This article examines citizen participation in health research, where funders increasingly seek to promote and define ‘patient and public involvement’ (PPI). In England, the focus of our study, government policy articulates a specific set of meanings attached to PPI that fuse patients’ rights and responsibilities as citizens, as ‘consumers’ and as ‘lay experts’. However, little is known about the meanings those who take part in PPI activities attach to this participation. Drawing on ethnographic data of PPI in three clinical areas (stroke, cancer and pre-term birth) we investigate citizen participation in health research as political ritual. We identify tensions between policy-driven and ground-level performance of citizenship, and use ritual theory to show how such tensions are accommodated in participatory structures. We argue that the ritual performance of PPI neutralizes the transformational potential of citizen participation, and we draw wider sociological implications for citizen participation beyond the health arena.