My name is Dr. Sherif Nasr, and I'm from the United States of America. This is our fourth time attending the IFAD meeting—we've only missed one—and it's always a pleasure to be here.

I really enjoy the venue, the quality of the program, and the speakers, many of whom I now know personally. Of course, being doctors, our dinner conversations tend to drift into work—two doctors at dinner? Forget it! But that's part of what makes this gathering special: we're passionate about what we do.

What makes IFAD truly unique is that no other conference is so dedicated to fluids and fluid monitoring. We often discuss many topics in medicine, but fluid therapy and hemodynamic monitoring are central to our daily clinical practice, and yet they rarely receive focused attention. This was the first conference to dedicate itself entirely to these subjects, and it remains the only one of its kind.

I come here to see where the rest of the world stands, and to compare that with our practice in the U.S.. It's always insightful to exchange perspectives and learn from our international colleagues.

One of the things that strikes me most is how, in Europe, clinical decision-making seems to be driven more by science and physiology. In the U.S., unfortunately, we often find ourselves practicing defensive medicine—guided not only by clinical evidence, but by concern over legal scrutiny. We think about how our documentation or treatment decisions might be interpreted in a courtroom, not just by peers or through the lens of scientific merit.

In contrast, here in Europe, there's more freedom for scientific thought, individualized care, and principle-based application of therapies. It's refreshing—and one of the reasons I keep coming back to IFAD.