Background: Patients in the emergency department are less involved in making decisions than they would like to be. Involving patients improves health-related outcomes, but success depends on the healthcare professional's ability to act in a patient-involving manner, and therefore more knowledge is needed about the healthcare professional's perspective of involving patients in the decisions. Aim: To explore what challenges healthcare professionals experience in their daily practice regarding patient involvement in decisions when planning discharge from the emergency department. Method: Five focus group interviews were conducted with nurses and physicians. The data were analyzed using content analysis. Findings: The healthcare professionals described how they experienced that there is no choice to offer the patients in the clinical practice. First, they had to manage the department's routines, which directed them to focus on acute needs and avoid overcrowding. Second, it was too difficult to navigate the diversity of patients with different characteristics. Third, they wanted to guard the patient from a lack of genuine options. Conclusion: The healthcare professionals experienced patient involvement as incompatible with professionalism. If patient involvement is to be practiced, then new initiatives are needed to improve the conversation with the individual patient about decisions regarding their discharge.