The work we turn down, and why

An agency that has never declined an engagement is an agency with no position. Everything it says about fit, method and standards is marketing, because nothing has ever cost it anything.

So here is what we do not take, stated in advance rather than discovered mid-engagement. Some of these will read as principled. They are mostly commercial, in the sense that taking the work produces a client who concludes we failed — which is more expensive than the fee.

1. Practices with a waiting list over six weeks

If the third-next-available appointment is more than six weeks out, you do not have a demand problem, and marketing will make the situation worse rather than better. More enquiries means a longer queue, which means more patients going elsewhere while they wait.

What we suggest instead: look at session structure and delegation before hiring. The capacity frequently exists inside the current establishment, consumed by follow-ups a registrar or nurse practitioner could take.

The exception: a full list of the wrong patients. If routine work is crowding out the complex cases a consultant trained for, the objective is composition rather than volume — content aimed at a specific presentation, and published case-selection criteria that referrers can act on. That is useful work with a full list, and it is nearly the opposite of a lead-generation campaign.

2. Anyone whose enquiry conversion is under 30%

If fewer than three in ten people who contact the practice end up in a chair, the constraint is the pathway, not the pipeline.

The cheapest intervention available in healthcare marketing is a person who answers the phone within three rings and can offer an appointment on the call. We have no product to sell against that, and it will outperform anything we could build.

We will run the diagnostic and hand it over. If the number is above 30% after the fix, come back.

3. Content mandates with no clinician time

The most common shape of a deal we decline: the practice wants forty articles a month, produced entirely by us, with no consultant involvement.

We cannot do this and neither can anyone else, though plenty will say otherwise.

The thing being published in clinical content is the clinician's expertise. Ghostwritten, unbylined, unreviewed content attaches expertise to nobody, fails the standard Google's raters apply to health content, and in Australia edges toward misrepresentation if it carries a doctor's name without their review.

What we need is three to five hours of consultant time a month. Interview-based, so the burden is editing rather than writing. If that is genuinely unavailable, the honest recommendation is to do the technical and entity work — which needs no clinical time — and publish nothing until it is.

4. Guaranteed rankings, guaranteed leads, guaranteed anything

We will not commit to a position, a citation, or a patient volume.

Not from caution. Because the mechanisms do not permit it. Ranking is competitive and the field moves. Citation behaviour in answer engines changes without notice — a model update can alter which sources get named, in either direction, overnight. Anyone guaranteeing an outcome in a system they do not control is either inexperienced or dishonest.

What we will commit to: the work, the timeline, the reporting, and telling you when something is not working.

5. Anything with a referral commission in it

Arrangements where a facilitator receives a payment per patient delivered to a hospital, or where a diagnostic centre pays a referring practitioner, have been prohibited under Indian medical ethics regulation for a long time.

We will not build acquisition infrastructure for a model structured that way, regardless of how the payment is described in the contract.

This matters more than it sounds because a considerable share of medical tourism and aggregator models in India sit exactly here. If the money flows per patient delivered rather than for clinical work performed, the model is in a contentious category and the marketing is the least of the exposure.

6. Testimonial-led campaigns for Australian practices

Outcome testimonials breach Section 133 of the National Law. This is not a grey area and it is the most common breach we find.

Where a practice wants a testimonial-led campaign because it worked for their competitor, our answer is that the competitor is exposed and we will not add a second liability to the market.

The substitute is better anyway. The clinician's own explanation of their case selection is unique, unfakeable, compliant, and is the format an answer engine will actually quote. A five-star review is none of those things.

7. Work where we would be the medical reviewer

We are not clinicians. We can build the pipeline, the markup, the review workflow and the publication standard. We cannot be the person who signs off that a clinical claim is correct.

If a practice cannot supply a registered clinician to review clinical content, we can still do the technical and entity work — but we will not publish clinical claims under an arrangement where nobody qualified has checked them.

8. Anyone who wants the reporting to look better than the results

Occasionally a prospective client wants a dashboard for a board rather than a diagnosis for a practice.

Impressions, reach, "brand visibility uplift" — the metrics available when the real ones are not moving. These are always available and they are always a way of not answering the question.

We report enquiries, citations across four named answer engines, and referral composition where the practice collects it. If the numbers are bad, the report says so. If that is not what is wanted, we are the wrong firm and it is better established at the outset.

What this costs us

More than it appears from the outside. These are not exotic edge cases — waiting-list constraints and unavailable clinician time are the two most common situations a specialist practice is actually in.

The reason we hold the line is that the alternative is worse arithmetic. An engagement taken against a constraint we knew about produces eight months of work, a client who reasonably concludes the marketing failed, and a reference we cannot use. The fee does not cover that.

There is also a simpler reason. In a category this small, where the buyers are consultants who talk to each other and where trust transfers through referral rather than advertising, being the firm that says no is a more durable asset than being the firm that says yes.

What we will always do free

Run the diagnostic. Four numbers — third-next-available appointment, enquiry conversion, referral base trend, and search visibility for your specialty's real questions — and an honest reading of which of the four possible problems you have.

If the answer is that marketing is not the intervention, you get that in writing and we do not invoice for it. That has happened, it will happen again, and it is the single most useful hour we spend with anyone.