Negative Keywords: The Searches Quietly Draining Your Clinic Ad Budget

When you tell Google you want to show up for "physio for sciatica", you think you have asked for that search. You have not. You have asked for that search and everything Google decides is close enough to it.

Broad match is the default match type now, and combined with Smart Bidding it reaches a long way past the words you typed. It will show your ad for synonyms, related concepts, and outright misspellings. Google looks at a search, decides it is relatively close to your keyword, and puts you out for it.

I describe it to clinic owners like this on calls. Google goes "oh, this one is relatively close, so we will show you for that as well". Sometimes that is brilliant and it finds you a patient you never would have thought to bid on. Often it is "exercise physiology degree" charged to a clinic that treats patients, not students.

The reach is not a bug. It is how the system is built to spend. Which means a tight negative keyword list stopped being optional the day broad match became the default. It is now load bearing.

Every other screen in Google Ads is an estimate. The keyword planner guesses. Your keyword list shows what you asked for. Only one report shows the actual words a real person typed before your ad charged you money.

You find it under Campaigns, then Insights and reports, then Search terms. That is the most important page in the entire account for a clinic, and most owners I meet have never opened it.

Do not read it alphabetically. Sort by cost, highest first, and look for spend sitting next to zero conversions. Then sort by clicks and look for the high click low intent queries that quietly nibble. That order surfaces the budget drains in about ninety seconds.

One honest warning. You will never see every search. Google hides a large share of low volume queries for privacy reasons, somewhere in the range of 20 to 80 percent depending on the account. So a clean looking report is not proof of a clean account, it is just proof you have read what Google is willing to show you.

Once you have read a few hundred clinic accounts you stop being surprised. The junk is remarkably consistent across physio, podiatry, psychology, osteo and chiro.

Price shoppers search "free", "cheap", "bulk billing" and "medicare free". If you are a private billing clinic, every one of those clicks is someone who will bounce the second they see your fees.

Job seekers and students search "physio jobs", "careers", "salary", "course", "degree" and "university". They want employment or study, not an appointment. Information only searchers want "exercises for", "how to fix", "stretches", "symptoms" and "YouTube". They want content, not a clinic.

Then there are the wrong searches specific to you. Competitor brand names. Body areas you do not treat. Modalities you do not offer. A clinic that does not do dry needling should not be paying for "acupuncture".

Let me put a number on it, because abstract waste is easy to ignore and a dollar figure is not.

Agency and practitioner estimates put unmanaged healthcare ad waste somewhere between 25 and 50 percent of spend. Those are directional ranges, not a Google published figure, and they swing by account. But even the conservative end is brutal. On a $5,000 a month budget, a quarter wasted is $1,250 gone every single month.

In Australian allied health, a physio click runs roughly $1.50 to $4.50, and the cost to acquire a patient sits between $65 and $120 across the board. Under $90 is strong. Once you are paying $200 or more, the levers are loose, and a leaky search terms report is usually one of the loosest.

Work out your own number below. It tends to change how often someone opens that report.

Here is the trap that catches almost everyone, including me early on. Positive keywords are generous. They catch plurals, synonyms and misspellings. Negative keywords are the exact opposite. They are deliberately literal.

Block "jobs" and you still pay for "job". Block "free" and you still pay for "no cost". Block "flowers" and you still pay for "flower". A negative does not catch the singular, the plural, the synonym or the typo. You have to add each form yourself.

Worse, there is a default that quietly betrays you. When you add a negative straight from the search terms report, Google adds it as negative exact match, which blocks only that one literal string and nothing close to it. So you block "free physio assessment" and keep paying for "free initial consult".

The fix is to add most clinic negatives as phrase match instead. Phrase catches the future combinations from a single entry. One "free" as a phrase negative blocks the whole family. The lazy default exact blocks one and lets the dozen variants keep spending.

Negatives live in three places, and using the right one keeps the account tidy as it grows.

Universal junk that no clinic ever wants goes high up. Account level negatives, set in account Settings, apply across every campaign type including Performance Max, with a limit of 1,000. That is the home for "free", "jobs", "course" and the rest of the always block list. A shared negative list does a similar job across chosen campaigns, holds up to 5,000 terms, and you can run up to 20 lists per account.

Service mix noise goes lower, at campaign level, because it depends on the clinic. "Bulk billing" is only a negative if that clinic does not bulk bill. "Acupuncture" is only a negative if they do not offer it. Campaign level lets each campaign block what is wrong for it specifically.

One caution that has no native warning. A negative can block your own positive keyword. Add an overly broad one like "pain" or "physio" and you can silently strangle your best traffic, then watch impressions collapse with no report telling you why.

This is where most clinics get it wrong even when they know about negatives. They treat it as a one time cleanup. A spring clean, done, walk away.

It is not. New irrelevant queries appear continuously as broad match and Smart Bidding keep exploring. The leak you sealed reopens within weeks if nobody is watching. Negatives are an ongoing system, never a single purge.

On a fresh clinic build, every 72 hours we do what is called negative keywording. I have an AI pull every account's search terms into Slack on that loop, and someone approves or denies each one, no, no, no, yes. Early on the junk is heavy and the loop has to be tight. As the negative list matures and the bad queries dry up, you can stretch to weekly, then fortnightly.

That is the whole discipline. Read the real report often. Add as phrase, not the lazy exact. Check for conflicts monthly. Cadence and precision beat a big static list every time.

You do not have to wait for waste to teach you. Build a starter list before the campaign ever goes live, then refine it from the real search terms report once data comes in.

Add these as phrase negatives so they catch the variations. Price and freebie hunters: free, cheap, bulk bill, bulk billing, medicare free. Job and study seekers: jobs, careers, vacancy, salary, course, degree, university, certificate. Information only: how to, exercises, stretches, symptoms, definition, meaning, wikipedia, youtube, reviews.

Then add the ones specific to the clinic. Competitor brand names go on your generic and service campaigns so you are not paying inflated competitor intent prices there. Out of scope body areas and modalities the clinic does not treat go on at campaign level.

This is a head start, not a finish line. The account that gets cheaper every month is the one where someone reads the real searches every few days and keeps Google honest. That is the job. Do it well or do not run ads at all.