The rude and arrogant Alex Karev started out as a foil to the gentler George O’Malley, but he soon became an indispensable part of the hit medical drama Grey’s Anatomy, and, over time, he even went on to become a firm fan-favorite. Alex had his drawbacks—after all, every character in the Shonda-verse is flawed, but he was also kind and compassionate in his own way.
Seeing how contradictory some of his qualities were, one wonders what kind of a doctor Alex really made, as even Grey's Anatomy's Cristina Yang was good and bad in equal parts. But, underneath his rough exterior, there lurked a comparatively nicer guy.
Is A Good Doctor: He Was Great With Kids
Alex made himself an instant favorite with his young patients. His own difficult past played a part in how compassionate he was towards the children who were under his care.
Alex had the one quality that a pediatric surgeon would covet most; he cared deeply for his patients and became almost immediately enamored by Dr. Karev. Alex was constantly doing nice things for young patients on Grey's Anatomy such as giving a prematurely born baby the 'kangaroo hold' to share the warmth of his body and save his life and flying back on the day of his boards for a 'tiny human' as Arizona would call them.
Isn't A Good Doctor: He Was Too Arrogant
Initially, for several seasons, Alex was an arrogant, insolent, couldn't-care-less smartmouth. He was too caught up in his own arrogance to be a good surgeon, and most fans likely hated him during Grey's Anatomy's first years.
In his introductory scene itself, Alex is shown looking down his nose at a nurse and refusing to consider Meredith's opinion before treating his patient. He was simply too big for his boots, and that's not a very desirable trait in any individual, least of all a doctor.
Is A Good Doctor: He Was Dedicated
Alex grew devoted to his work with time as he became a mellower personality. He would spend night after night in the hospital sleeping by the sides of his patients so that he could throw himself into nurturing a new trachea that was being grown in the lab.
He still had some residual arrogance and bragged a bit from time to time, but, overall, he was dedicated to his work, and, especially with Izzie gone, he has nothing to hold him back. Alex's dedication was easily one of his greatest traits on Grey's Anatomy.
Isn't A Good Doctor: He Froze During Crises
When he started out, at least, Alex didn't handle pressure very well. Fans will recall that he froze during that thrilling moment when he and George got stuck inside the elevator—one of Grey's Anatomy's most memorable elevator moments, and it was the latter who unexpectedly stepped up.
Alex threw his weight around enough for Burke to hand him the scalpel to cut open the patient inside the elevator, but, when it really mattered, Alex freaked out, and George, who was always the butt of the former's jokes, performed a feat by saving the man's life single-handedly. Although he learned to handle crises better later on, he wasn't all that great at it at first.
Is A Good Doctor: He Had An All-Round Growth As A Surgeon
Unlike Cristina, who spent much of her time hogging surgeries in the cardiothoracic department and therefore risked her own all-around development as a surgeon, Alex had a better training spread over different departments, eventually blossoming into one of Grey's Anatomy's best characters.
Even though he chose to work with kids and became the Chief of Pediatrics at a later stage, he was a capable physician who could help as much with trauma in the ER as with general surgery. While specialization is crucial, one expects a doctor to have a thorough knowledge of different fields, which Alex certainly has.
Isn't A Good Doctor: He Was Too Judgemental
Alex was way too judgemental and came with a lot of preconceived notions. Not only was he arrogant as a person, but he was also offensive in the way he treated certain areas of surgery—for example, obstetrics.
It was Addison Montgomery Shepherd who put Alex on her service to teach him a lesson for his arrogance, and this was in a way his baptism by fire into a career of peds. The two would have had quite an interesting romantic relationship on Grey's Anatomy, though it never happened. But, for a long time, even when he was on her service, Alex considered plastic surgery a more superior field than any other and couldn't wait to get away from the little kids. A doctor who judges his colleagues for the work they do doesn't have enough respect for his own work either.
Is A Good Doctor: He Was Not Cut-Throat
Alex wasn't as cut-throat as Cristina, and, although he had his selfish moments, he was altogether less competitive and could therefore think more of his patients than about his own ambitions.
Initially shown as a young man interested in making a pretty penny out of his profession, he was later transformed into someone who didn't care enough about material wealth but more about what he loved to do or believed in. Not focusing excessively on competition meant that he could care more for his patients' well-being, an example of how Alex grew to be better and better as Grey's Anatomy progressed.
Isn't A Good Doctor: He Lacked Professional Ethics
Alex had a track record of being unprofessional and unethical. From sleeping with nurses, interns, residents, and attendings, to performing surgeries without parental consent which he did in season 13 and even supporting Meredith in her insurance fraud, he wasn't exactly Employee of the Month.
The only time Alex wasn't in the wrong ethically was when he wasn't part of the entire L-Vad fiasco involving Izzie and Denny, a fact he was only too eager to share with Richard. However, most other times, Alex Karev wasn't a stickler for rules, and a doctor who lacks professional ethics might not be the best person to advise patients.
Is A Good Doctor: He Became A Good Leader
Over time, Alex became a good leader. In fact, one of the running gags in season 15 was Alex becoming Interim Chief when Bailey chose to take it easy for a while. The prospect of the insolent young intern from season 1 becoming responsible enough to be Chief was hilarious, and the show's writers capitalized on it.
However, Alex proved to be a surprisingly good leader after the first few hiccups, and, even later when he became Chief of Surgery at Pac North, he seemed to have a good grasp over his duties, making relevant changes and bringing the best resources and doctors in from Grey Sloan Memorial. A good leader, one assumes, would be in charge in an operating room, as well, and might be good for the patients in the long run.
Isn't A Good Doctor: He Was Emotionally Involved With Patients
Fans recall Izzie Stevens as the one who got excessively emotional and even got into a romantic entanglement with one of the patients, leading to a major scandal. However, Alex too had become involved with the patient Ava—arguably one of the worst workplace decisions on Grey's Anatomy—and took her her home against medical advice, according to which he should have had her admitted into the psych facility.
Ava was suffering from Acute Stress Disorder, and, although Alex very sweetly tried to take care of her, he was in too deep and should have listened to senior doctors like Mark Sloan. A good doctor, while connecting with his patients, should be able to keep themselves detached at some level.