Dr Kish Aesthetic Center

The brief

Dr Kish Aesthetic Center is a clinic in central Zurich led by Dr Deniel Kish, a plastic surgeon and gynaecologist, covering facial, body and intimate aesthetic surgery. The brief was the whole thing: design, build and search, in German, from nothing.

Three things made it harder than a normal build. It is a medical site, so it sits squarely in the category Google treats most cautiously. It is German-language and Swiss, which is a smaller and more particular market than it looks from outside. And a good part of the treatment list is the kind people research privately and never discuss, which changes how the queries behave and how the pages have to read.

The results, in full

What the data shows

Average position 43.5, and the best click rate of any project here

An average position of 43.5 is somewhere around page four. On paper that is the worst number on this website. The click rate sitting next to it, 2.5%, is the best. Lined up against the other five case studies, the relationship people assume exists simply is not there:

Best average position in the table, 7.3, returns 2.1%. Worst average position, 43.5, returns 2.5%. The ranking order of one column tells you almost nothing about the other.

The reason is that average position is an average over every query a site appears for, weighted by nothing. A site that ranks first for forty valuable terms and four hundredth for forty thousand irrelevant ones reports a terrible average and an excellent click rate, because the handful of terms that rank are the ones anybody actually searches with intent. That is this account.

The chart contains its own baseline

Only one other case study here can show a before. Guard Up Pest Control has Google's own year-on-year comparison on its Business Profile. The rest start mid-story. This one does not, because the twelve month window opens before the work had taken effect and closes well after.

Reading the chart from left to right, daily clicks sit in the ten to twenty band through autumn 2020, drop into single figures around the turn of the year, then climb steadily from the new year onward, reaching peaks in the forties by July 2021. The impression line does the same thing more sharply. Those are figures read off the chart rather than exported, so treat them as the shape rather than exact numbers.

The shape is a flat and falling line that turns and keeps going. It is the clearest visual evidence on this site, and it is still not proof of causation on its own. A chart can only tell you what happened and when. What it rules out is the comfortable explanation that the site was already growing.

Ranked first against a stronger competitor

The overlay numbers are the interesting part, because they go the wrong way:

Lower authority score, seven times fewer backlinks, ranking above. The line that explains it is the last one. The competitor's 1,650 links come from 61 domains, an average of twenty-seven links per domain, which is the signature of site-wide placements counted over and over: a footer link on a large site, a directory, a blogroll. The clinic's 232 links come from 73 domains, an average of three.

More distinct sites, fewer repeated links. Diversity is the thing that counts and raw link totals flatter the wrong profile. This is a single query on a single day and it does not prove a general law, but it is a clean illustration of why buying volume is the wrong instinct.

The brand took both of the top two results

Two results from one domain on a brand search means Google has worked out that the clinic and the named surgeon are the same entity and that both pages deserve the space. On a medical site that is worth more than it looks: the surgeon's credentials page ranking in its own right is the thing that makes the rest of the site credible, to readers and to Google.

It is the same entity work described in what entity building actually means, applied to a person rather than a business.

A medical site in German, which is two constraints at once

Health content is held to a higher standard than almost anything else, and the thing that satisfies it is not a keyword. It is a named, qualified, checkable practitioner attached to the pages, with the clinic address, the registrations and the procedure detail that a prospective patient would actually want. That is why the surgeon's profile page ranking alongside the homepage matters.

The language side is the easier half to get wrong. Swiss German usage is not identical to German German, the audience spans both markets, and the treatment vocabulary patients type is frequently not the clinical term a surgeon would write. Writing for the second and ranking for the first is most of the job.

What this does not prove

• The site no longer exists as built. drkish.ch was redesigned after this engagement and the current version is credited to another agency. There is deliberately no link to it from this page, because the point of that link elsewhere on this site is to let you check my work, and it would not.
• The evidence is from 2021. Rankings, authority scores and backlink counts all move. None of the figures above should be read as current.
• The overlay figures are third-party estimates. Domain Authority, referring domains and backlink counts come from MozBar and the Surfer extension, not from Google. They are useful for comparing two sites on the same screen and not much else.
• No patient, enquiry or revenue figures are published here. That data is the client's, and in a medical context it is more sensitive than most.
• The before and after is read off one chart, not from two exported date ranges. The shape is clear. The precise daily values are not, and I have not pretended otherwise.

If someone is reporting your performance to you as an average position, the useful question is what it is averaging. That is one of the first things a free audit pulls apart.