Patient and public involvement and engagement (PPIE) is increasingly expected in health research, yet its influence on research decisions remains uneven. This paper presents a role-play approach designed to explore how power dynamics shape interactions in engagement settings and how they affect the uptake of patient input. The role-play was developed from two contrasting cases in the Swiss research context, in which patient contributions led to different outcomes. Implemented during conference workshops, the exercise used contrasted personas and a decision-making scenario to make interactional dynamics visible. By requiring participants to take a position and respond to competing perspectives, the role-play created a space to engage with the practical tensions between research constraints and patient input. This contribution illustrates how role-play can complement existing frameworks by offering a practical and experiential way to explore the “how” of engagement in research.