This may be a "bread and butter" run, but that doesn't make it any easier.
Why are we so fast in disregarding fatigue or tiredness?
I know how I feel after 13-14 hours. My performance feel like it is similar to what it would be after 2-3 pints. If I had a bad nights sleep before the flight and no nap in flight, I feel even worse.
What about subtle incapacitation?
When was the last time we got checked for signs of Alzheimer?
I have discussed this with our trainers. They admit we have pilots who fail or struggle in the sim, no matter how much they read and prepare. The information will not stick, and the affected pilots are quietly taken off the roster.
These (very few) guys would probably perform OK in normal ops, but would most likely struggle if anything out of the ordinary happened.
Now we can fly until 65, and they are working to remove that limit too.
The medical examination is still eyes, ears and heart. No brain.