a new production at ENO next year, another in Brooklyn and various others in the mind, all the while insisting that the world has forgotten him and doesn’t want to know. It’s a sorry story, the Miller’s tale, full of sound and fury and riddled with self-contradictions, but the significance of what he has done is not small and it is heartening to know that there may be more to come.