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Zhang Zhen has learned a few tricks for her job accompanying people to their hospital appointments: Don’t ask too much about a person’s illness, have a wheelchair ready, bring snacks and “focus on the positive,” she says.
The 44-year-old Beijinger is part of a booming profession in China: She’s a “patient companion,” someone who hires themselves out to go along with patients during medical services, from regular doctor’s appointments to chemotherapy sessions. It’s the latest rent-a-service in a country where you can pay someone to be your boyfriend during the holidays or a bridesmaid for your wedding.
Patient companions often take the place of adult children who cannot take their aging parents to the hospital, either because they live too far away or can’t take time off work. The job is demanding physically and mentally, said Zhang, who is often up by 5:30 a.m. and on her feet so much that her knees and feet have started to hurt.
“Patient companions really are temporary children for these people. You want to make them feel comfortable and safe — maybe even more so than their own children would,” she said.
“In their hearts, they really want their children to be with them,” she said. “That’s why we have to show them love.”
While companions began appearing at Chinese hospitals in the mid-2010s, they grew popular during the coronavirus pandemic. Chinese authorities instituted strict “zero co” rules that prohibited travel across provinces and even neighborhoods of the same city. Residents who couldn’t take their parents for hospital visits turned to friends and family — and eventually the internet, where these services were taking off.
But the service also reflects some of China’s most-pressing societal and demographic problems.
As China’s elderly population has grown, so have their medical needs, yet their children are fewer and farther away, often moving across the country for work. Decades of family planning policies have left millions of aging residents with few relatives to look after them.
It is also a symptom of the difficult job market many young Chinese face today after three years of co-19 policies that paralyzed the world’s second-biggest economy.
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“Although China still values intergenerational care, because of this migration, it’s very difficult,” said Yuying Tong, a demographer at the Chinese University of Hong Kong. “As the parents and grandparents of the one-child-policy generation age, this will be an emerging industry to cope with aging issues in China.”
Although coronavirus infections have subsided in China, the patient companion business continues to expand.
On the shopping platform Meituan, where users order food delivery or hail a car, they can now book patient companions. For as little as $13, a companion will pick up medicine or a medical report. Escorting a patient to and from the hospital in a private car costs $86.
According to a report in the People’s Daily newspaper last year, there were more than 500 businesses offering patient companion services on e-commerce sites such as Taobao and Jingdong.
Hundreds of s of companions advertising their services in major Chinese cities can be found on Little Red Book, a lifestyle platform, or Douyin, the Chinese version of TikTok.
Uplifting classical music plays over footage of them walking through hospital wards, waiting in long lines and waving hospital registration numbers — needed for getting an appointment in China’s public hospital system. They introduce themselves, their background and why they got into this field.
Trips to the hospital are a fixture in the lives of many Chinese citizens, most of whom do not have a regular doctor and go to public hospitals for even routine care.
Yet hospitals in major cities like Beijing are infamous for being crowded and overwhelming. Just getting an appointment is a competitive process that often requires waking up at dawn to begin fighting for a slot as soon as registration opens online. Residents from rural areas, where health care lags far behind, also flock here.
Visits easily become day-long affairs of waiting in lines and shuffling back and forth across a sprawling hospital for tests and to make payments, or to pick up medical files or prescriptions — a labyrinthine system where each step is its own lengthy process. After all that, patients often get only a few minutes with a doctor.
“With us, an appointment that would have taken a day can be done in possibly half a day,” said Jiang Jiang, a 27-year-old in Hangzhou, who does this work full time and recently organized a collective of about 20 medical students to work as patient companions.
They help about 300 people a month, doing everything from recommending hospital departments to explaining the doctor’s words.
Companions can pick up prescriptions for their clients, register and wait in line for appointments, and escort them home after a procedure.
With a list of their client’s symptoms, the companions can also see a doctor in lieu of the patient, a service called daizhen, or getting a diagnosis on behalf of the client. It was especially popular during the pandemic when people stayed away from hospitals for fear of catching the coronavirus.
At the height of China’s coronavirus outbreak, Liu Xiaoli, a 34-year-old in Hangzhou, was working 14-hour days as she ran to different hospitals to get medicine for sick residents or accompanied anxious patients to hospitals, where even the lobbies were crammed with people on intravenous drips. People begged for help and offered to pay her any price.
“You saw it all,” said Liu, who struggled to find a job with flexible hours and good pay during the pandemic after staying at home for years to raise two children. “You really felt how fragile life is.”
As a new industry, patient companionship is not regulated, and there are no requirements for becoming a companion. Legal scholars have called for more oversight, including protections for both sides, and standardized prices.
Zhang, who learned from another patient companion and started taking jobs last September, said she doesn’t believe a medical background is necessary. “That’s why people go see the doctors, right?” she said.
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Vicky Li, 35, who works in insurance in Shanghai, has used patient companions twice — once to accompany her mother-in-law and daughter to the hospital because she worried her mother, who had recently arrived from rural Yunnan, would struggle on her own, and another time when Li needed a gastroscopy.
“If you want to get an appointment quickly, see a doctor or have to stay overnight for a procedure, this saves you time. It also saves you worry,” she said.
A colleague of Li’s uses a companion to take her father, who has cancer, to the hospital when she cannot ask for leave. “I call this a kind of ‘alleviation’ service. It gives us middle-aged people a little breathing room,” Li said.
There is still, however, some reticence around this emerging industry. Doctors are not always familiar with the idea of paid companions. And in some cases, the children doing the hiring don’t want their parents to know someone is being paid to accompany them.
Jiang, in Hangzhou, said some clients hiring her to accompany their elderly parents will ask that she pretend to be a friend or a classmate. “I’ve played all kinds of roles,” she said, noting that she and the client make sure their stories “match up.”
Many patient companions defend their line of work in promotional s. They explain that their work is different from that of scalpers, who sell hospital appointments and are seen as profiting from other people’s misfortune.
“Is this an embarrassing line of work?” one companion in Henan province said in a of him walking through a hospital. “What’s embarrassing is having empty pockets. Working hard and earning money is something to be proud of.”
But patient companions and experts alike think the profession will be accepted eventually. That may already be happening. Liu, in Hangzhou, said half of her clientele now is young people who don’t want to go to the hospital alone or bother friends or family.
Tong, the demographer, agrees that society will adjust. “In the future, maybe people will realize this is normal, like paying people to clean the house, or taking a taxi.”
Lyric Li in Seoul and Vic Chiang in Taipei, Taiwan, contributed to this report.
