Hi there,
Thanks for reaching out! Happy to give you some initial thoughts on your Google Ads campaign. It's a classic and tricky situation you're in – caught between what Google pushes and what actually makes sense when you can't see the final, most important conversion. The lack of offline conversion data for a high-involvement service like a medical practice is a common headache, but definately solvable.
You're right to question the 'Max. Conversions' recommendation. When the algorithm is flying blind on what a *real* conversion is, it can often optimise for the wrong kind of activity, wasting your limited budget. Let's get into how you can take back control and make that budget work a lot harder for you.
TLDR;
- Stop using the Target CPA bidding strategy immediately. With incomplete conversion data, you're teaching the algorithm to find 'clickers', not actual patients, which wastes your budget.
- Switch to a more manual bidding strategy like Enhanced CPC (eCPC). This gives you control over keyword-level bids, allowing you to spend more on high-intent searches and less on informational queries.
- Improve your conversion tracking signals. Instead of just tracking a 'click to call', track phone calls over 60 seconds as a more valuable conversion. This gives Google a much better signal of genuine interest.
- Your ad copy and landing page forms need to do more pre-qualification. Add more questions to your forms and be explicit in your ad copy to weed out tyre-kickers before they even click.
- Below, you'll find an interactive 'True Cost Per Appointment' calculator to show how misleading 'proxy' conversion costs can be, and a visual flowchart of the patient journey you should be building towards.
We'll need to look at why 'Max Conversions' is a trap for you...
First off, let's be brutally honest about Google's automated bidding. It can be incredibly powerful, but only when you feed it clean, accurate data. The system is designed to find more people who look and act like the people who have already converted. In your case, a 'conversion' is a click on a phone number, an email, or a form fill. You've told Google, "find me more people who do this stuff".
The problem is, the algorithm doesn't know the difference between a person who clicks the call button by accident and hangs up, and someone who calls and books a £500 consultation. It doesn't know the difference between a form submitted by a serious potential patient and one submitted by someone just asking a quick question with no intention of booking. It treats them all as equal successes.
So, what happens? It gets really, really good at finding people who are 'click-happy'. It finds the people who will perform those low-friction actions, driving your 'proxy' conversion numbers up and making the campaign *look* efficient on paper. But it's not optimising for what actually pays the bills: appointments. You're effectively paying Google to find tyre-kickers.
This is made worse by the fact you mentioned it takes 2-4 visits for someone to convert. This is typical for any high-consideration purchase, especially in the medical field. People do their research, they compare options, they think about it. The 'Max Conversions' model, particularly with its default last-click attribution, is terrible at handling this. It gives all the credit to the final touchpoint, ignoring the crucial research and awareness-building steps that happened before. It fails to understand the journey, so it can't possibly optimise for it correctly.
I remember one client we worked on, a medical job matching platform. Their initial setup was very similar to yours. They were optimising for 'registrations', which was just an email and password. Their CPA was about £100 per registration, and they were stuck. The problem was that most of these registrations were low-quality candidates who never completed their profiles. The algorithm was just finding people happy to create a login, not serious job-seekers. The first thing we did was change what we were measuring and how we were bidding. By shifting focus to a higher-quality conversion (a fully completed profile) and taking back manual control of the bidding, we managed to bring the cost per *quality* user acquisition down from £100 to just £7. It's the same principle: feed the machine better signals, or don't let the machine drive at all.
I'd say you should rethink your bidding entirely...
Your instinct to consider 'Max Clicks' is a logical step away from the flawed 'Max Conversions' model. The thinking is sound: if I can't track the final outcome, let's at least get as much relevant traffic as possible for the budget and hope a percentage of them convert. It's not a bad strategy, and it can work for filling the top of your funnel, especially since you know you need those multiple touchpoints.
However, with a limited budget, 'Max Clicks' can also be wasteful. It will try to get you the most clicks for your money, but it doesn't distinguish between a click from a low-value, informational keyword (e.g., "what causes back pain") and a high-value, high-intent keyword (e.g., "private back pain specialist near me"). It will often favour the cheaper, broader keywords to maximise the click count.
This is why I'd strongly suggest you go a step further and reclaim control by using Enhanced Cost-Per-Click (eCPC). This is a semi-automated strategy that lets you set your own maximum CPC bids at the keyword level, but it gives Google a little bit of leeway to adjust your bid up or down if it thinks a particular click is more or less likely to lead to a conversion. It's the best of both worlds for your situation. It puts you in the driver's seat but still benefits from some of Google's machine learning without handing over the entire steering wheel.
Why is this better for you?
- -> Budget Allocation: You can decide exactly how much you're willing to pay for a click on each specific keyword. You can tell Google, "I'm willing to pay up to £5 for a click on 'emergency [specialty] appointment', but only £0.50 for a click on '[condition] symptoms'". This ensures your limited budget is prioritised for the searches most likely to be from ready-to-book patients.
- -> Control & Insight: You get a much clearer picture of what's working. You'll see which keywords are driving your best leads (even if they are just proxy leads) and you can adjust your bids accordingly. You're no longer guessing what the black box of 'Max Conversions' is doing.
- -> Efficiency: It forces you to have a much tighter, more organised campaign structure, which is always a good thing. You'll need to group your keywords by intent, which in turn leads to more relevant ad copy and better Quality Scores, often lowering your actual CPC.
It's more work upfront, there's no doubt about it. But the control and efficiency it gives you when dealing with imperfect data and a tight budget is more than worth the effort. You stop letting Google guess and start telling it what you know about your own business and customers.
To really hammer home why this matters, let's look at the financial impact of optimising for the wrong thing. A low cost per 'proxy' conversion can look great in your Google Ads dashboard, but it often hides a dangerously high cost for an actual appointment. Use the calculator below to see for yourself.
You probably should focus on what you *can* track...
Since you can't track the final appointment due to privacy rules, the next best thing is to make the signals you *can* track as high-quality as possible. The goal is to make your trackable "micro-conversions" align as closely as possible with genuine patient intent. Here's how you do it.
For Phone Calls: Stop tracking "clicks to call". This is one of the noisiest, most unreliable metrics available. People mis-click on mobile all the time. Instead, you should implement call tracking (Google's native tool is free and pretty good to start with) and set your conversion goal to only fire for calls that last longer than, say, 60 or 90 seconds. A call that short is likely a wrong number or a quick, unqualified question. A longer call is almost certainly a serious enquiry. This one change alone will massively clean up your conversion data and give any bidding algorithm (even eCPC) a much better signal to work with.
For Form Submissions: You need to introduce a bit of positive friction. A simple form with "Name, Email, Message" is easy to fill out, which means you'll get a lot of low-quality submissions. Change the form to be an "Appointment Request Form". Add more qualifying fields that a serious patient wouldn't mind filling in:
- -> What is the primary reason for your enquiry?
- -> Are you a new or existing patient?
- -> What is your preferred day of the week for an appointment? (Mon-Fri)
- -> What is your preferred time? (Morning/Afternoon)
Yes, this will likely *reduce* your total number of form submissions. But that's the whole point. You'll scare away the time-wasters, and the submissions you do get will be from people who are much further down the consideration path. Each of these form fills becomes a much more valuable signal of genuine intent.
Embrace the Multi-Visit Journey: You already know it takes 2-4 visits. You need to build your campaigns around this fact instead of fighting it. This means remarketing is not optional for you; it's mandatory. You should have audiences set up in Google Analytics for "All Website Visitors", "Visited Contact Page but Did Not Convert", and "Visited specific service pages".
Then, you can use these lists in two ways:
- RLSA (Remarketing Lists for Search Ads): This is powerful. You can bid *higher* for users on your remarketing list when they search again. So, if someone visited your site after searching for "knee pain symptoms" (your informational keyword), and a week later they search for "private knee specialist London" (your high-intent keyword), you can tell Google you're willing to pay 50% more for that click because you know they are already familiar with your practice.
- Display Remarketing: A simple, low-budget display campaign to show a professional banner ad to your recent website visitors as they browse other sites. This just keeps your practice top-of-mind during their consideration phase. It's the digital equivalent of them keeping your brochure on their coffee table.
This is what the ideal journey looks like, and it's what your campaigns should be structured to facilitate.
Step 1: Awareness
User makes a broad search like "[symptom] treatment". Clicks your ad.
Step 2: Consideration
User is added to your remarketing audience. They see a display ad later that day.
Step 3: High Intent
Two days later, user searches for "[specialty] near me". Your RLSA bids higher for their click.
Step 4: Action
User lands on your site again, feels confident, and makes a quality conversion (long call / detailed form).
You'll need a tighter keyword and ad copy strategy...
Switching to eCPC and focusing on better signals is only half the battle. This control is useless without a rock-solid keyword and ad copy strategy to back it up. With a limited budget, you can't afford to waste a single click. Every part of your campaign needs to work together to attract the right people and deter the wrong ones.
Your keyword strategy should be tiered based on user intent. This is fundemental. Don't just lump all your keywords into one ad group. You need to separate them so you can manage bids and write hyper-relevant ad copy. A good structure might look like this:
| Ad Group Theme | Keyword Examples | User Intent | Bidding Strategy |
|---|---|---|---|
| High Intent - "Problem/Solution" | private [specialty] clinic, book [service] appointment, [specialty] consultant near me | Actively looking to book. Ready to solve their problem now. | Set your highest Max CPC bids here. These are your money keywords. |
| Mid Intent - "Research" | best treatment for [condition], [symptom] causes, cost of [procedure] | Problem-aware, but still researching options and solutions. Not ready to book today. | Set lower Max CPC bids. The goal is to get them to your site and into your remarketing funnel cheaply. |
| Branded | [your practice name], [doctor's name] | Already know you. Either a returning patient or a referral. Very high intent. | Bid to ensure you are always #1. You can't afford to let a competitor show up above you for your own name. |
And you must be ruthless with your negative keywords. This is probably the single fastest way to reduce wasted spend. You should have a standard list that includes terms like "free", "cheap", "NHS", "jobs", "training", "course", "salary", "reviews". You are not a public health service or a recruitment agency, so make sure you're not paying for clicks from people looking for those things.
Finally, your ad copy needs to do some of the heavy lifting of qualification for you. Don't just list your services. Speak directly to the searcher's problem and make it clear who you are for. Use the Problem-Agitate-Solve framework. For example, for the "High Intent" ad group:
Headline 1: Private [Specialty] Clinic London
Headline 2: Get A Clear Diagnosis & Treatment Plan
Headline 3: Book Your Consultation Today
Description: Tired of long waiting lists and unanswered questions? Our expert consultants provide rapid access to diagnoses for [condition]. Take control of your health. Schedule your private appointment now.
This copy works because it:
- -> Immediately qualifies the service as "Private".
- -> Agitates the pain points of the alternative (long waits, uncertainty).
- -> Presents a clear solution (rapid access, expert consultants).
- -> Has a strong, direct call to action.
Someone looking for a free NHS option will see the word "Private" and "Consultation" and likely won't click, saving you money. Someone who *is* looking for a private option will feel like you understand their exact needs, making them much more likely to click and convert.
I've detailed my main recommendations for you below:
This is a lot to take in, I know. To make it simpler, here is a summary table of the strategic shifts I'm recommending you make to your campaign. This is the main advice I have for you:
| Area of Focus | Your Current Approach | Recommended Change | Reasoning |
|---|---|---|---|
| Bidding Strategy | Max. Conversions with Target CPA | Switch to Enhanced CPC (eCPC). | Gives you keyword-level bid control to prioritise high-intent searches, essential for a limited budget and flawed conversion data. |
| Conversion Tracking | Tracking clicks to call, email, and basic form fills. | Track call durations (>60s) and more detailed form submissions as primary conversions. | Dramatically improves the quality of the signals you send to Google's algorithm, leading to better optimisation. |
| User Journey | Optimising for a single-click conversion. | Implement RLSA and Display Remarketing. | Actively nurtures prospects through their 2-4 visit decision-making process, increasing final conversion rates. |
| Keyword Targeting | (Assumed) Broad ad groups. | Tier keywords into High, Mid, and Low intent ad groups. Be aggressive with negative keywords. | Allows for precise budget allocation and hyper-relevant ad copy, improving Quality Score and reducing wasted spend. |
| Ad Copy | (Assumed) General service descriptions. | Write copy that pre-qualifies users (e.g., mention "Private Clinic"). Use Problem-Agitate-Solve. | Weeds out irrelevant searchers before they click, ensuring your budget is spent on the most promising prospects. |
As you can see, turning this campaign into a truly efficient patient acquisition machine involves more than just flipping a switch on the bidding strategy. It requires a holistic approach that takes into account your specific business realities, like the lack of offline tracking and the high-involvement nature of the service you provide. It's about moving from letting Google guess, to building a deliberate system that guides the right people towards becoming patients.
Making these changes correctly—setting up the right conversion actions, restructuring campaigns, researching keywords, and implementing remarketing lists—requires a good deal of technical know-how and ongoing managment. With a limited budget, every pound really does count, and the cost of getting it wrong can mean the difference between a campaign that generates a steady flow of new patients and one that just drains your bank account.
This is often where bringing in an expert can make a huge difference. We specialise in untangling these kinds of complex paid advertising puzzles. We offer a free initial consultation where we can take a look at your account together on a call, and I can give you some more specific, actionable feedback based on what I see. It's a great way to get a second pair of expert eyes on your setup with absolutely no obligation.
Hope this helps!
Regards,
Team @ Lukas Holschuh
