Why the Chronic Disease Model Is Outdated: Dr. Arun Veera on the Multimorbidity Era
In American medicine, chronic disease is treated like a series of separate battles: one guideline per diagnosis, one specialist per organ system, one set of targets at a time. But Dr. Arun Veera, a board-certified family medicine physician with more than 14 years on the front lines, says that model no longer matches the people walking into clinics.
“Most patients aren’t showing up with a single problem anymore,” Veera says. “They’re showing up with multiple conditions that collide. And our system was never built for collisions.”
The modern reality is multimorbidity — the presence of two or more chronic conditions in one person. It’s now the typical adult patient experience, not the exception. Yet the structure of U.S. healthcare still runs on single-disease playbooks: diabetes programs, heart-failure pathways, depression screenings, arthritis protocols — each sensible on its own, often unmanageable in combination.
When Guidelines Compete, Patients Lose
Veera sees the consequences daily in primary care. A patient may have diabetes, hypertension, depression, and chronic pain. Each condition comes with evidence-based recommendations. Each recommendation tends to assume it is the top priority.
“The problem isn’t that the guidelines are wrong,” he says. “It’s that they weren’t designed to share the same body.”
In real life, those recommendations can work against one another. A medication that improves blood sugar may worsen nausea or fatigue. A blood-pressure plan may raise fall risk. An antidepressant may help mood but make weight management harder. The result is often polypharmacy, conflicting instructions, and patients unsure which doctor to listen to.
“Nobody is responsible for the friction between plans,” Veera says. “But that friction is where patients live.”
Polypharmacy Is a Design Problem
Because multimorbidity stacks conditions, it stacks medications too. Public debate often frames polypharmacy as a cautionary tale about “too many pills.” Veera calls it something different: a symptom of a system that keeps adding treatments without reconciling priorities.
“Polypharmacy isn’t a moral failing,” he says. “It’s a design failing. We treat every guideline as sacred even when they collide.”
That collision doesn’t just affect outcomes. It affects adherence, trust, and quality of life. Patients withdraw when the burden becomes too much. Clinicians burn out trying to solve contradictions in 15-minute visits. Fragmentation grows because no specialty “owns” the trade-offs.
A System Built Around Complexity
Veera argues that chronic care has to shift from disease-centered logic to complexity-centered care. In practice, that starts with a different first question.
“Instead of asking, ‘What’s the target for this disease?’ we have to ask, ‘What matters most to this patient living with all of them?’” he says.
That goal might be mobility, independence, mental well-being, or staying functional at work — not another lab number. Evidence still matters, he emphasizes, but it has to be ranked and tailored to what a person can realistically carry.
From there, Veera points to a few system shifts that make multimorbidity care possible:
• Goal-based care over number-based care. Align treatment with patient priorities and tolerable burden.
• Routine medication simplification. Deprescribing and rationalization should be ongoing primary-care work, not an occasional project.
• Team-based primary care as the hub. Integrated pharmacists, behavioral-health clinicians, and care managers help reconcile cross-condition trade-offs.
• Guidelines and metrics that reflect real patients. Quality measures need to account for competing risks and the total burden of care.
