This chapter reviews recent developments in user involvement practices across a range of European health care systems in terms of their implications for the medical profession and regulation of its practitioners. It will review the dominant models of user involvement, from Arnstein (1969) ‘ladder of participation’ onwards within Europe. The chapter will be particularly concerned with the growing linkages between user involvement in its various guises and the governance and regulation of European health care and medicine. The analysis will critically examine the variations in user involvement from ‘choice’ to ‘co-production’ and the range of ways they have been implemented in various European countries, with particular attention to England, Italy and Denmark. The discussion will focus on the implications for the medical profession as much as for the patients themselves.