"Patient escort" -- a new occupation in China
He acts like family by their side, feels their pain, and witnesses people making life-or-death decisions.
The population in the Chinese mainland recorded negative growth for the first time in 61 years, decreasing by 850,000 in 2022, data released recently by the National Bureau of Statistics of China (NBS) showed. According to China News Service, the decrease reflects the drop in the birth rate and the growth in the mortality rate resulting from population aging.
It is foreseeable that China's population aging will keep deepening, which means society needs more quality healthcare services. As a budding occupation in big hospitals, the professional "patient escort" may play a bigger role in the industry.
Most hospitals in China have a set of professional departments for diagnosing, examining, and treating patients. But an important part that goes unnoticed is linking these departments for patients. [Another part of China's hospital system that also needs more attention is special clinics. See a previous GRR post on China's transgender clinic.]
Patients, especially those from rural regions who are not familiar with procedures in big hospitals and the elderly who don't understand hospitals' intelligent systems well, easily get petrified in front of procedures. For example, they get lost when facing preliminary consultations with doctors, tests in different departments on different floors, and medical jargons from doctors' mouths ...
This is where "patient escorts" came in. They generally make a living by offering services that patients need in exchange for some fees. Their services include collecting medical test results at different departments, fetching prescriptions, and taking notes when the doctor communicates with the patient.
Sometimes, "patient escorts" temporarily act like family members in the hospital and provide emotional support. With an experienced guide in the hospital, the system may work more efficiently, and patients would be more reassured, which would boost the quality of China's medical care. However, as with any rising nascent occupations, there are gaps that current laws and regulations don't cover, including how to settle disputes between "patient escorts" and their "clients."
Today's newsletter is a translation of the summary of Lifeweek's new documentary Yes, it's a job too —— 100 new occupations in China《对，这也是工作——100个新职业》(Episode one: I am the "temporary family" for patients 我是患者的“临时家人”). The video was first published on Jan. 10, and through patient escort Han Zheng's first-hand experience in Beijing, it answers the following questions: How did the job come into being? Who are the target clients? What are the risks of becoming a "patient escort"? And what does it feel like to accompany patients in the hospital where death comes and goes every day?
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Han Zheng tested positive for COVID a few days after an interview with us. He rested for a week or so and then started taking orders again.
"I don't dare to linger long in the hospital for fear of catching the virus again. So I only take easy orders, including getting prescriptions or medicines," said Han, adding that the only "accompany" order he took was from a few days ago. It was a regular client in his 30s. After recovering from COVID, he suffered chest pain and shortness of breath. The client couldn't get an appointment with a pulmonologist, so Han took him to the ER (Emergency Room) directly.
At the hospital, Han wore an N95 mask with a regular mask on top of it. He didn't dare to take them off for one second.
The ER was filled with patients, and the ambulance kept sending people in. Han and his client arrived at 1 p.m. They didn't see the doctor until 6 p.m. and finally had a CT scan at nearly 9 p.m. "It only takes two hours on normal days," added Han.
As a "patient escort," Han and others in the business have several WeChat groups. Recently, people talk a lot about the elderly that they had accompanied passed away and tight medical resources in hospitals. Han hardly reveals any bad news to his family, which is a rule he has set for himself since the first day he became a "patient escort."
Han Zheng is 35 years old and comes from north China's Inner Mongolia Autonomous Region. Han became a "patient escort" in 2022.
After graduating from the China University of Geosciences, Han found a job in an international trade company in Beijing. Later, the company didn't go well, so he resigned and started his own business. However, the timing was not right. His capital chain ruptured due to the pandemic. "I was recovering debt throughout 2020," said Han.
In the hardest moment, he thought about returning to his hometown. But he finally decided to stay so that his wife and kid may have a better future. Then the next question was what job he could do. He was already used to a flexible work schedule, so he didn't want to work nine to five in some organization again.
Han first learned about "patient escort" while watching short videos. "I helped friends and relatives from my hometown when they came to hospitals in Beijing. So I can do this job!" He recalled.
Beijing is a big city with many medical resources. People across China come here to see doctors. The population is aging, but young people are often too busy with work. So, when someone in their family gets sick, young people don't have time to take them to the hospital. On the other hand, the procedures of seeing doctors in the hospital are becoming increasingly complicated ... After a quick analysis, Han believed that there's a strong demand for the service and the job is promising.
After making up his mind, Han immediately created a Douyin account, the Chinese version of Tiktok. He put his real name, photo, and ID in his profile. "People only trust you when you give them real information about yourself," explained Han.
Han had worked in the Middle East before, so he also wrote in his profile that he could provide services in English and Arabic. Although he hasn't met any clients with the need so far, he keeps the description to make himself more competitive.
When Han first opened the account, there were only dozens of "patient escorts" on Douyin in Beijing. But now there are about 1,000. "The competition is getting more fierce in about half a year," he said.
At first, Han did the job secretly. He didn't tell his family or friends. "Because I thought it was not like a serious job," he said, adding that his family only learned about the job when clients called him. Later, he had an interview with media, and many of his friends in Beijing saw him on the video and sent it to more people. From then on, he no longer kept his job a secret.
"However, back then, I thought that had I known that my friends would find out about the video, I wouldn't do the interview," said Han.
The clients of Han mainly include:
a) the elderly who cannot figure out intelligent equipment and systems at the hospital;
b) nonlocals who visit the famous hospitals in Beijing to treat rare diseases;
c) restless parents taking their kids to the hospital;
d) young people who don't want to go to the hospital alone.
"I accompany patients to the hospital and help them solve procedural problems, such as pre-consultations, making inquiries with the doctor, and getting reports or medicines for them. But I'm not responsible for making hospital appointments nor recommending a specific hospital," explained Han clearly and fluently. In this way, he could draw a clear line between himself and Huangniu, a hospital scalper.
Han's first order was from a mother. She needed to take her kid to a children's hospital. Han has a four-year-old son, so he understands the hardship of taking kids to the hospital alone. For the first order, he didn't have any business experience to draw on, and all he could rely on was his life experience.
In the beginning, Han made quite an effort. If the patient required Han to take them to a hospital unfamiliar to Han himself, he would visit the hospital in advance. He would go to the clinic, ER, different departments and examine rooms on every floor. Moreover, he would get himself familiar with the procedure before clients come.
Before going to the hospital, he would ask clients to write down symptom details, including when the symptoms started, what medicines the patient had taken, what exams the patient had done before, and whether the patient still had the previous medical report or not. If Han didn't know about the disease, he would do some research on the internet.
Even though there seem to be few requirements for the job, there are risks in the business because the government had no clear regulations or standards for this new occupation.
Not all clients tell the truth about their conditions. "Some wouldn't tell you they had infectious diseases like HBV," said Han.
What if the elderly fall to the ground or bump into something [in the hospital]? Who would be responsible?
What if the "patient escort" pays the examination fees in advance, but the patient decides not to do the examination? Who should cover the cost eventually?
Some clients treat patient escorts as waiters, according to Han. He said he sees himself as a professional assistant, but some clients boss him like a minion.
The list of "gray areas" goes on and on. Some "patient escorts" would draw up an agreement and ask clients to sign it. But Han has consulted with a lawyer. The lawyer said that such agreements basically have no legal validity. "It's like seeing an old lady falling, and you step up to help. [Whether the old lady would blame you or not] totally depends on her moral standards," Han said with an example.
Being a "patient escort" means that Han always shows up when someone is in the most vulnerable state. He acts like family by their side, feels their pain, and witnesses people making life-or-death decisions.
Many may ask, why are people in big cities so cold-blooded? Why do they need to hire a person to accompany them in the hospital? Where is their family? In the eyes of Han, behind the phenomenon is the pressure and helplessness facing many people in big cities.
Han accompanied many seniors to the hospital, and it was their kids who hired him. These elders mostly suffer from chronic diseases or cancers and need to do chemotherapy regularly. "They need to go to the hospital five or six times per month, but their kids have to work," he said.
Some people worry that the elderly cannot accept [hiring someone for accompany], so they lie and say the escort is a friend. But old people may wonder, "how come your friends always have time?" If the lie doesn't hold up, they will patch it with another lie. For example, lying about the price of the service in case the elderly think it is too expensive. They might say it only costs 100 yuan to hire an escort instead of 300 yuan, which is the actual price.
Some families come from other cities. These patients usually suffer from some rare diseases. Before coming to Beijing, most of them have spent a lot of money on medical treatments back home. Families with sick kids are especially generous about seeing doctors but are extremely frugal about food and accommodation. These families have zero idea of what to do in Beijing. So they are even more dependent on Han Zheng.
Some clients are middle-aged people that need to take care of the whole family. These clients can find someone in the family to accompany them, but they don't want others to worry, so they secretly hire an escort on the internet.
Sick people tend to be vulnerable. Some patients get frozen the moment they enter the clinic. They can't remember anything the doctor said. In that case, Han will take down the doctor's words while comforting patients as if he is one of their family members. Later, he would tell the patients what the doctor had said.
Some young people have trivial problems. But they are too busy to spare time for doctors. So they hire Han to run errands in the hospital for them, including getting medical reports. In fact, the hourly fees they pay are about the same as what they earn per hour. They hire "patient escorts" anyway because they don't dare to take sick leave.
Some of the young clients are just too anxious. Under the high-pressure work schedule of 007 (working or on call 24 hours a day, seven days a week) or 996 (working from 9 a.m. to 9 p.m. six days a week), they are worried about their health conditions. But when they go to the doctor, the whole process takes only several minutes. Because symptoms largely come down to psychological reasons.
Witnessing sickness and death at the hospital every day brings intense mood swings to "patient escorts."
Han remembered making inquiries with the doctor for a client in the early days of his escort career. The client reached out to him late in the night and sent him several voice messages. Han was about to go to bed, so he didn't listen to them. He just pushed the "convert to text" button and took a glance. When he listened to the messages the following day, he found out that the client was talking in a desperate tone.
That was the father of a newborn baby with congenital heart disease. Because of the pandemic, he couldn't take the baby to Beijing for treatment. Han helped the father make inquiries with the doctor at distance, and they have been trying to save the baby for about half a month. One day, the father suddenly stopped replying to Han. Days later, Han saw the father's post on WeChat —— The child had passed away.
"I felt very sad. We tried so hard but still couldn't save the baby." Han still keeps the WeChat messages from the father, especially those voice messages he sent. From then on, whenever a client sends him a voice message, Han listens to it immediately because "many emotions cannot be expressed in words."
After making inquiries with doctors and getting medical reports, Han found it hard to convey certain information to his clients. For example, a terminal cancer diagnosis.
Although a cancer report is full of medical terminologies, Han understands what it means immediately because he has read a lot of medical reports. When his patient is diagnosed with cancer, Han needs to muster up the courage to call the client. And he always comforts his client, saying, "let's try other hospitals."
The other day, Han got a call from the Beijing Municipal Health Commission and learned that the government wanted to set standards for "patient escorts."
Han's younger friends believe the job is promising, but older people find it difficult to accept the idea. They think it's unethical to charge sick people for errands.
Han doesn't explain himself. One night when he walked a client out of ER, the client was finally relieved. At that moment, Han believed the job was worth it.
Having taken my father to the the ER in 3 different hospitals in Taiwan, I can attest that my mind was complete haze before, during and after each ER trip which either resulted in a stay in the ICU or a discharge. I just got better at it with each visit...navigating the hallways, asking the right questions, requesting for tests/second opinions and making sure I don't get overwhelmed by the situation.
陪診師 is a good start to help patients. What we have in Taiwan that is somewhat regulated are caregivers that stay with patients during short term hospitalizations, though hospitals do not check their certifications. I've stayed with my father in the hospital before and that was not easy work. Since then, I always appreciated the care and attentiveness the hired caregivers gave my father while he was hospitalized. Of course, we had our share of questionable caregivers -- hence the necessity of standardized training -- to eliminate unfit caregivers. Not all caregivers comprehend the magnitude of their carelessness.