A wasted-spend audit for a Los Angeles practice looks at the searches, locations and recorded conversions that produced clicks but not a qualified patient, then excludes or fixes those, before anyone raises the budget. It does not promise that costs will fall or that more consults will follow.
This post is for practices that already run Google Search ads and want a way to find spend that cannot become a patient. It is not a second full-account checklist and it is not a hiring guide. For the broader check order, see Google Ads audit: what to check first. For a printable list, see the ad account self-audit checklist. If you want help running this work, see our Google Ads agency in Los Angeles page.
1. Say what wasted spend means in a practice account
In this audit, wasted spend is a click that was never in a position to become a patient: the search was for a job, a different specialty, a city you do not serve, a "what is" question, or a free or DIY query. It is not a dramatic dollar story, and it is not a judgment that every unconverted click was a mistake. Some people need more than one visit to the site before they book.
Write down the actions that would count as useful (a booked consult, a qualified form, or a phone call the practice can answer) and the searches or locations that never should have been paid for. The rest of the audit is a comparison of the live account against that list.
2. Confirm that conversions are measuring the right actions
If conversion measurement is wrong, a wasted-spend audit will point at the wrong thing. You may cut useful search terms, or you may leave waste in place because the account looks busier than it is.
Google's Help on conversion measurement says website conversion measurement "analyzes specific actions that users take on your website after interacting with your Google Ads," such as purchases, sign-ups and other actions completed on the site. For practices, the useful website actions are usually a completed form or an appointment request, not a page view. The same Help page describes phone call conversions: "By connecting call data to your campaigns, you can identify which ads are driving valuable phone leads." It lists calls from ads, calls to a phone number on the website, and clicks on a phone number on a mobile website.
Before you read search terms, confirm that those actions are what the account is counting, that test submissions and staff clicks are not inflating the numbers, and that a call is only counted when the practice can actually take it. If you cannot trust the conversions, fix measurement first. Do not use the audit to justify a larger budget.
3. Read the search terms, not only the keywords
Google's Help on the search terms report says to use it "to know how your ads performed when triggered by actual searches within the Search Network." It also draws a clear line between two ideas: "A search term is a word or set of words a person enters when searching on Google or one of our Search Network sites. A keyword is a word or set of words that Google Ads advertisers can add to a given ad group so that your ads are targeting the right audience." The report, it says, "provides insight into the searches that trigger your ads and how those searches are performing."
To open it, Google's Help says to select Campaigns, then go to Search terms under Insights and reports. The report shows search terms used by a significant number of people that triggered impressions and clicks. The same page notes that some search terms "that don't have enough query activity are omitted from the search terms report in order to keep with our standards on data privacy." Treat the list as useful, not complete.
For a Los Angeles practice, mark terms that cannot be a patient, for example:
- Job, salary, training or "how to become" searches.
- A different specialty, or a procedure the practice does not offer.
- Another city, neighborhood or state the practice does not serve.
- "What is," "vs," DIY, student or free-advice searches, if those visitors never book.
- Supplier, wholesale or patient-login searches.
Keep terms that clearly describe a service you offer, in a place you serve, from a person who could book. Do not pause a term only because it has not converted yet in a short window.
4. Add negative keywords for searches that cannot be a patient
Google's Help on negative keywords says they "let you exclude search terms from your campaigns and help you focus on only the keywords that matter to your customers." It advises looking for "search terms that are similar to your keywords, but might cater to customers searching for a different product." Its example is an optometrist who sells eyeglasses and may want to exclude terms such as "wine glasses" and "drinking glasses."
The same page is explicit about limits. "Negative keywords won't match to close variants or other expansions." Google's example is that excluding the negative broad match keyword "flowers" means ads will not serve for "red flowers", but can still serve for "red flower." It also says you need to add synonyms and singular or plural versions if you want to exclude them. Misspellings and casing are handled automatically.
Add negatives for the terms you marked as unable to become a patient. Recheck the search terms report after the change. Do not build a huge list from guesses. Use the searches that already triggered the ads.
5. Check whether ads are reaching people actually in your area
A Los Angeles practice can pay for clicks from people who are not in the area the practice serves. Google's Help on location targeting says: "Be sure to target the locations where you can find your customers, which isn't necessarily the same place that your business is located." You can target countries, regions, cities, postal codes, or a radius around a location, and you can exclude areas you do not serve.
Google describes two location settings that matter here. Broad geo targeting, labeled "Presence or Interest," "can help you reach people who not only exist in your targeted locations, but have shown an interest in your targeted locations." Google says to consider "Presence" targeting when "You only want to target users in specific locations and not users who may be in other locations but are still interested in your product or service." For a local practice, Presence is often the tighter reading: people who are actually in the neighborhoods or cities you serve, not people elsewhere researching a Los Angeles trip or a celebrity clinic.
Confirm the campaign's location list, any exclusions, and whether the setting is Presence or Presence or Interest. If ads are showing for searches in cities you do not serve, add those places as exclusions or tighten the target. Google also notes that a very small location target may show ads only intermittently, or not at all, if it does not meet targeting criteria.
6. Decide what to change before you change the budget
After you have a trusted conversion setup, a marked search terms list, new negatives, and a checked location setting, write the next step in one place:
- Which search terms will be excluded, and which will be left alone.
- Whether location targeting should move to Presence, or stay as it is, and which cities to exclude.
- Whether any ad group is sending the right search to the wrong page.
- When you will read the search terms report again.
Leave the budget where it is until those changes have had time to show up in the report. A wasted-spend audit is a cleanup of what the account is already buying. It is not a reason to spend more, and it is not a promise of more patients.
Wasted-spend audit checklist
- Conversions count a qualified form, appointment request or answerable phone call, not a page view.
- Test and staff activity is not inflating those counts.
- The search terms report has been read, not only the keyword list.
- Terms that cannot be a patient are marked, and negatives are added for those terms, including obvious singular and plural forms.
- Location targets and exclusions match the area the practice actually serves.
- The location setting (Presence, or Presence or Interest) has been checked.
- The next review date is written down. The budget is not raised as part of the audit.
If you want this kind of review done on a Los Angeles practice account, see our Google Ads agency in Los Angeles page. For the wider audit sequence, see Google Ads audit: what to check first.
Questions people ask
What is a Google Ads wasted-spend audit for a practice?
It is a review of the searches, locations and conversion actions that produced clicks but were never in a position to become a qualified patient, followed by exclusions or fixes. It does not promise lower costs or more bookings.
How is this different from a full Google Ads audit?
A full audit also covers tracking setup, campaign structure, budget split and landing pages. This post focuses on spend that cannot become a patient. For the broader order of checks, see the already-live Google Ads audit post.
Where do I find the searches that triggered my ads?
Google's Help says to open Campaigns, then go to Search terms under Insights and reports. The report shows actual search terms that triggered impressions and clicks. Some low-activity terms are omitted for privacy, so the list is useful but not complete.
Do negative keywords block close variants?
No. Google's Help says negative keywords will not match to close variants or other expansions, and that you should add synonyms and singular or plural versions if you want to exclude them. Casing and misspellings are handled automatically.
Should a Los Angeles practice use Presence or Presence or Interest?
It depends on whether you want ads to reach only people who are in your targeted locations, or also people elsewhere who have shown an interest in those locations. Google says to consider Presence when you only want users in specific locations. For many local practices, that tighter setting is the one to check first.
Will a wasted-spend audit guarantee lower costs or more patients?
No. The audit can remove clicks that cannot become a patient, and it can make the remaining data easier to trust. Results still depend on the practice, the offer, the pages and the work itself. No outcome is promised.
