Over the past four decades, UK governments have moved towards an increasingly pro-market model of healthcare provision. Under this system, patients are not only encouraged, but expected, to take increasing responsibility for healthcare decision-making and the risks that it might entail. This article investigate how and why patients make choices about their health care and how service providers help facilitate this. Between October 2014 and May 2015, the researcher was embedded as an emergency nurse practitioner at two minor injury units in order to undertake direct and participant observation. During this time, 40 patients, 17 service providers and 1 senior manager also consented to semi-structured interview. The findings suggest that patients should continue to be encouraged to make decisions about their health care, but only if they feel confident to do so. The challenge for service providers is to recognise when this is or is not appropriate and tailor interaction accordingly.