SEO is not a well known or understood field of web development, unless you are in the digital media industry. If you use the internet then you have at some point used Google. For many internet users, Google is accessed daily. Search engines like Google make life easier by helping us find the information that we want.

Google scours the internet, scans and indexes tens of millions of websites and then provides us with the most relevant website when we conduct an online search. Yahoo and Bing are less popular search engines but essentially provide the same service as Google’s search facility.

Ever wondered how Google decides which website to rank at position one, two, three and so on? This is where SEO comes in.

What is SEO?

SEO stands for Search Engine Optimisation (or Optimization). It is a web development practice whereby a website is optimised to rank high on search engine results. SEO targets specific words or phrases, broadly referred to as keywords, for each website that is being optimised.

In medical SEO a medical website is optimised for specific medical keywords.

For example, a gynaecologist in Sandton, Gauteng should have an optimised practice website that ranks for search terms like ‘gynaecologist in Sandton’, ‘pregnancy care’ (as well as ‘prenatal care’ or ‘antenatal care’), ‘ovarian cysts’,  ‘endometriosis treatment’, ‘infertility treatment’ and so on.

This means that if a Google user searches for ‘gynaecologist in Sandton’ then the practice website should appear high in the results, ideally in the first position or top three positions. This ranking does not occur automatically. Google decides which website will appear at specific positions on the search results.

Google Maps has become a quick and convenient way to feature at the top of search results. It works for search queries that are location based, like ‘gynaecologist in Sandton’. However, for search queries that are location-independent, Google Maps does not have significant benefits.

However, leaving this to Google and chance does not help a business get the visibility they want and need on a search engine. This is where SEO comes into play. SEO assists websites in ranking higher on a search engine for specific search terms or phrases (keywords).

How does SEO work?

Although our focus is on medical SEO, the basic workings of a search engine applies to any industry. It is important to understand that your revenue is directly affected by how your website appears on search engines like Google. It even affects your customers’ perception of your brand, products or services.

Consumers search for more information on search engines in the same way patients Google their symptoms before seeing a doctor. Therefore it is imperative that every business owner has at least a basic understanding of search engines and SEO.

From Directories to Algorithms

The search engines that we now know – Google, Yahoo and Bing (formerly MSN) – started as directories. Websites were listed under different categories and in alphabetical order. A business that had a name starting with ‘A’ had the highest position and therefore an unfair advantage.

Jeff Bezos, the founder of, chose the name ‘Amazon’ because it started with ‘A’. He wanted to be listed as high up in the website directories of yesteryear. However, this system was not practical and did not always offer internet users the best experience.

A website starting with ‘A’ may not necessarily have the best information, product or experience. Websites that started with ‘Z’ would be seen last and could have far more to offer the internet user. Therefore the method to categorise and list websites had to become more dynamic.

The search engine algorithm was born

The algorithm uses various signals that are present on a website to determine a ranking. In the early days, Google’s algorithm used a handful of factors or metrics to rank websites by what was deemed as quality. ‘High quality’ websites ranked higher than ‘low quality’ websites.

However, these early search engine algorithms were so simplistic to the extent that any web developer could optimise a website to rank high on the search results. This did not mean that high quality websites were guaranteed a position at the top of the search results. Both low quality and scam websites quickly took advantage of this situation.

In response, Google kept tweaking its algorithm. With every new algorithm update the search results changed drastically. Web developers and the early SEO ‘experts’ had to adapt.

Content and Backlinks

There were a multitude of signals that determined a website’s quality in the ‘eyes’ of Google. SEO consultants focussed on these tweaking these various signals to ‘convince’ Google’s algorithm that a specific website was high quality and should therefore be given a higher ranking on the search results.

These various signals were categorised as on-page (or on-site) and off-page (or off-site) SEO factors/metrics. The most important on-page SEO factor was the content.

A website that was rich in content with articles exceeding 500 words (length), filled with keywords (keyword density) and had a title and subtitles that matched what the search engine user was looking for was the most important on-page SEO factor of the time.

A website that received many links from other websites (backlinks) was the most important off-page SEO factor. Getting a website to rank high was time consuming but still possible. SEO consultants would focus their entire campaign on  one or the other, either content or backlinks, or both factors.

Google’s algorithm evolved further but the two constants always remained – content and backlinks. With time and effort, even the most undeserving of websites could rank relatively high in search results. It was a constant battle between Google’s search algorithm and the search engine optimisation (SEO) industry.

The end user (internet user) was never the winner. Sometimes search results were relevant and of a high quality while at other times it was not. The rise of social media use left many internet users relying on referrals and recommendations from friends to determine what was relevant or not. It also opened the avenue for fake news to proliferate, both on social media and high on search engine results.

The A.I. search algorithm

As time passed, Google’s algorithm evolved and tens of signals were considered in ranking a website. SEO consultants kept pace with every algorithm update. However, Google always stayed one step ahead. Some algorithm updates really did rank the best websites in the highest positions on search results. Other algorithm updates were less successful.

There were too many signals that determined the relevance of a website to a specific search engine user. For example, the results that were relevant to a person in the United States may not be relevant to a search engine user in South Africa. Results had to differ not just by location but even by user preferences and previous browsing history.

Eventually machine-learning had to adopted by Google and other search engines. This form of artificial intelligence (A.I.) was not without its flaws, especially in the early stages. However, by 2018 Google’s A.I. driven search algorithm had significantly improved to offer a fairly good user experience with relevant search results. There is still much room for improvement and Google’s search team is constantly working on it while their machine-learning system is tweaking results on an almost daily basis.

SEO Lives On

A few years ago when Google introduced its A.I. driven search algorithm, the web development industry questioned whether SEO was still relevant. Changes in SEO were necessary but seemed exhaustive to adopt. Some believed that the days of SEO were over and website owners should succumb to Google. However, this could not be further from the truth.

Google is still the most widely used search engine globally and it continues to rank high quality websites above low quality websites. The role of the SEO consultant has changed to some extent. SEO’s as they are commonly referred to do not have to undertake intricate campaigns to ‘trick’ the system.

Instead SEO’s have to focus more on quality. Google has provided several sets of guidelines for search engine optimisation (SEO). Content has now overtaken backlinks at the most important SEO factor but even great content is not sufficient. Various SEO signals still need to incorporated into articles and within the unseen parts of a web page.

SEO lives on and as long as search engines exist and are used, SEO will be necessary. This may not always be a consideration for smaller business websites or bloggers that derive a large portion of their traffic from social media. However, if a business wants to be visible on search engines and maximise their access to online traffic then SEO is vital for their website.

Can SEO experts guarantee ranking?

Any SEO ‘expert’ who guarantees ranking at the top of Google’s search results page (SERPs) should be reconsidered. The industry has been flooded with web developers who claim to be SEO experts, offering ‘cheap SEO’ with guaranteed rankings.

Most of these so-called SEOs used automated software to post thousands of links to your website, mainly from low quality and irrelevant website directories. Some of these web directories are not entirely useless. Google has explicitly stated that web directory link spamming can harm your website’s SEO.

However, website owners receive emails almost daily offering these web directory services under the pretext of SEO. Needless to say that this type of SEO almost never pans out and often these ‘SEO’ practices damage a website’s reputation in the long term.

Nevertheless a reputable SEO (who would never call themselves an ‘expert’) should be able to assist you in increasing website traffic from search engines. This does not happen overnight. Legitimate SEO techniques (also known as white hat SEO) can take anywhere from 3 to 6 months to yield any results. The benefits of a well structured SEO campaign are ongoing for months and even years thereafter.

It is important to note that despite the advantages of search engine traffic, there are other sources of website traffic. Social media traffic is proving to be a popular choice of website traffic these days. However, the quality and high conversions of organic search traffic can never be matched with organic social media traffic. Despite the initial expense of SEO, the long term benefits without any further cost is relatively unmatched online.