The challenges of securing ethical approval to undertake qualitative research in the English National Health Service have been previously detailed. Acknowledging these general challenges, this case study describes some further issues specific to gaining approval for ethnographic research in National Health Service settings. Ethnographers attempt to understand the world from the vantage point of those that inhabit it. As it entails a concern for the perspectives and experiences of others, ethnography is an invaluable approach to understanding the social and cultural dimensions of health and illness. Ethnographers spend time with people in their "natural habitat" or social setting, seeking to engage with people on their own terms. Ethnography can offer critical insight into the practices of healthcare, as well as the contexts within which these practices take place. Gaining access to National Health Service settings for the purpose of research that includes patients requires prior approval from a National Research Ethics Committee. The bureaucratic structure within which these committees operate is designed to weigh up the potential harms and benefits of biomedical research. It does not, therefore, fit neatly with ethnographic research. This case study describes three important questions which arose in the course of seeking approval for my doctoral research: first, how to provide an account of a research proposal that involves an inherently unpredictable process in a format designed for carefully controlled biomedical research; second, how personal perspectives affect research; and third, the difficulty of working across the complicated organizational structures found in and around the National Health Service. I provide some reflections on these issues, and my experiences, with the aim of helping other students as they prepare to undertake ethnographic research in the National Health Service.