Google just published their internal Search Quality Rating Guidelines: a 160-page document used by Google’s human evaluators to measure the overall quality of web pages in search results.

According to Google, their human evaluators don’t use these guidelines to directly influence rankings. Instead, they use them as part of an internal Page Quality (PQ) rating test.

And since medical websites can “potentially impact the future happiness, health, or wealth of users,” according to Google, they’re holding doctors, physicians, and medical practices to a much higher Page Quality rating standard they call “Your Money or Your Life” (YMYL).

Why have internal Page Quality tests?

Google uses internal PQ tests to determine whether or not an algorithm update or experiment has successfully improved search results:

Developing algorithmic changes to search involves a process of experimentation. Part of that experimentation is having evaluators—people who assess the quality of Google’s search results—give us feedback on our experiments.”Google

During a Page Quality rating test, an evaluator is given a specific URL along with a series of questions, then they’re prompted to measure how well a web page achieves its purpose.

Evaluators then choose one of nine Page Quality Scores:

page quality score index

While ratings from evaluators might not determine your rankings, adhering to Google’s Search Quality Rating Guidelines will. I promise.

Think about it: If Google uses its search quality guidelines to check the efficacy of an algorithm update, and an algorithm update is meant to improve search results, then we can assume that following the criteria provided in this document will improve your search engine optimization (SEO) and increase your rankings, too. Right?


In this article, I’ll explore which search quality guidelines Google considers most valuable when evaluating medical websites. And I’ll uncover which characteristics they believe all high-quality, high-ranking medical websites should epitomize, including:

  • High-quality main content
  • Expertise/Authority/Trust (E.A.T.)
  • Positive reputation
  • Helpful supplemental content
  • Functional page design
  • Satisfying amount of website information
  • Well-maintained and updated

Let’s get started.

“Your Money or Your Life,” Eh?

YMYL guidelines

Section 2.3 of Google’s Search Quality Rating Guidelines

First things first: Any website that could “potentially impact the future happiness, health, or wealth of users” falls under the “Your Money or Your Life” (YMYL) category within Google’s Search Quality Rating Guidelines.

According to Google, medical YMYL pages include “web pages that provide advice or information about health, drugs, specific diseases or conditions, mental health, nutrition, etc.”

Which mean hospitals, private practice doctors and surgeons, dentists, and any other physician website that shares medical advice or information with its visitors is held to a higher standard than your average blog about cooking recipes.


Google makes money by providing the best results to its users’ search queries. If they didn’t, then we wouldn’t come back, and Google wouldn’t own 70% of the search market (nor would they be the wealthiest business in the world).

If Google allows doctors, physicians, surgeons, or other healthcare professionals and practices to rank atop search, despite a poor reputation or lack of proven expertise, then patients could potentially discover negative (even fatal) solutions to their problems.

And aside from the obvious desire to avoid such scenarios, Google’s reputation for providing users with the best solutions to their problems would unravel- and Google would lose money.

To circumvent adverse outcomes originating from Google search, they’re holding medical websites to a much higher standard (as they should).

What constitutes a “highest” quality YMYL medical website?

According to Google’s Search Quality Rating Guidelines, highest quality YMYL medical websites that achieve their purpose well require at least one of the following:

1. Quality and quantity of main content: “Very high or highest quality main content, with demonstrated expertise, talent, and/or skill.”
2. Level of expertise, authoritativeness, and trustworthiness (E-A-T) of the page and the website: “Very high level of expertise, authoritativeness, and trustworthiness (page and website) on the topic of the page.”
3. Reputation of the website/author: “Very good reputation (website or author) on the topic of the page.”

Examples of highest quality YMYL medical websites from Google’s Search Quality Rating Guidelines:

highest quality ymyl

Section 5.4 of Google’s Search Quality Rating Guidelines

Though the examples within Google’s Search Quality Rating Guidelines can only be seen by Google employees, they do provide some insight and explanation into how they evaluate characteristics of highest quality YMYL medical websites:

While quality and quantity of content, subject-matter expertise, and positive reputation hold the most value when rating page quality, supplemental content, functional web design, sufficient information about the website, and whether or not a site is frequently updated and maintained play an important role, too.

Let’s dive into each of the seven core characteristics of a high-quality YMYL web page, as defined by Google’s Search Quality Ratings Guidelines, and discover how each characteristic impacts your medical website differently.

1. Highest quality “Main Content” (MC)

Main content refers to the primary content on any given web page (home page, procedure page, gallery, product page, etc.) that helps the visitor accomplish the main purpose of the page, including page features and functionality.

In Google’s words: “We will consider the MC of the page to be very high or highest quality when it is created with a high degree of time and effort, and in particular, expertise, talent, and skill.”

To achieve a high-quality main content rating on your medical website, it should:

  • Be factual, accurate, and clearly written
  • Be comprehensive and detailed
  • Clearly demonstrate a considerable amount of time, effort, expertise and skill to create.
  • Function properly

Google explicitly states in Section 9.2 of their Search Quality Ratings Guidelines that high-quality main content is one of the three primary considerations when rating Page Quality, especially for YMYL medical websites and web pages.

What does low-quality main content look like on a YMYL website?

If your main content is not sufficient enough, Google instructs its human evaluators to rate the page lowest:

“YMYL pages with absolutely no website information, or other pages where the available information is completely inadequate for the purpose of the website… should be rated Lowest.”

In Google’s words, here is how they rate lowest-quality web pages:

lowest quality main content

Section 7.4 of Google’s Search Quality Rating Guidelines

In other words, Google wants your content to comprehensively answer the question your users intended on finding. And like with any YMYL medical website, Google expects that authoritative medical experts will write the main content on your site.

How to Optimize Your Treatment and Procedures Pages for User-Intent First, Search Engines Last

2. High level of expertise/authority/trust (E.A.T.)

In order for a medical website to be authoritative and trustworthy, says Google, it must demonstrate a high level of expertise:

“High-quality medical advice should come from people or organizations with appropriate medical expertise or accreditation. High-quality medical advice or information should be written or produced in a professional style and should be edited, reviewed, and updated on a regular basis.”

high level eat

Section 5.2 of Google’s Search Quality Rating Guidelines

In addition, Google identifies two types of experts they consider trustworthy: Everyday experts and medical experts (i.e. medical professionals).

Everyday E-A-T vs. medical expertise

Since certain topics require “less formal expertise,” and since “ordinary people may be considered experts in topics where they have life experience,” Google values expertise, authority, and expertise from both everyday experts and medical professionals:

1. Medical professionals:

Accredited medical professionals like doctors, physicians, surgeons, dentists, or nurses.

“YMYL topics such as medical advice, legal advice, financial advice, etc. should come from authoritative sources in those fields.” – Google

Examples of E-A-T web pages from medical professionals:

  • Blog posts written by doctors or accredited staff members
  • Procedure pages written and authored by the doctor or the expert
  • Research journals or scientific studies

2. Everyday experts

Patients or friends and family of patients who have personal medical experiences to talk about. These normal people are experts in their own life experience.

“Please value life experience and ‘everyday expertise.’ For some topics, the most expert sources of information are ordinary people sharing their life experiences on personal blogs, forums, reviews, discussions, etc.” – Google

Examples of E-A-T web pages from “everyday experts” include:

  • Written testimonials
  • Patient case studies
  • Video testimonials
  • Patient blog posts or photo journals
  • B/A galleries
  • First-hand forum discussions and comments

Note: If your marketing agency ghostwrites content on your behalf (that’s most of you), make sure that authorship gets attributed to you on the site.

Like with every guideline, Google advises their evaluators to consider the purpose and topic of the page before rating E-A-T.

You should do the same.

For medical information, only doctors should author content. But for certain topics, like surviving cancer or recovering from a breast augmentation, first-hand accounts are just as trustworthy and authoritative.

Page level E-A-T or website level E-A-T

Google advises their evaluators to rate E-A-T on a page-by-page level and a website level.

eat page level

Section 9.3 of Google’s Search Quality Rating Guidelines

For websites with less established reputations, less stringent editorial guidelines, or who frequently allow guest contributors to post blogs, a more granular, page-by-page analysis is warranted (e.g. medical practices, user-generated forums, personal blogs).

However, for reputable industry leaders with active editorial standards and a long-standing rapport with Google, only a website level analysis is required (Wikipedia, Mayo Clinic, WebMD,, Cleveland Clinic).

Tip: No matter which scenario your website belongs to, assume that Google will measure the trustworthiness of your website on a page-by-page basis.

What does low-quality E-A-T look like on a YMYL website?

Since expertise/authority/trust (E-A-T) is one of the three primary considerations when rating highest quality YMYL websites, “lacking sufficient EAT is enough to warrant a low-quality rating,” says Google.

Google also mentions that even if an evaluator is unable to confirm that a site is untrustworthy or unreliable, if it appears untrustworthy, that’s enough to warrant a low-quality score.

low quality eat

Section 7.6 of Google’s Search Quality Rating Guidelines

3. Very positive reputation

“Many websites are eager to tell users how great they are. But for Page Quality rating, you must also look for outside, independent reputation information about the website. “ – Google

Google explicitly instructs their human evaluators to measure the reputation of a website based on third-party review sites and other external factors.

Which also implies that their ranking algorithm takes third-party reviews, their sentiment, and their overall star rating into account when ranking your medical site (according to Moz’s 2015 Local Ranking Factors, review signals comprise 8.4% of overall ranking factors).

More specifically, Google instructs evaluators to check industry affiliations/professional societies and patient reviews:

Industry affiliations/professional societies:

“Very positive reputation is often based on prestigious awards or recommendations from known experts or professional societies on the topic of the website.”

For example, the following would fall under this category:

  • RealSelf Top Doctor
  • Castle Connolly Top Doctor
  • Best Doctors by U.S. News
  • Local awards, like “Best Place to Work in Denver”
  • Patients’ Choice awards from reputable affiliations
  • Vendor awards like: “Botox Top Injector 2016”
  • Board certifications

Patient Reviews:

“Look for articles, reviews, forum posts, discussions, etc. written by people about the website. For businesses, there are many sources of reputation information and reviews.”

For example, the following would fall under this category:

  • Testimonials on your site with star ratings
  • Third-party non-industry reviews (BBB, Yelp, Google, etc.)
  • Industry-specific review sites (HealthGrades, RateMDs, Vitals)

They don’t expect perfection

“When interpreting customer reviews, try to find as many as possible. Any store or website can get a few negative reviews. This is completely normal and expected. Large stores and companies have thousands of reviews and most receive some negative ones.”

Takeaway: Google doesn’t expect 5-star ratings across the board. In fact, they expect an authentic review profile to include a few sour apples. So don’t sweat a few 3-star reviews. But keep working on improving your patients’ experience.

How to Conduct an Online Patient Review Audit from Third-Party Review Sites

How much impact does your reputation have on your quality score?

“While a page can merit the High rating with no reputation, the High rating cannot be used for any website that has a convincing negative reputation. A very positive reputation can be a reason for using the High rating for an otherwise Medium page.” – Google

In other words, a positive reputation is so important to YMYL pages that the presence of a positive reputation alone can catapult an otherwise mediocre web page to a high rating. 

Conversely, if you show any sign of a convincing negative reputation, you will never achieve a high rating. Yikes.

What does a low-quality reputation look like on a YMYL website?

“Extremely negative, malicious, or financially fraudulent reputation information should result in a Lowest rating. Credible negative (though not malicious or financially fraudulent) reputation is a reason for a Low rating, especially for a YMYL page.” – Google

Where a normal website might skate by with a credible negative reputation, your YMYL medical website definitely won’t.

Anything egregious, like an F grade from BBB, reviews about fraud from reputable sources, or accusations of threats made towards users, will result in an extremely negative reputation.

Google also hints that they consider the sentiment of third-party reviews, suggesting that that Google’s sentiment analysis is still a pivotal part of rankings:

negative reputation

Section 2.7.3 of Google’s Search Quality Rating Guidelines

4. Helpful supplementary content (SC)

According to Google, supplementary content is any content that “can help a page better achieve its purpose.”

All supplementary content must benefit the website and help the visitor satisfy the purpose the page was meant for, not distract or lead the visitor to unrelated content (the latter can hurt your quality score).

For example:

  • Links to related blog posts
  • Links to related procedures
  • Help/FAQ sections
  • Filtering options
  • Tools: BMI tool, finance/interest calculators, 3D imaging tools, etc.
  • Content upgrades: templates, presentations, audio recordings, etc.
  • Educational videos
  • Location details
  • B/A galleries
  • Testimonials section on page

Google also makes a clear distinction between what they expect from large websites versus small, local business websites:

low supplementary content

Section 4.5 of Google’s Search Quality Rating Guidelines

What does low-quality supplementary content look like on a YMYL website?

If your supplemental content is designed to “lure” visitors to another page and in no way helps the purpose of the page, then you could receive a low-quality rating:

“Unhelpful or distracting SC that benefits the website rather than helping the user is a reason for a Low rating.” -Google

So how important is supplemental content when considering your overall quality rating?

Not very.

Google says that “a page can still receive a High or even Highest rating with no SC at all (emphasis mine).”

5. Functional page design

“High-quality pages are designed to achieve their purpose: they are well organized, use space effectively, and have a functional overall layout.” – Google

According to Google’s Search Quality Rating Guidelines, a functional page design should accomplish the following:

  • Main content prominently displayed “front and center.”
  • The main content should be immediately visible when a user opens the page.
  • It should be clear what the MC actually is. The page design, organization, and use of space, as well as the choice of font size, background, etc., should make the MC very clear.
  • It should be clear what parts of the page are ads, either by explicit labeling or simply by page organization or design.
  • Function trumps “prettiness”

“Some pages are “prettier” or more professional looking than others, but you should not rate based on how “nice” the page looks. A page can be very functional and achieve its purpose without being “pretty.” – Google

Takeaway: Google’s algorithms can’t measure for aesthetics since design is 100% subjective. However, they can determine how well a site has structured and organized its main content.  Always think about the user experience of your page design.

What does a low-quality page design look like on a YMYL website?

As long as you haven’t manipulated the design of your website with distracting ads that encourage visitors away from the main purpose of the page, you have nothing to worry about.

However, Google says that “if the page was deliberately designed to draw attention away from the MC,” then a Low rating is appropriate.

6. Satisfying amount of website information

“High-quality websites provide clear and satisfying information for their purpose. YMYL websites demand a high degree of trust and need satisfying website information.” – Google

Google defines website information as follows:

  • Customer service information
  • Contact information
  • Information about who is responsible for content and maintenance
  • About Us information that defines who runs the site and why

But since medical websites fall under the higher standards of YMYL pages, I would also add the following website information:

  • Privacy/Terms of Use: explaining what you do with submitted personal data
  • HIPAA compliant logos and disclaimers
  • Legal information
  • Updated copyright year in footer

What does low-quality website information look like on a YMYL website?

Google explicitly states that for YMYL pages like medical websites, which require a higher level of trust, any failure to include the following website information could result in a low-quality rating:

low quality website information

Section 6.5.5 of Google’s Search Quality Rating Guidelines

If you don’t have any website information like a HIPAA disclaimer, contact information, about information, or a terms of use page, then you can expect a low-quality rating.

“YMYL pages with absolutely no website information, or other pages where the available information is completely inadequate for the purpose of the website (for example, an online bank with only an email address), should be rated Lowest,” says Google.

7. Well-maintained and updated

“High-quality medical advice websites should keep all of their informational pages current,” says Google.

According to Google, all high-quality websites “are well cared for, maintained, and updated appropriately.” Which means your medical YMYL website should keep all procedure or treatment information current.

A well-maintained website includes:

  • No broken links
  • No load errors
  • Fast loading images
  • Regularly added/updated content
  • Most current medical information

Also, Google claims that they handle certain sites differently when it comes to maintenance. For example, they expect national news websites to update and post frequently (to keep up with the news), whereas they don’t expect the same frequency from your medical site:

What does a low-quality maintenance look like on a YMYL website?

Medical information must stay up to date and you should always tend to website issues, no exceptions.

Otherwise, whether or not Google feels you should update your content remains circumstantial:

“If a website feels neglected, look carefully. Think about the purpose of the website. A year without updates for “Uncle Alex’s Family Photos” website (a hypothetical High-quality example) is fine. A few days without new articles on a major national news website is not acceptable. Use your judgment. If the website feels inadequately updated and inadequately maintained for its purpose, the Low rating is probably warranted.” – Google (Section 6.5.4)


It’s rare that Google publishes explicit search guidelines or ranking factors (almost never).

In fact, until recent, Google has kept their Search Quality Rating Guidelines confidential, away from the clever gaze of the SEO world, away from everyone.

It wasn’t until after several “leaks” of this document that Google decided to make it public. 

Key Takeaways:

•  Google holds “Your Money or Your Life” (YMYL) websites to a much higher standard than others.

•  Google covets high-quality main content, E-A-T (expertise, authority, trust), and a positive reputation more than anything else.

•  Medical websites should always stay current with medical information.

•  Functionality and user experience trump aesthetics. You can still look ugly and rank in search (but good luck converting visitors into patients).

•  Your reputation on third-party websites and amongst industry affiliations and experts matters… a lot.

•  Add supplemental content to your site to help your web pages achieve their purpose, but it won’t hurt you if you don’t.

•  If Google uses these guidelines to measure how well an algorithm update or experiment improved overall search quality, then you can guarantee they directly impact your rankings.

Continued reading:


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