Is your Google Ads budget being wasted? Check in 15 minutes.
Owners assume auditing an ad account requires an expert. Finding waste doesn't — the account will confess if you open the right five screens. You need read-only access (which you should have anyway — it's your account) and fifteen honest minutes. Here's the walkthrough I'd give any clinic owner before they pay anyone, including me.
On this page
The five leaks at a glance
Screen 1 — search terms report
Campaigns → Insights and reports → Search terms. This is the list of what people actually typed before your ad spent money. Scan the first hundred rows for queries no patient of yours would type: jobs, DIY, other cities, "free," competitors you'd never win. Every one of those rows is budget converted directly into nothing. A healthy account has negatives blocking these; an unmanaged one reads like a confession.
Screen 2 — conversion actions
Goals → Conversions → Summary. Two questions: what events are listed, and what counts as primary. If "Page view," a duplicate form event, or anything nobody would call a patient sits there as a primary conversion, your bidding has been optimizing toward it — the account isn't wasting money by accident, it's wasting it on target. This screen explains more bad accounts than any other, and it's the reason Google's numbers and your CRM disagree.
Screen 3 — brand inside PMax
If you run Performance Max: open the campaign's search-term insights and look at the top categories by conversions. If your clinic's name is among them, PMax is charging you for patients who had already chosen you — and reporting them as wins. The mechanics and the fix are in the hidden subsidy inside PMax.
Screen 4 — budget pacing
Look at when your ads stop serving. If the daily budget is exhausted by early afternoon, you're invisible exactly when many owners and patients search — evenings. That's not always wrong (sometimes mornings convert best), but if nobody has ever decided it, it's a leak by neglect: the cheapest hours of your market may be the ones you never show up for.
Screen 5 — bidding vs structure
Open each campaign's bid strategy. Target ROAS on a campaign whose conversion values are made up, Maximize Conversions feeding on the junk events from Screen 2, or fifteen tiny campaigns each too small for automation to learn — these are strategies at war with the structure carrying them. This one is harder to self-fix, but easy to self-detect: if you can't explain why each strategy was chosen, nobody chose it.
What to do with what you find
- One or two dirty search-term rows: add negatives yourself — it's a ten-minute fix and safe.
- Wrong primary conversions: this is the dangerous one. Don't re-flag events blindly — bidding will lurch. It needs a measurement fix first, then re-aiming.
- Brand inside PMax at meaningful share: brand exclusions + a dedicated brand campaign, in that order.
- All five screens dirty at once: stop paying for optimization of this structure — it's past saving, and patching it teaches the machine to be wrong faster.
VERIFIED EXAMPLE · When I inherited a wasteful account at a luxury US healthcare clinic, it was optimizing toward platform conversions. Rebuilt around admitted patients imported from the CRM, cost per admitted patient fell ~78% while spend scaled ~2× and approved patients rose ~9×.
| Screen | What to check | Red flag |
|---|---|---|
| Search terms report | Actual queries triggering your ads | Junk queries with real spend behind them |
| Conversion actions | What's being counted as a conversion | Duplicates or actions that aren't real leads |
| Brand inside PMax | Share of PMax conversions from branded terms | A third or more of "acquisition" is your own name |
| Budget pacing | Daily spend against daily budget | Consistent overspend or erratic pacing |
| Bidding vs. structure | Whether Smart Bidding has clean signal to learn from | tROAS set before tracking was ever verified |
Questions owners ask
My agency won't give me read-only access. Now what?
That's finding #1, and it outranks everything in this article. You own the account as the business; access is a checkbox. An agency curating your view of your own money has answered the audit's main question already.
I found leaks. Should I fix them myself?
Negatives and pacing — yes, safely. Conversion actions and bidding — carefully or not alone: changing what bidding optimizes toward mid-flight causes turbulence, and sequencing matters.
The screens all look fine. Is the account good?
These five catch waste, not upside. A clean account can still be aimed at form fills instead of patients — that's a measurement question, and it's the difference between an account that's tidy and one that makes money.