In previous research, patients did not achieve desired levels of engagement in discussions about implantable medical devices [18–21]. This study assessed whether and how, from a physician's perspective, it was feasible to engage patients in such discussions. Most participants informed patients about the device they chose, the rationale for that choice and associated risks. Few involved patients in decisions by discussing evidence for the device, eliciting concerns and expectations, confirming understanding or revealing conflicts of interest. None partnered with patients to choose particular devices. Participants described multiple interacting patient, physician, health system and device/market factors that constrained PE, which were common for disparate types of devices and among physicians with different characteristics.