
I recently played through Scarlet Keys with a Gray's Anatomy-focused Joe Diamond deck, dual-wielding Survival Knives. Is it efficient? Absolutely not, but it's fun.
In a vacuum, one click for +3 damage on the next attack sounds great, but considering most basic weapons (and certainly any you spend XP on) deal two damage per attack, you're netting out to spending the same two actions to deal the same four damage, but the first action provokes opportunity attacks, you're required to spend a second action to inflict anything, and three actions only nets you 5 damage instead of 6. You can alleviate these by combining it with weapons and upgrades, but you're going to be sinking a lot of cards and XP into something objectively less efficient and flexible than a big stick, and you've already sunk 5xp on the book itself.
So where does it shine? Testless damage. Blood-Rites and Ancient Stones as mentioned in the other review, but my favorite is Alice Luxley. One action to set up with Grays, one action to investigate, get a clue and deal four damage to any enemy at your location. No ammo needed, no engaging enemies, just mashing your best skill and blasting things while you do it.
The (currently) Joe-exclusive Survival Knife combo is also effective, but very niche. Using Gray's on the third action and triggering the reaction in the enemy phase nets you 5 damage for a single action, but the stars have to align to set up that scenario. More often you start your turn engaged and are left to the usual Grays > Stab two-action combo, which is frustratingly inefficient against common 2-health enemies.
It should also be noted, if pairing with the The Raven Quill, that the Supernatural Record ability is XP-cheaper and more effective than actually buying a second copy of Gray's Anatomy. You effectively get three copies of Gray's in your deck, as well as the ability to pull them from your discard in the event that it gets Crypt Chilled or similar. The total resource cost is higher, but you're already paying that for the ability to avoid AoOs.