Every new Google Ads campaign arrives pre-filled. Before you've written a keyword, Google has already chosen who can see your ads, which websites can show them, how loosely your keywords can match and whether it may write parts of your ads for you. Those choices are built for advertisers who want reach. A medical practice wants patients it can actually treat.
Most of the waste in a new healthcare account doesn't come from a bad keyword or a weak ad. It comes from a setting nobody changed. The good news is that fixing it takes one careful pass through the campaign settings before launch, and it only has to be done once per campaign.
Google's Own Help Page Names Healthcare's Case for "Presence"
Start with location. Under the targeted areas sits a smaller control, "Location options," that decides which people count as local. It has two positions:
- Presence or interest: anyone located in or often visiting the area, plus anyone elsewhere whose searches suggest an interest in it. Google sets this one unless you change it.
- Presence: just the patients who live, work or regularly spend their days inside the map, the ones who could realistically walk through your door.
For a travel agency, reaching someone in Chicago who's reading about San Diego makes sense. For a practice in San Diego, it means paying for clicks from people who are researching the city and have no plan to see a doctor there.
Google's own help page is unusually direct about this. After recommending the wider option for most Search advertisers, it lists two exceptions: businesses in sensitive categories that carry strict targeting limits, and businesses that only want people physically in certain places. A medical practice fits both descriptions. The method this guide teaches sets every healthcare campaign to Presence at build, before the first dollar is spent. After launch, check the locations report, which shows where the people who saw and clicked your ads actually were. If a real share of clicks comes from far outside the area you serve, this setting is the first place to look.
Every Service Line Draws Patients From a Different Distance
Presence decides who counts. The map decides how far out they can be. The answer is different for each service line, which is one more reason Chapter 7 gave each line its own campaign.
Urgent care patients come from a few miles away. Nobody with a sprained ankle drives across the county past three other clinics. Primary care draws from a little farther, since patients choose a doctor once and then keep coming back. A specialist, whether orthopedics, fertility or a subspecialty surgeon, can reasonably draw from the whole metro area, because patients will travel for the right doctor. Draw each campaign's map around where that line's patients actually come from, not around a single radius copied from one campaign to the next. Google lets you draw the map by radius, by city or by ZIP code, and exclude the parts you can't serve. A practice with three offices can give each office its own radius inside the same campaign, rather than one giant circle that covers the gaps between them.
Telehealth works differently. A virtual visit has no parking lot, so distance stops mattering, but licensing takes its place. A clinician generally has to be licensed in the state where the patient is located at the time of the visit. So a telehealth line's map is the list of states its clinicians are licensed in, and nothing wider. An ad shown to someone in a state you can't serve is a click that ends in a polite "sorry, we can't see you."
Two more targeting choices belong here. Language follows the patients. San Diego patients wrote 23 of our 824 sampled reviews in Spanish, so a practice with Spanish-speaking staff has a second audience worth its own ads and pages. Age and income targeting exist, and some lines have a real case for them, such as leaning into older searchers for cardiology. But they're levers to pull once the account has enough data to show a difference, never a launch setting.
Search Partners and Display Stay Off Until the Account Knows What a Patient Looks Like
A Search campaign doesn't have to stay on Google Search. The network settings offer two add-ons, and in a new campaign they're easy to leave switched on without noticing:
- Google search partners: other websites that show Google's search ads alongside their own search results.
- The Display Network: a much larger collection of websites and apps where your ad can appear to people who didn't search for anything.
Both add reach. Neither adds the thing a new account needs most, which is clean data about which searches turn into patients. Search partner traffic is harder to judge, and it's where many advertisers report clicks that look automated rather than human. Display traffic comes from people browsing, not people who just typed a specialist's name and "near me."
So both stay off at launch. Months later, once Isolation's bookings give a baseline, partners can be switched on as a trial and judged purely on whether their bookings cost about the same. The test is easy to read, because Google Ads can split any campaign's results by network, showing Google Search and search partners side by side with their own clicks, costs and bookings. Display belongs in its own campaign type later in the rollout, not tucked inside a Search campaign.
AI Max Comes On by Default. In an Exact-Match Account, It Goes Off at Build.
The newest default is the most expensive one to miss. Google now turns on AI Max for new Search campaigns unless you switch it off. Of the features packed inside AI Max, the one that undoes an exact-match launch is search term matching. Google describes it as broad match plus clues taken from your ad text and landing pages. AI Max can also send clicks to pages other than the one you chose, through a feature Google calls final URL expansion, and Google notes that when it's on, the pinning from Chapter 8 isn't respected.
That's the opposite of what Isolation is for. Chapter 6 built the first campaign on exact match so every search it buys is one you chose. If AI Max stays on, that campaign quietly starts matching searches you never picked, before it has a single booking to learn from. AI Max has a place at the very end of this method, once the account has months of history. In an exact-match launch, it goes off at build.
Automatically created assets deserve the same treatment. With that switch on, Google can draft new ad lines by reading your site. In healthcare, where a single loose phrase about a treatment or an outcome can create a problem, every line in the ad should be one the practice wrote and approved. Turn it off, and make sure no dynamic ad groups sneak in either.
Tracking Switches Go On Before the First Click
A few settings need to be on, not off, before launch.
- Auto-tagging adds a click ID to every ad click so Google Ads and Google Analytics can connect the click to what happened next. Without it, the booking tracking from Chapter 1 loses the thread.
- Call reporting lets Google count calls from your ads, including the 30-second calls Chapter 1 set as conversions.
- Ad rotation should be set to let Google favor the best-performing ads, so the strongest headlines from Chapter 8 get shown more.
While you're in the settings, check which conversion actions count. Google's bidding learns only from the actions included in the "Conversions" column, so the primary actions Chapter 1 chose, the finished booking, the appointment request and the 30-second call, should be the ones included, and nothing softer.
Two more habits belong at launch. Start the budget on the low side while bids settle, so the first week's lessons are cheap ones. And keep the brand campaign separate, as Chapter 6 set up, rather than letting searches for the practice's own name mix into Isolation's numbers.
A Call That Rings Out After Hours Is a Click You Already Paid For
Healthcare runs on the phone, and patients notice when nobody answers. Across our San Diego review sample, phones, callbacks, messages and hold times came up in 94 reviews, and 64 of them were unhappy. Patients wrote about calling repeatedly, leaving messages that never got returned and sitting on hold.
An ad that invites a call at 9 p.m. into an empty office is paying for one of those complaints. So match the ad schedule to how the practice actually answers. Call assets, the phone number shown with your ad, should run only during the hours someone picks up. Ads that send people to an online booking page or a form can keep running after hours, because the patient can finish the job without anyone on the other end.
If an answering service covers nights and weekends, the picture changes, and so does the schedule. Keep the call ads running through those hours, then check whether the calls the service takes turn into booked visits the next morning. If they do, the night hours earn their place. The setting should follow the phones, not the other way around. Before launch, call the number in your own ad at a few minutes before opening and a few minutes after closing, and hear what a patient hears.
Our specialty guides cover settings in their own fields. The dermatology guide covers location and health settings for a dermatology practice. The plastic surgery guide covers location targeting for plastic surgery patients who travel. The optometry guide covers the campaign settings an optometry practice should change at launch.
Next: What Google's Health Rules Leave Performance Max to Work With
With the Search account launched and tracked, the rollout moves to its next campaign type. Chapter 10 covers Performance Max for a medical practice: when it's ready, what Google's health rules take away from it, and why it never comes first.
Catch up on Chapter 8 on ad copy from patient reviews, or see every chapter on the guide home for Google Ads for Healthcare. When a practice hires us for Google Ads management, every setting in this chapter is checked before the first ad goes live.
