Including the parts clients found uncomfortable.

We were told for a year that a 3x return meant we were doing well. Finding out which products were actually losing money was the most useful bad news anyone has given us, and every decision since has been made on a number we can defend.

We had been paying to appear in areas where no patient would ever drive to us. Nobody had ever looked at the map before. Eight months on, two of our branches finally exist as far as Google is concerned.

Our lead count halved and the sales team thanked us. I would not have believed that if I had not watched it happen month by month.

The first monthly report showed our cost per lead had nearly quadrupled. It took real nerve to sit through that meeting and keep going — and we filled the batch with a third fewer enquiries than the year before.

For fifteen years our enquiries came from one listing we did not control. Having our own channel changed what we could say no to, and what we could charge.

Cutting spend in cities that felt busy was the hardest thing to agree to. The job data made the argument for us, and we booked more work on the same money.

What I value most is the Monday note. Two paragraphs, plain language, what moved and what they are doing about it. I have not had to chase a status update in nine months.

They told us on the first call that we did not need half of what we had asked for, and to fix our missed-call problem first. That is not a sales technique I had encountered before.

One shoot day gave us more usable video than the previous two years combined. We stopped running the same three ads and our costs came down without touching a single bid.