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Neurologist Vikram Madireddy discusses his article “How Japan and the U.S. can collaborate for better health care,” examining the parallels and contrasts between two of the world’s most influential health systems. Vikram explains how Japan’s universal Social Health Insurance model emphasizes preventive care, affordability, and trust, while the U.S. excels in medical innovation, precision medicine, and specialized care. He highlights opportunities for mutual learning—from Japan’s aging-in-place strategies and holistic practice culture to America’s team-based workforce models and digital health leadership. Listeners will gain insights into how transnational collaboration can reduce burnout, improve equity, and build resilient systems that honor both patient dignity and global health progress.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Vikram Madireddy. He is a neurologist. Today’s KevinMD article is “How Japan and the U.S. can collaborate for better health care.” Vic, welcome to the show. Thank you so much for joining me from Tokyo today.

Vikram Madireddy: Yeah, thank you for having me.

Kevin Pho: All right, so tell us a little bit about your story and then the article that you co-wrote on KevinMD.

Vikram Madireddy: OK, well, sure. So I am originally from New York City, born and raised, and the first time I ever left New York was to go to medical school in the Deep South in Memphis, Tennessee, home of barbecue, Elvis Presley at one point, and I think the Memphis Grizzlies. Yeah. So, a New York transplant. Halfway through medical school, I was starting my clerkships, and I actually had an opportunity to go to Japan for the first time.

Now I am living in Tokyo. I am a resident of this country. I am a guest on a student visa doing medical research, and then I hope to pass the Japanese license one day. But yeah, I have been back and forth a few times, and I just fell in love with this country out of all the places I have studied medicine and practiced medicine. So I am working to establish roots here and try to bring Japanese medicine out to the wider world, including my home country.

Kevin Pho: All right. So, what led you to Japan to do medical research in the first place?

Vikram Madireddy: OK. Well, growing up, I was always big into anime: Dragon Ball, Pokémon, all that Saturday morning cartoon stuff. You know about these countries just in the back of your head. Like Japan, you think of Samurai, you think of Mount Fuji, you think of sumo wrestling, the emperor, the bushidō code, and World War II. Those are all things that we loosely associate with it, the same as we associate the U.K. with the Queen, with crumpets, with Mick Jagger, for example. But then once you actually start to delve into it, just like with medicine, it starts to take on a life of its own. You learn new things as you go. You go back and forth; you are adding to it.

One thing I am doing now is translating Japanese medical textbooks into English, and that really helps me when I practice medicine on the English side. I memorized more of the pharmacology, memorized more of the anatomy because I had to take my time. How that started was I was doing internal medicine in Nashville, Tennessee, and I actually had a patient close to my age. We hit it off because of that shared mutual interest in anime and Japanese culture. Unfortunately, I later found out towards the end of that rotation that he had committed suicide. That caught me completely off guard. I thought he was OK. You never really know.

My friend and classmate could see that was bothering me, and he said, “What is something you have always wanted to do to de-stress?” And I was like, “You know what? I have always wanted to learn Japanese. I never got around to it. It is a very hard language.” And then he just looked at me and he was like, “OK, I am going to bet you twenty dollars you cannot learn it while doing medical school.” Before I graduated, I actually passed an exam in Japanese proficiency called JLPT. To this day, he has not paid me. I do not know what happened, but that was probably the best bet I ever made because after that, I got invited to Tokyo the first time to learn neurosurgery. I met my best friend in all the world who is now my roommate, Heikki. We co-wrote that article together that we made for the website for you. He is my partner in crime. He is my confidant. When I am not sure of something, I can ask him, and vice versa. It goes both ways. I just fell in love with this country, and the rest is history. I went back and forth, and now I am a resident of this country.

Kevin Pho: All right. And I think we mentioned offline that I visited Japan a few months ago with my family and completely agree with you. It is a fantastic country. I would love to go back. Now, in your article, you contrast the American and the Japanese health care systems and what we could learn from that. So for those who did not get a chance to read your article, tell us what it is about.

Vikram Madireddy: Well, if you are interested in medicine from a different perspective, a non-Western one… I know a lot of medical students, myself included, from the U.S., we like to go to England for study abroad rotations. We like to go to Australia or Europe. Going to the eastern side of the world is a whole different ball game. It is like going to another planet in a way.

Japan and the U.S. share many similar problems right now when it comes to health care, like chronic health conditions and an aging population. But one thing Japan does well is, just like England, they have socialized medicine. Japan, similar to the NHS over in England, has a government-run, socialized health care system. However, there are some caveats. While in the U.K. they do not pay for anything (it is free at the point of contact), it is a government-run, centralized bureaucracy. Japan, I would say, is more of a hybrid system between America and the U.K., kind of like Australia, which is also a hybrid system of America and England.

Every Japanese citizen, from birth, is automatically enrolled in national health insurance. They do not have to worry about, “Hey, can I see a doctor or not?” You are born here, you have citizenship, you will see the doctor. It is just a question of: Do you pay a thirty percent copay versus the full one hundred percent? The government usually takes care of that other seventy percent. But even that full price, if you cannot afford it, or let us say you are visiting Japan as I was before I got my residence card, you would be surprised what the price is. An eye appointment for these glasses, for example, for an ophthalmologist in America, if I did not have insurance, I would probably be paying just for the visit 200 to 300 dollars. In Japan, even without insurance, the most I paid for that ophthalmology visit just to get new glasses was fifty dollars. Then even without insurance, to get these glasses as well, the max it cost me was 250 dollars, just for the basics. If I wanted to add on stuff, I would pay extra, but even the most basic set of glasses will cost 200 dollars. With insurance, according to my friend, Heikki, it will probably cost about fifty to seventy-five dollars. In America, I do not want to think about what this would cost.

One way that is different from the U.K. is that Japan is not centralized. Just like the U.S., they have a vast, different network of insurance systems, audits, inspections, and everything else, just like America does with creditors. Meanwhile, in the U.K., everything is run from London or Liverpool and so on and so forth. So you have to go to a GP first, and only then can you see a specialist. In Japan, you do not have to do any of that, and yet they have more efficiency compared to England. But at the same time, because of that non-centralized approach, they do have the same rural-urban divide as America does.

Kevin Pho: So in terms of some of the biggest things that we in the United States can learn from Japan, number one, of course, is the prices. Number two is kind of a bigger public responsibility when it comes to health care. It seems like in the United States, we have been dealing with these potential solutions for a while now. Now that you have lived in Japan, do you have any advice for our health care leaders in terms of how we could implement some of these ideas from abroad?

Vikram Madireddy: I think so. There are two specific things I can think of. I know AI is gaining traction in a lot of fields, including medicine at the moment, especially in America, in terms of medical education, improving outflow like discharge summaries, patient notes, pharmacy records, everything like that, and also just teaching the stuff. I sometimes use ChatGPT to help me learn medical Japanese, because that is a whole different ball field from basic conversational Japanese when I am going to a supermarket or a restaurant.

That is one big thing I would say we can implement more. One thing the Japanese are doing with AI, they are not as big on it as we are at the moment, or as the West. They are a bit skeptical, but they are looking at ways to implement it into social care. How can we merge it with robotics to do surgery and all that other stuff that the U.S. is doing? Medical education, getting notes ready, translation services, for example. Sometimes for foreigners who do not learn Japanese, certain idioms do not translate, and vice versa from when I was learning it.

The second thing I can think of is elder care. Japan is an aging society, I would say a lot more than we are, but we are catching up, unfortunately. They have actually had to tackle that problem head-on in terms of social services, nursing care, home visits, and that kind of thing. AI is also assisting in that department because if you go to a Japanese restaurant, I am sure you have probably seen a robot waiter. That is one thing that they are trying out. I would say the elder care model has actually been started in the U.K. NHS; they have actually taken some of that and they are just experimenting with it. The U.S. could be next.

Kevin Pho: What is it like to be a doctor in Japan? Tell us about some of the rewards and challenges they face.

Vikram Madireddy: Well, I would say the biggest challenge at the moment is the language barrier. I am trying every day to study Japanese so I may pass the license exam. I would say my level right now, having passed N3, which is the intermediate level, I can talk at a high school level. Sometimes I still have to draw it out, go across that barrier, like point and say, “I need blood from you,” or that kind of thing, or “I need a scan.” But I would say it is a lot better than where I was compared to 2022, where it was like, “I do not know what this person is saying.”

At the same time, it is very rewarding. When you see an IMG come to America and they are trying to learn the language, I have some understanding now, some humility of how that feels. I am the fish out of water. No one is going to learn English for me. My coworkers can speak English, but you should make an effort now that you are here. It has been very rewarding. It is like being on another planet compared to if I was in Europe. At the same time, once I cross that barrier, once I can fully understand a patient and write a note in Japanese for that person’s condition, it is very worthwhile. It is like I have already studied medicine, I have had to learn antibiotics, I have had to learn anatomy, I have had to learn surgical procedures and complications. Now I have had to translate it nonstop. It has just been a very blood, sweat, and tears process, but also very rewarding at the end of the day or the month.

Kevin Pho: Now, how about your physician colleagues in Japan? I know that physicians in other countries, like Korea for instance, there is a lot of dissatisfaction among physicians. Talking to your Japanese physician colleagues, are they generally happy with the system?

Vikram Madireddy: That is another issue I feel like they could probably learn from us about. Burnout is a huge problem, not just in medicine, but in every aspect of Japanese work culture. It actually has a term called “karoshi,” death by overwork. Some people literally work themselves to death. It is just like, “I am going to stay and work until the point at which I collapse from a heart attack or collapse from some other long-term medical complication.” That is still a major problem, but I would say in 2025, it is starting to loosen up a bit. Maybe not as much as we are, but it is a different culture, a different perspective. I know it is going to be slow to change. Who am I to decide, “Hey, you should do that,” from a Western perspective? I am not from here. I am not a native. I am still learning your language.

Trying to understand that gap, it is like they see this as normal. At the same time, one of my colleagues who has actually spent time in America, he is like, “Yeah, I agree. This is not healthy. This cannot go on.” Because if people keep dying, who is going to take care of them? Aside from the usual, “You have to take care of yourself, you need to be healthy yourself,” it is just like, “If you die on me, I am a man down.” So that is one big incentive why they are thinking, “OK, we need to start having a better work-life balance. We need to work on physician burnout.” And me being from an outside perspective, they are like, “What are your thoughts on this?”

Kevin Pho: One of the things that your article highlights is the concept of medical bushidō. Can you explain what that is and how that shapes the physician-patient relationship?

Vikram Madireddy: Sure. So I have actually lived a little bit of it now, being here for a few months and witnessing it firsthand. It is kind of like, have you seen that movie with Tom Cruise, The Last Samurai? It is kind of like a slow metamorphosis over months, if not years. I am not at the “years” level yet. One day, fingers crossed. It is like I am still learning the hallway signs and everything else after being here. It is more muscle memory than simply reading, but I have gotten better at reading the various specialties as I am going around the hospital.

At the beginning, I figured, “OK, I come in, someone is going to have the reports ready for me, someone is going to have the handover ready for me, and then if I order an X-ray or if I need a procedure, one of the nurses or nursing assistants will handle that.” Then I tried to say it in rudimentary Japanese, “Sumimasen, I need this EKG.” And they are like, “Go get it.” It is like, “What?” Then my senpai, or seniors, point me over, and it is like, “Oh, no, no, we have to handle that ourselves.”

It is like every day you come in, you pull up the list, you see what the problems are, just like in America. But then if you need something, if you need a test like a nerve conduction study in neurology, you are going to perform the test yourself and interpret it yourself. If you ask for radiology, they are not going to automatically hand you a report. They are just like, “OK, here is the image. You do it.” So it is very hands-on, very like you have to put the work in, kind of like a samurai. It is not like, “Oh, someone is going to sharpen your sword for you. Someone is going to have your armor ready.” It is like, “This is your job. This is your equipment. This is your duty. You take care of it from step A to step Z.” You will be involved in every step of the process, which is contributing to that burnout which I mentioned earlier. I am telling them, “Hey, maybe we should relegate this to a nurse. I understand we need to look at the X-ray, we need to be able to see that in case a radiologist cannot give us a report or it is not ready in time. This is an emergency.” But maybe if it is non-urgent or if it is a routine thing, they could take some of the workload off. That is not something they are used to yet, but it is something I just suggested that is a very simple, straightforward thing you could do to make things more efficient. And I know you guys love efficiency, to make things less hectic for us. But I would say that duty to care is very ingrained. I have seen one of my senseis start his day at 6:00 a.m. and then he is there until 11:00 p.m. almost every single day.

Kevin Pho: One of the things I want to ask you is about primary care. In the United States, there is a seventy to thirty ratio in favor of specialists, and that ratio is flipped in countries like England where there are more primary care clinicians than there are specialists. What is it like in Japan? Do they value primary care? Is it easy to find a primary care clinician? What is that primary care-specialist ratio like in Japan?

Vikram Madireddy: I would say if it is thirty-seventy in America and it is flipped around in England, like seventy percent primary and thirty percent specialists, Japan would fall more sixty-forty for primary to specialists. The training pathway in Japan is historically heavily influenced by England, by Germany, by European countries. Just like in Europe, just like in India, just like in Australia, they start medicine right after high school. It is a six-year degree, like an MBBS, not the BS/MD or BA/MD like we do.

After you do that six years, then you are two years kind of like a house officer in England. You are doing four months in gynecology, four months in internal medicine, four months in surgery. Then the next year you are doing four months in psychiatry, another specialty, and so on. So it is very similar to what the British do and then what some of the Europeans do. Then after that, if you want to specialize in, say, neurology, you are going to do some core internal medicine just like in England, then you are going to do neurology. So the whole process, I think for one of my fellows, it took him anywhere between six to eight years to qualify as a specialist in neurology. He had to go through that internal medicine pathway first because, one, you are still expected to take care of primary issues in a neurology patient, like a pyelonephritis or something like that. And at the same time, Japan is like, “We still need primary care, so we need bodies. You can specialize, but for a few years, you belong to internal medicine.”

Kevin Pho: As far as you know, are there current transpacific partnerships as it relates to health care between the United States and Japan?

Vikram Madireddy: Yes, for both research and clinical. The most recent one I can think of, when that pandemic hit, I was just starting medical school in 2020. Just like everyone else, that took a huge hit on my mental health, not being able to leave the house, not being able to go through the normal traditional lectures and classes like everybody else before me or after. So we were the first group to really feel the full brunt of that. At the same time, I think my Japanese counterpart and my roommate was finishing his senior year of high school about to apply to medical school, and that really affected him. Mental health is already a problem in Japan, so on top of that, you are trapped in your own home. So for the COVID-19 vaccine, Japanese companies and U.S. companies definitely collaborated there.

Another famous partnership in medical research, after we dropped the atomic bomb on Japan, was on the long-term effects of radiation from dropping, hopefully, this once-in-a-lifetime event. We are still seeing the fallout. Japanese clinicians and Americans still talk to survivors. They still look at the historical data, and they are still compiling information on the long-term effects of dropping a giant, lethal weapon of mass destruction the world had never seen on this city.

Kevin Pho: We are talking to Vikram Madireddy. He is a neurologist. Today’s KevinMD article is “How Japan and the United States can collaborate for better health care.” Vikram, let us end with some take-home messages that you want to leave with the KevinMD audience.

Vikram Madireddy: OK. So I would say that Japanese medicine, learning from a different perspective, a non-Western side, can really open your eyes. It can really help you learn patient empathy because there is a bigger gap versus going from America to a European country or another Western country like Germany. At the same time, some of what they do, their out-of-the-box thinking, their mentality, their culture, how they approach a medical question or a research question, that could help clinicians in America in terms of how they practice medicine and how they approach medical research.

Finally, it is always good to just see how medicine is practiced on the other side of the world, or even if you are not a clinician or a doctor, just see how this country lives and how they operate. Because when you meet a new person, you finally have that new perspective. It is like I always assumed, “Hey, I am just living in my American bubble. Why can they not learn English?” Or, “This overwork culture, this suicidal mentality, this is not healthy.” And to them, it is completely normal. If you live amongst them for a while, you finally see that, and it is like, “Maybe I can figure out a way to explain to them, ‘Hey, your life is worth living,'” for example, or, “This is a unique way to approach that. Thank you for teaching me.”

Kevin Pho: Thank you so much for sharing your perspective and insight. Thanks again for coming on the show.

Vikram Madireddy: Thank you for having me.