Impressions Are a Surrogate Endpoint. Booked Patients Are the Outcome.
You would not change how you practice based on a study that only reported a biomarker moving in the right direction. Surrogate endpoints are where you start looking, never where you stop: the intervention has to reach the outcome that actually matters before you act on it. Every physician learns to read evidence this way.
Then a marketing vendor sends a monthly report, and the discipline evaporates. Impressions up 340 percent. Ranking on page one for a dozen keywords. Ten thousand website visitors. These are surrogate endpoints, every one of them, and the report conspicuously does not say how many patients booked. Practices that would never accept this reporting standard in a journal accept it in an invoice, month after month, mostly because nobody ever told them they were allowed to ask for the hard outcome.
You are allowed to ask for the hard outcome.
The endpoint hierarchy, applied to your marketing
Ranked from most surrogate to most real:
Impressions count how many times your listing appeared on someone’s screen. A patient scrolled past you. This is the marketing equivalent of receptor affinity in vitro: not nothing, but a long causal chain away from anything you care about, and the number vendors quote most because it is always the largest one on the page.
Rankings measure where you appear for specific searches. Closer to useful, but rankings for searches nobody runs are worthless, and vendors choose which rankings to report. Page one “for a dozen keywords” tells you nothing until you know whether those are phrases a patient in your area would ever type.
Traffic means people actually reached your website. Now there is a pulse. But a thousand visitors who leave in eight seconds are worth less than fifty who read your service page and tap the phone number.
Contacts are the first hard event: a call, a form submission, an online booking request. These are countable, attributable, and they are where honest reporting begins.
Booked patients are the outcome. Everything above this line exists only to produce this line.
The chain matters because each link can fail independently. Plenty of practices rank well and convert nothing, because the website that receives the click gives the visitor no reason and no easy way to book. If you only watch the surrogate, that failure is invisible: the report looks better every month while the schedule does not.
The instrumentation is the unglamorous part, and it is the whole game
Connecting the chain takes plumbing, not genius: a tracking number so calls from Google can be counted, form and booking events that register when someone acts, and a front desk habit of asking new patients how they found you, which remains crude but catches what the software misses. None of this is exotic. Most practices simply never had it installed, which is why their marketing decisions run on anecdote: things feel busier, the vendor’s chart points up, who can say.
Once the plumbing exists, real questions become answerable. What does a new patient from Google actually cost, compared to one from a directory or a referral? Which service pages produce calls and which produce only visits? Did last quarter’s spend produce patients, or impressions? You make clinical decisions with instrumented data. The same becomes possible here the moment the instruments exist.
How to read the next report you receive
- Find the number of contacts: calls, forms, booking requests. If it is not in the report, that is the first thing to say in the reply.
- For every surrogate the report celebrates, ask the connecting question: these impressions, these rankings, this traffic, resulting in how many contacts?
- Ask what one new patient from this channel costs. A competent vendor can answer within a session or two of setting up tracking. Note whether yours can.
- Cross-check against the only source that never lies: your own schedule. New patient volume, and what they say when the front desk asks how they found you.
- If the answer to a hard-outcome question is a larger surrogate number, you have learned something important about the vendor, at a much lower price than learning it next year.
None of this requires you to become a marketer. It requires applying a standard you already hold everywhere else: interventions justify themselves at the outcome, or they do not get continued.