A knee starts complaining on the stairs. For a while its owner ignores it. Then they buy a brace at the drugstore, try ice, ask a friend who had a scope, and one night type "why does my knee hurt" into a phone. Months later there's a cortisone shot, a round of physical therapy, an X-ray that says "bone on bone," and finally a search that looks completely different: "orthopedic surgeon near me."
Both searches came from the same person. Only one of them was ready to book.
A Knee Can Take Months to Get From "Why Does It Hurt?" to a Surgeon's Office
Patients describe the path in their own words, and it isn't short. We read 882 Google reviews of 115 orthopedic listings in our example market, Nashville, and the early stages show up again and again. People put things off: "I had an injury that I put off going to see someone about." They try to tough it out: one reviewer "determined that I could 'work through the pain' and eventually get used to it." Then something names the problem ("the ball in my hip was bone on bone"), and the questions change to treatment ("Does anyone regret getting a cortisone injection?") and finally to who should do it ("How to research your surgeon").
Surgery sits even further out. In two peer-reviewed studies of spine clinics, between 15% and about 42% of new patients ended up in surgery within the study windows. A practice sees far more people than it operates on, and many of them arrive after months of trying something else first.
None of this is a problem for your ads. It's a map of where to spend. Most of that long path happens on health sites, forums and in conversations with a primary care doctor, nowhere near a Google ad, and a new account shouldn't try to follow the patient through all of it.
One Sore Knee Runs Five Different Searches Before It Books a Surgeon
The method sorts every searcher into five stages of awareness. Here is what each one looks like in orthopedics, with national monthly searches from Google's Keyword Planner:
- Unaware. Living with it. No search yet, or searches that have nothing to do with a doctor: braces, ice, the stairs.
- Problem aware. Something is wrong and they want to know what. "why does my knee hurt" (14,800 a month), "acl tear" (74,000). High volume, low intent. These people want an answer, not an appointment.
- Solution aware. They know the options exist and are weighing them. "knee replacement" (33,100), "knee replacement recovery" (9,900), "do i need knee replacement" (140). Some are months away, some are researching a surgery already scheduled somewhere else.
- Service aware. They want a person to do it. "orthopedic surgeon near me" (33,100), "knee replacement surgeon" (1,900), "best knee replacement surgeon near me" (720). This is where the appointment happens.
- Most aware. They know exactly who they want. They search the practice name or a surgeon's name. In our example market, individual surgeons' names draw 260 to 590 searches a month each.
One note on the phrase in this chapter's title: Keyword Planner returns no data at all for the plain search "knee pain," so we don't put a number on it. The pattern holds without it. The higher up the funnel a search sits, the more people type it and the fewer of them are anywhere close to booking.
Demand Gen Warms Up an Aching Knee. Search Ads Book the Appointment.
Each stage wants a different job done, and Google sells a different tool for each.
- Create awareness for the unaware: video on YouTube and image ads through Demand Gen, which reach people before they search. Health ads there run under tighter rules, which Chapter 11 covers.
- Drive interest for the problem aware: educational content and video that explain what's going on and what can be done.
- Influence a decision for the solution aware: pages and ads that compare options honestly, including the conservative care most practices offer before surgery.
- Compel action for the service aware and most aware: Search ads on exactly the searches where people pick a surgeon, plus a brand campaign on your own names.
Performance Max spans several of these at once, which is exactly why it comes later, in Chapter 10. Usually that's around months six or seven, but the real gate is volume: a steady 30 or more quality new-patient conversions a month, which bigger, busier accounts reach sooner.
The mistake is judging every channel by the same number. A YouTube view that makes someone remember your hip surgeon's name six months from now is doing its job, even though it will never book anything this month. A Search click on "orthopedic surgeon near me" that doesn't book is a problem to fix. Different stages, different scoreboards.
Half of Orthopedic Patients Arrive by Referral. Search Wins the Ones Who Choose for Themselves.
Orthopedics has a quirk most industries don't: a big share of new patients never shop at all. Their primary care doctor sends them. In a survey of 329 patients at five orthopedic groups, 45% came through a primary care physician, 14% through their insurance company, 13% through a friend and 9% through an emergency room. About 8.5% found the practice through an internet search or website. A survey of joint replacement patients at one academic center found physician referral at about 50% and self-guided research at about 25%. A hand surgery survey put internet resources at 24%.
Read those numbers the right way. Google Ads will not replace your referral network, and any agency that promises it will is selling something. What it does is win the patients who choose for themselves, a real share in every study, and those are patients who picked you rather than being sent.
There's a second, quieter group. In the five-group survey, 39.5% of patients searched the internet before their first visit. The survey doesn't say what they typed. Our reading is that plenty of them were referred patients looking up the surgeon their doctor named, and a search for a practice or surgeon name is exactly what a brand campaign is for. A referral that searches your surgeon's name and finds a competitor's ad on top is a referral you paid for in relationships and lost in the auction.
Ready-to-Book Searches Are the Smallest Slice. That's Why a New Account Can Afford to Own Them.
The rule in this method is simple: start at the bottom of the funnel unless your budget is large. New accounts spend first on service-aware and most-aware searches, prove they turn into booked consults, and only then walk up toward the bigger, colder searches.
The bottom is small. In our example market, "orthopedic near me" and its close variations draw about 720 searches a month, against 110,000 nationally. Your own market will have its own number, and it will feel small too. That's the point. A modest budget can show up on nearly every one of those searches, which is impossible at the top, where the volume is ten times bigger and almost none of it books this quarter.
The auction agrees. To land above the organic results on "orthopedic surgeon near me," Google estimates $1.70 to $8.09 a click nationally. Problem-stage searches like "why does my knee hurt" run a few cents up to about $2. The cheap clicks at the top are cheap for a reason: they rarely become patients. Advertisers pay more for the bottom because the bottom books.
In practice, month one for most orthopedic accounts means three things: exact-match Search on the service-aware searches for the procedures you want most, a brand campaign on the practice name and every surgeon's name, and nothing else. No video, no display, no broad match. Chapters 5 through 7 show how to pick those searches and bid on them.
A large practice with a real awareness budget can run both from day one. Everyone else earns the right to go up the funnel by getting the bottom right first, which is also how the account builds the conversion history that every later campaign type in this guide depends on.
Loyalty Belongs to the Surgeon, Not the Practice
The last stage has an orthopedic twist. When patients get loyal, they get loyal to a person. In our review sample, 93 reviews on 56 listings expressed that kind of loyalty, and they named a surgeon, not a practice: "Dr. Staelin is the ONLY person I trust with my needs from the elbow down." Another: "I've been a patient since 2003 and I won't let anyone else touch my knee." Some reviews praise the surgeon and criticize the practice around them in the same breath, which tells you where the loyalty actually lives.
That changes what "most aware" means for your account. The most valuable searches you'll ever see may be a surgeon's name, not your logo. So the brand campaign that launches in month one carries every surgeon's name alongside the practice name, and Chapter 15 covers how to build it properly.
Next: The Knee That Comes Back for the Other Knee
Now you know where to start: the searches where people pick a surgeon, and the names of your own. Before choosing keywords, you need to know how much each of those patients is worth, and orthopedics has an unusual answer, because a knee patient often comes back for the other knee. Chapter 3 builds the math.
If your calls and bookings aren't counted cleanly yet, go back to Chapter 1 first. The guide home has the full list of sixteen.
Every orthopedic account we run through our Google Ads management opens the same way: surgeon names and the searches nearest the consult first, awareness spending only after those book.
