This assumes all human therapists are ethical and never make mistakes, and that all of their offices, notes and data syatems are secure too. All security is porous.
furrowsofar
This is a great example of how impossible it is not write down usernmes and passwords and how infeasible forcing changes is.
The other thing people do not talk about enough is user names. They should be somewhat random too and not reused. Forcing people to use their email address is particularly stupid but very common.
The missleading thing about passphrases is that anything a human can remember is low entropy. That it has 20 charachers says nothing about how random.
Edit: I also wonder how much randomness is really needed. Properly salted and hashed passwords shoud not need that much randomness. Lot of this is about users just choosing bad passwords, reusing, and IT not properly salting and hashingon their end.
I wonder how much of this stems from two stupid IT policies. For decades users have been told to not write down passwords and to change them regularly. The result of this policy is to use a small number of password variations that one reuses. Then IT complaims about it.
The better plan has always been to use long random passwords that you never reuse and write them down by some method like a password manger and only change them rarely for example when they may be compromised,
The two downsides of a custom domain are:
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Only as private as the least private use of the domain. No crowd to mix with.
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Delivery through SPAM filters of other providers more troublesome. Delivery to AOL/Yahoo, and one of the AT&T managed mail domains has been the biggest issues for me. GMail delivery seems fine.
Do get a common mainstream suffix not the cheapest. Some filters may tend to filter some TLDs.
Edit: By the way, I have my own domain and the email for it is hosted at a hosting provider. I recommend it but the above are the downsides.
Drainage is often done incorrectly in new construction too. Very common to have all the water drop beside the front door and create a pond. Very common to have beds around the house that create little swimming pools. If nothing else the ground will sink around the foundation and have to be filled quite soon.
That assumes you can tell and that the best people and processes are flawless which is not true by a wide margin.