Written by Eric Buchman and directed by Michael Grossman, the episode aired on the American Broadcasting Company (ABC) in the United States on January 25, 2007.

Further storylines include George O'Malley (T. R. Knight) mourning his father, Miranda Bailey (Chandra Wilson) trying to get financial support for a free clinic, Cristina Yang (Sandra Oh) dealing with her troubled relationship with Burke.

Meanwhile, news of Chief of Surgery Richard Webber's (James Pickens Jr.) retirement sparks a competitive race among Derek Shepherd (Patrick Dempsey), Preston Burke (Isaiah Washington), Addison Montgomery (Kate Walsh), and Mark Sloan (Eric Dane) to fill the position.

Meanwhile, Jillian Miller (Jessica Stroup), a young woman admitted to obstetrics and gynaecology, is diagnosed with advanced cervical cancer.

Bailey ultimately finds a partner for her free clinic dream in Izzie, who enthusiastically offers to use her $8 million inheritance to fund the project.

Buchman initially planned for Cristina Yang and Preston Burke's cold relationship to be maintained by depicting silent sex between the two, but this idea was ultimately rejected as "boring, neither dramatic nor comedic" and not reflective of the characters' deeper emotions.

[1] The story arc involving the four attending physicians (Derek Shepherd, Burke, Addison Montgomery, and Mark Sloan) vying for the position of Chief of Surgery after Richard Webber's retirement was intended as comic relief, designed to highlight the more immature side of their personalities, a facet that had not been explored before.

Additionally, Buchman described Webber's retirement as part of his attempt to reconcile with his estranged wife, Adele leading to his emotional devastation upon discovering that she had moved on with another man.

[5] "Great Expectations" remained the time slot leader, drawing one-fourth more viewers than CBS's juggernaut CSI: Crime Scene Investigation, which ranked fourth in weekly viewership with a 7.5 rating.

Staci Krause of IGN had a mixed reaction to the episode, appreciating the development of personal storylines while finding the medical cases disappointing.

Krause noted that Adele's revelation of moving on from Richard Webber was an "interesting twist with unexpected repercussions," but found Izzie Stevens' offer of money for the free clinic "the most predictable event of the episode".

Krause also commented on the Amish storyline, describing it as an unexpected but "significantly helpful" addition to the episode's entertainment value, although the medical aspect lacked realism: "No one bothered to really mention that it would have been nice if it had been caught earlier.

"[6] Regarding the race for Chief of Surgery, Krause found Mark Sloan's candidacy "hilarious, but a tad unbelievable" and questioned whether Addison Montgomery's relationship with Alex Karev might compromise her professional integrity.

"[7] She praised the Amish girls' storyline as "a touching and well-written side story," commending the realistic portrayals and how the arc impacted Izzie.

[7] West also highlighted the first interactions between Torres and Yang, noting how their personalities clashed initially but later bonded through surgery, calling it "an obvious parallel to the rest of the episode.