"In mythology, and in the study of folklore and religion, a trickster is a god, goddess, spirit, man, woman, or anthropomorphic animal who plays tricks or otherwise disobeys normal rules and norms of behaviour."
"A few years ago I realized that my bonus, based on my "quality" management of diabetes, was compromised by the poor quality of my patients. I then dismissed many of the alcoholics and non-compliant (more correctly, I maneuvered them to dismiss me -- much less hassle); and my bonus scores have greatly improved. I thought I was clever, but I've come to believe that this is exactly what the the network, the insurance companies, and the gov't, wants me to do."