15 Behind-the-Scenes Facts You Didn't Know About Grey's Anatomy, 20 Years After It Premiered

Grey’s Anatomy has been a cultural phenomenon since it premiered 20 years ago on March 27, 2005.

The show, created by Shonda Rhimes, follows the personal and professional lives of doctors and medical staff at Grey Sloan Memorial Hospital (originally Seattle Grace). With its blend of intense surgeries, dramatic relationships plus emotional storylines, Grey’s constantly keeps viewers on their toes — just when you think the show has explored it all, Rhimes manages to introduce yet another surprising twist.

Now in its 21st season, Grey’s continues to leave quite a mark on viewers. Its original cast — which included Ellen Pompeo as Meredith Grey, Patrick Dempsey as Derek Shepherd, Sandra Oh as Cristina Yang and Justin Chambers as Alex Karev — have also become household names.

From heartbreaking deaths to romantic twists, the drama has left fans with plenty of unforgettable moments over the last 20 years.

Here’s a look at some behind-the-scenes facts from the show that have shaped Grey’s Anatomy into the beloved series it is today, 20 years after its premiere.

The show went through numerous title changes

Before Grey’s had the iconic name we know today, the show went through a few title changes.

According to Kate Walsh, who played Dr. Addison Montgomery, the drama initially had three different names. She shared her thoughts on the evolving titles with Buzzfeed in 2017, saying, “It was ‘Doctors’ and then ‘Surgeons’ and then ‘Complications’ and I was like, ‘What a bulls--- show title!’ Grey’s Anatomy is the perfect title.”

The title not only references the lead character but also pays homage to the famous medical textbook Gray’s Anatomy.

Rhimes took inspiration from ER shows on the Discovery Channel

Rhimes drew inspiration for Grey's from other surgical shows, specifically those on the Discovery Channel. She explained in a 2006 interview with Oprah that she and her sisters were "obsessed with the surgery channels" and would frequently discuss the operations they saw on TV.

Rhimes realized the operating room was the perfect setting for a show, saying, “There's something fascinating about the medical world — you see things you'd never imagine, like the fact that doctors talk about their boyfriends or their day while they're cutting somebody open. So when ABC asked me to write another pilot, the OR seemed like the natural setting.”

Every episode is named after a song — except for one

One unique element of Grey’s is that nearly every episode title is named after a song.

The only exception is "1-800-799-7233," which is the National Domestic Violence Hotline — a fitting name given the significance of this season 14 episode's storyline.

In the episode, Dr. Jo Wilson (played by Camilla Luddington) confronts her abusive ex-husband Paul, after years of living in fear and secrecy. The episode sheds light on the impact of domestic violence and the lasting effects it can have on survivors like Jo.

It is the longest running primetime medical drama in the United States that’s still in production

Grey's holds the title of the longest-running primetime medical drama in U.S. television history, surpassing other medical shows like ER. Premiering in 2005, it has continued for more than 20 seasons and over 400 episodes, with no sign of slowing down.

The show achieved this milestone in 2019 when it aired its 332nd episode, surpassing ER as the longest-running medical drama in primetime television.

It was originally going to be set in Chicago — where Rhimes is from

Although Grey's has become synonymous with Seattle, that actually wasn’t Rhimes’ original plan. She reportedly initially envisioned setting the show in a city like Boston or New York, as she wanted Grey's to center around a “big city, big medical center, big surgical opportunities.”

Chicago was also a contender, especially since it’s Rhimes' hometown. However, she decided against it because ER was already set there.

Ellen Pompeo didn’t actually audition for the role of Meredith

Pompeo didn’t go through the typical audition process to land the starring role of Meredith — in fact, she was offered the part directly by Rhimes herself. Reflecting on the opportunity with Backstage, in 2020 Pompeo shared, “Shonda Rhimes wasn’t really ‘Shonda Rhimes’ at the time. It wasn’t a big deal — it was just another pilot.”

Her role in the film Moonlight Mile had already garnered her some attention in Hollywood, with the buzz ultimately leading to her being offered the role. Pompeo initially thought it would be a short-term gig, recalling, "My agent said, ‘Just do the pilot and make some money — these things never go.’ And then 12 years later… yup!"

The organs on the show are real cow organs

To create realistic surgical scenes, the production team uses actual cow organs. Sarah Drew, who played Dr. April Kepner, revealed to the Miami Herald in 2010 that they also use fake blood made from a mix of chicken fat and red gelatin.

Describing the experience on set, per RTE, Drew said, “The smell is repulsive and makes us all gag.”

The actress also shared that they use real soldering tools to simulate surgeries, which intensifies the experience with the unsettling scent of burning flesh. Drew explained, “There’s also a lot of silicone and blood matter ... It’s pretty gross.”

Alex Karev was not in the original script

Alex, one of the show's main characters who was on the show for 16 seasons, wasn't originally part of the script.

In fact, the character was added after the pilot episode had already been filmed. Chambers, who portrayed Alex, was inserted into scenes during the editing process, per CBR, making it seem like he had been there all along.

In a panel at PaleyFest in 2008, Chambers elaborated on how his role came to be. “They had shot the pilot before I came on ... and then sent the pilot to New York where I lived and I saw it and I loved it, and I went out to L.A. to try to win the part and auditioned, and got the role."

Three cast members have made their directorial debut on the show

Several cast members from Grey’s have made their directorial debut on the show. Pompeo stepped behind the camera for the first time during the show's 13th season, following in the footsteps of her costars Kevin McKidd (Owen Hunt) and Chandra Wilson (Miranda Bailey).

Additionally, Grey’s executive producer and recurring star Debbie Allen (Catherine Fox) has frequently taken on directing duties.

Rhimes told The Hollywood Reporter in 2017 that her goal at her production company, Shondaland, is to hire the best people and give them room to grow — including the actors. “They have to continue learning and doing what they’re passionate about — whether they are an actor that wants to learn how to direct or a PA that wants to take the next step,” she said.

Real doctors are brought onto the show as consultants

Dr. Michael Metzner serves as both a producer and medical adviser on Grey’s, and plays a crucial role in bringing complex medical procedures to life on-screen. When the show includes experimental surgeries, Metzner is deeply involved all the way from the writers' room to post-production.

He explained that his role involves pitching medical stories that align with the episode's themes, often drawing from his own experiences or those of fellow physicians.

“I get to actually see the idea be created, and help to create it, and then actually make it happen, and then work in the back end as well," Dr. Metzner shared with Shondaland in 2024.

Denny Duquette was originally a love interest for Cristina

According to Elle, in an online television writing masterclass, Rhimes revealed an interesting behind-the-scenes detail: the character of Denny Duquette (Jeffrey Dean Morgan) was originally written as a love interest for Cristina.

The surgeon’s plotline was initially set to involve her falling in love with a dying patient, which would have significantly altered her trajectory.

Had this original storyline remained, it would have added another layer to Cristina’s character, including a connection between her father and the hospital as a major donor. However, the shift to Izzie Stevens (Katherine Heigl) falling for Denny ultimately led to one of the most memorable and heart-wrenching storylines in Grey’s Anatomy history.

Jessica Capshaw and Kevin McKidd originally auditioned for other roles

Jessica Capshaw and McKidd, who became beloved as Arizona Robbins and Owen Hunt respectively, originally auditioned for different roles on the show. During a panel at the ATX Television Festival, Shondaland producer Betsy Beers revealed that Capshaw first tried out for the role of Nurse Rose, who was a love interest for Derek during seasons 4 and 5.

Beers said that during a chemistry read with Dempsey, “we fell in love with Jessica Capshaw,” but she ultimately wasn't cast for the part, per Variety. However, the actress' performance left a lasting impression, and she was later brought on to play Arizona in season 5.

Similarly, McKidd also auditioned for Grey’s long before landing the role of Owen. According to Beers, she “met Kevin McKidd generally for a couple of different parts,” but none of them were the right fit at the time. It wasn’t until Rhimes developed the character of Owen that McKidd was cast in a role suited for him.

Until season 19, Meredith was in almost every episode

Until season 19, Meredith appeared in nearly every episode of the series. There were only five exceptions, coming in seasons 13, 14 and 17. In a few of these, her presence was still felt through voiceover narration.

However, after season 19, Meredith's role in the series significantly downsized as Pompeo stepped away from her long-standing position as the show's lead. Although she still makes occasional on-screen appearances, her character’s presence was significantly reduced after 2022.

Sandra Oh auditioned first for the role of Miranda Bailey

Oh’s portrayal of Cristina in Grey’s may have earned her critical acclaim, but she initially auditioned for an entirely different role — Miranda. Speaking at PaleyFest in 2008, Oh revealed that while she was originally asked to audition for the strong character, she had already set her sights on Cristina.

At the time, she said she was focused on “asking for what I wanted in my life,” and she felt a strong connection to Cristina’s character.

“I saw the part of Cristina, and I wanted to do that part, and so even though producers wanted me to come in for the part of Bailey, I said, 'No, I want to come in for Cristina,’ ” Oh said.

Interestingly, Miranda’s character also underwent significant changes before the show began filming. Initially, Rhimes told Oprah she envisioned Miranda as a "tiny blonde with curls," aiming for an unexpected contrast between her sweet appearance and her tough, brutally honest personality.

However, when Wilson auditioned for the role, it became clear to Rhimes that she was the perfect fit for Miranda’s character.

Rhimes only regrets killing off one character

One of Rhimes' biggest regrets on Grey's was the decision to kill off Mark Sloan, a fan-favorite character played by Eric Dane.

According to Rhimes, Mark was “one of [her] all-time favorite characters to write,” and she tried to find a way to keep him on the show after his love interest Lexie Grey's (Chyler Leigh) death in season 8. However, Rhimes noted that no storyline felt authentic enough to continue Mark’s journey without Lexie, ultimately leading to his departure from the series.

Reflecting on the season 9 loss, Rhimes wrote a 2012 obituary for Mark’s death in Entertainment Weekly, saying, “After six seasons, the end of Mark Sloan was a great loss for me as a writer and for the show. And for the fans.”

She added that she likes to believe Mark and Lexie are together in the afterlife, living the relationship they never had a chance to fully experience on the show. As Rhimes poignantly put it, “she and Mark were ‘meant to be.’ ”